Metabolism and ketosis
Since posting the piece on ketone bodies and their causing breathalyzer problems I’ve had enough comments and emails to make me realize that there are probably many people unsure of what ketones really are, where they come from and why. Let’s take a look at the goals and priorities of our metabolic system to see what happens. I’m going to try to keep the biochemistry to a minimum, so fear not.
The primary goal of our metabolic system is to provide fuels in the amounts needed at the times needed to keep us alive and functioning. As long as we’ve got plenty of food, the metabolic systems busies itself with allocating it to the right places and storing what’s left over. In a society such as ours, there is usually too much food so the metabolic system has to deal with it in amounts and configurations that it wasn’t really designed to handle, leading to all kinds of problems. But that’s a story for another day.
If you read any medical school biochemistry textbook, you’ll find a section devoted to what happens metabolically during starvation. If you read these sections with a knowing eye, you’ll realize that everything discussed as happening during starvation happens during carbohydrate restriction as well. There have been a few papers published recently showing the same thing: the metabolism of carb restriction = the metabolism of starvation. I would maintain, however, based on my study of the Paleolithic diet that starvation and carb restriction are simply the polar ends of a continuum, and that carb restriction was the norm for most of our existence as upright walking beings on this planet, making the metabolism of what biochemistry textbook authors call starvation the ‘normal’ metabolism.
So, bearing in mind that carb restriction and starvation are opposite ends of the same stick and that what applies to one applies to the other, let’s look at how it all works. I’ll explain it from a starvation perspective, but all the mechanisms work the same for a carb-restricted diet.
During starvation the primary goal of the metabolic system is to provide enough glucose to the brain and other tissues (the red blood cells, certain kidney cells, and others) that absolutely require glucose to function. Which makes sense if you think about it. Your a Paleolithic man or woman, you’re starving, you’ve got to find food, you need a brain, red blood cells, etc. to do it. You’ve got to be alert, quick on your feet, and not focused on how hungry you are.
If you’re not eating or if you’re on a low-carbohydrate diet, where does this glucose come from?
If you’re starving glucose can really come from only one place and that is from the protein reservoir: muscle. A little can come from stored fat, but not from the fatty acids themselves. Although glucose can be converted to fat, the reaction can’t go the other way. Fat is stored as a triglyceride, which is three fatty acids hooked on to a glycerol molecule. The glycerol molecule is a three-carbon structure that, when freed from the attached fatty acids, can combine with another glycerol molecule to make glucose. Thus a starving person can get a little glucose from the fat that is released from the fat cells, but not nearly enough. The lion’s share has to come from muscle that breaks down into amino acids, several of which can be converted by the liver into glucose. (There are a few other minor sources of glucose conversion: the Cori cycle, for example, but there are not major sources, so we’ll leave them for another, more technical, discussion.)
But the breakdown of muscle creates another problem, namely, that (in Paleolithic times and before) survival was dependent upon our being able to hunt down other animals and/or forage for plant foods. It makes it tough to do this if a lot of muscle is being converted into glucose and your muscle mass is dwindling.
The metabolic system is then presented with two problems: 1) getting glucose for the glucose-dependent tissues; and 2) maintaining as much muscle mass as possible to allow hunting and foraging to continue.
Early on, the metabolic system doesn’t know that the starvation is going to go on for a day or for a week or two weeks. At first it plunders the muscle to get its sugar. And remember from a past post that a normal blood sugar represents only about a teaspoon of sugar dissolved in the entire blood volume, so keeping the blood sugar normal for a day or so doesn’t require a whole lot of muscular sacrifice. If we figure that an average person requires about 200 grams of sugar per day to meet all the needs of the glucose-dependent tissues, we’re looking at about maybe a third of a pound of muscle per day, which isn’t all that big a deal over the first day. But we wouldn’t want it to continue. If we could reduce that amount and allow our muscle mass to last as long as possible it would be a help.
The metabolic system could solve its problem by a coming up with a way to reduce the glucose-dependent tissues’ need for glucose so that the protein could be spared as long as possible.
Ketones to the rescue.
The liver requires energy to convert the protein to glucose. The energy comes from fat. As the liver breaks down the fat to release its energy to power gluconeogenesis, the conversion of protein to sugar, it produces ketones as a byproduct. And what a byproduct they are. Ketones are basically water soluble (meaning they dissolve in blood) fats that are a source of energy for many tissues including the muscles, brain and heart. In fact, ketones act as a stand in for sugar in the brain. Although ketones can’t totally replace all the sugar required by the brain, they can replace a pretty good chunk of it. By reducing the body’s need for sugar, less protein is required, allowing the muscle mass (the protein reservoir) to last a lot longer before it is depleted. And ketones are THE preferred fuel for the heart, making that organ operate at about 28 percent greater efficiency.
Fat is the perfect fuel. Part of it provides energy to the liver so that the liver can convert protein to glucose. The unusable part of the fat then converts to ketones, which reduce the need for glucose and sparing the muscle in the process.
If, instead of starving, you’re following a low-carb diet, it gets even better. The protein you eat is converted to glucose instead of the protein in your muscles. If you keep the carbs low enough so that the liver still has to make some sugar, then you will be in fat-burning mode while maintaining your muscle mass, the best of all worlds. How low is low enough? Well, when the ketosis process is humming along nicely and the brain and other tissues have converted to ketones for fuel, the requirement for glucose drops to about 120-130 gm per day. If you keep your carbs below that at, say, 60 grams per day, you’re liver will have to produce at least 60-70 grams of glucose to make up the deficit, so you will generate ketones that entire time.
So, on a low-carb diet you can feast and starve all at the same time. Is it any wonder it’s so effective for weight loss?
hello, i read somewhere that being in ‘deep’ketosis can cause some side effects including diarrhea. is this because fat is not stored in the absence of insulin, and is therefore excreted, or because of high levels of ketones in the blood. also are certain fats more likely to cause diarhea eg coconut, dairy? what i mean is can some fats (or too much fat)cause reactions like some proteins or sugars do (gluten lactose).great blog by the way.
Hi Tony–
I’ve never heard that ‘heavy’ ketosis causes diarrhea, nor can I see how it could physiologically. Ketones never make it to the digestive tract: excess ketones are gotten rid of through the breath and the urine, not the stool.
People who are on low-carb diets and have constipation can usually get rid of it by increasing the fat intake in their diets. It is normal for a small amount of fat to make it through the small intestine and into the colon. People who have conditions causing them to be unable to break down and absorb the vast majority of their dietary fat in their small intestines can end up with larger amounts of fat than normal in their colons, which does usually result in diarrhea. But, people with normally functioning GI tracts and gall bladders don’t get diarrhea with increased fat intake. Especially not with coconut oil, which has a fair amount of a type of fat that is easily and readily absorbed.
Cheers–
MRE
Very informative post. What happens if you eat more calories than you need, while still restricting the carbs enough to induce ketosis? Does your body convert extra protein to fat for storage? Does it store the excess fat you eat, even as it’s burning fat to make glucose?
I’ve read that diets with extremely limited calorie intake have been shown to increase life span. Do those diets induce ketosis, too? Could that be associated with the increase in longevity?
Hi Keith–
Most people who consume rigorous low-carb diets at high caloric levels don’t tend to gain weight. They don’t lose – unless they are very large to start – but they typically don’t gain. No one knows why for absolute certain, but I have my own theory.
There are many futile biochemical cycles in the body. By futile I mean cycles where energy is expended – usually as heat – but no work is done. It would be like putting your car up on blocks, starting it, and putting a weight on the accelerator pedal so that the engine would run fast. You would burn up a lot of gas over a couple of hours, but the car wouldn’t go anywhere. The body has ways of dissipating excess energy involving the reduction of protonmotive force across the inner mitochondrial membrane (a subject way too technical to address here, though I may try sometime in a long post), which is precisely what I believe happens when insulin is kept low and calories high.
Long term low-calorie diets have been effective in animals, but haven’t been studied in humans for obvious reasons. Animals that are put on alternate day fasting regimens (see post here on the subject) have the same longevity benefits as do animals on caloric restriction despite the fact that the animals that eat only every other day consume way more calories overall (they double up on feeding days) than the calorically restricted animals. One of the main differences labwise between the caloricall restricted animals and the alternate day fasted animals is that the latter have high levels of ketones on their fasted days. Could that be the factor that makes these animals live as long as the calorically restricted ones despite eating 30-40% more? No one knows. But ketones do more than simply act as a fill in for glucose. (Click here for a post I did on this subject a while back.)
Cheers–
MRE
Great explanation Dr. Mike! Thanks for posting it. I’m going to link to this on my blog today.
Hi Amy–
Glad you liked it. Link away.
Cheers–
MRE
I don’t think I’ve seen this explained quite so clearly before. Thank you.
And ketones are THE preferred fuel for the heart, making that organ operate at about 28 percent greater efficiency.
Source, please?
Hi Jari–
Here is one source.
Richard Veech, the author, is probably the world’s leading authority on ketone metabolism.
Here is a quote from the article that you won’t find in the abstract. After discussing his experimental results in determining heart efficiency with different fuels and finding that ketones increase efficiency by 28 percent, he writes:
Cheers–
MRE
…cave men?
“…cave men?” I’m lost.
Dr..many thanks yr time.
Could you qualify starvation please i.e. when it kicks in or does that seem like a ‘who longs a piece of string question’
thanks
Hi Simon–
Actually, all these processes are going on concurrently: we’re storing fat as we’re pulling it out to metabolize it, and gluconeogenesis is taking place to some extent most of the time. It’s a question of which processes predominate at any given point.
It’s like when you’re driving your car on the freeway in normal traffic and only have to use the brake occasionally (you’re predominately in accelerator mode) verses being in a traffic jam where you are constantly riding the brakes with a bit of the gas pedal here and there.
Cheers–
MRE
I’m also interested in how to use ketosis to help maintain/measure weight loss.
First, are test strips which detect acetoacetic acid in urine a good measure of ketosis in general? Are they too specific? Too inaccurate?
Reviewing Protein Power and the PPLS, is it correct to ’summarize’ the broad steps to weight loss, Protein Power style, as (Each step includes the previous):
1) Achieve and maintain ketosis by restricting carbohydrate intake.
2) Consume adequate protein to minimize usage of muscle tissue for gluconeogenesis.
3) Maintain a caloric deficit (How necessary is this, if you’ve got the ‘metabolic advantage’ working for you?).
4) Drink plenty of water to help your body eliminate waste and as much ketone as possible before it can be used for energy.
This is kind of my take on it, but it seems to shift the emphasis from insulin to ketones a lot more than your writings do. This makes practical sense to me since (If those strips are a good measure) ketosis is A LOT easier to check than blood insulin levels! One possible hole here is if you can be in ketosis AND have elevated insulin levels simultaneously, with insulin ‘trumping’ ketosis. (I also know that micronutrients and essential fatty acids can have a huge impact on the weight loss equation, too.)
Thanks!
Hi Bob–
Yes, the strips are fairly accurate as to the amount of ketones in the urine. But there is individual variability in terms of getting rid of ketones. Since ketones can be discharged in both the breath and the urine, some people have a tendency to prefer (based on their own biochemical makeup – not by their conscious choice) to eliminate them more via the breath than the urnine. These people can be in heavy ketosis and not show much in their urine. There are breathalyzer-like devices that give readings for breath ketones. A combination of both would be the best way to truly quantify the amount of ketones being gotten rid of.
Your steps 1-3 are accurate. As far as I can tell, the metabolic advantage is worth about 300 calories.
Step 4 is probably okay, but I don’t know that you’re going to get rid of the ketones before they can be used. Tissues in need of energy voraciously grab the ketones from the blood long before they can be filtered out by either the kidneys or the lungs.
I emphasize insulin in my writings because excess insulin causes most of the problems. You’ve got to deal with that before you can even get into ketosis. And, when people go on a rigorous low-carb diet, they will ultimately get into ketosis a lot of the time. I’ve seen a lot of people frustrated with the Atkins diet because they feel like failures if they don’t get into ketosis, when the reality is that they are probably in ketosis a lot of the time, but just not when they happen to check. I’ve seen many people become obsessed with turning their strips purple instead of obsessing on their diet and health. Atkins himself – I suppose – got tired of hearing people complain that they couldn’t get into ketosis, so he had them do a ‘fat fast’ using (as I recall) macadamia nuts and cream cheese only diet, which is primarily fat. If you reduce the carbs to practically zero and increase fat markedly – as this ‘fat fast’ would do – you will go into ketosis, but that’s not the point. The point is to lose weight and improve health, not to obsess on the urine strips. For that reason MD and I have always played down the ketosis aspect in our books.
Cheers–
MRE
Dr. Mike
I have recently switched from a calorically restricted very low carb diet to a non-restricted zero carb diet. My weight has gone from 161.5 to 178.5 in about 40 days. Granted I was previously eating 1000 calories per day and am now eating ~4000. Is it possible for this gain to represent a fat gain? I simply do not see how it could be possible. The only thing I can think of is that it must have been muscle mass.
In your post you stated that glucose needs may come from muscles and this seems to be especially true on a restricted diet.
Thanks
Hi Freddy–
Right you are: glucose comes from muscle on a restricted diet.
I would suspect that you weight gain is primarily muscle mass. If you’ve been on a 1000 kcal/day diet for any length of time, you will have almost certainly reduced your lean body mass, which will return once you start consuming more calories and more protein. You should be able to tell yourself whether it’s fat or muscle. Has your waist size increased significantly?
The interesting part of your history is what has happened to the extra calories you’ve consumed since increasing your caloric intake. If my math is correct, you’ve gained 17 pounds since you increased your caloric intake. The rule of thumb on stored fat is that it contains about 3,500 kcal/lb, so (assuming you stored all your excess energy as fat) the 17 lb gain represents 17 X 3500 = 59,500 kcal. You’ve increased your daily caloric intake by 3000 kcal (4000 – 1000) and you’ve been doing so for 40 days. 40 X 3000 = 120,000 kcal. Yet you’ve only stored about half that. Where did the rest go? You’re metabolic rate is probably about 2000 kcal/day so that extra 1000 kcal (above the 1000 kcal provided by your original diet) represents 40,000 kcal. 59,500 + 40,000 = 99,500. 120,000 – 99,500 = 20,500 kcal unaccounted for. 20,500/40 days = 512.5 kcal/day. Where did it go? If you converted most of the excess calories into lean body mass (muscle + organ + bone), calories would be required for the growth. So, given the calculations, I would bet you put most of the excess calories into lean body mass.
Cheers–
MRE
Yes, yes, Dr. Eades: this information I/we know. Where is the long promised post on electrolyte/mineral homeostasis during LC diets?
Prodding you gently with my post,
R Cooney
OHSU MSIII
Hi Robert–
You may have to refresh my memory. Did I promise a post on electrolyte/mineral homeostasis?
BTW, do you know an anesthesiologist on staff at OHSU named Jeff Swan? If so, say Hi for me. He and I were great friends during medical school and had many escapades together. If you do talk to him, don ‘t believe anything he might tell you about the good ol’ days.
Cheers–
MRE
I second the motion, a great explanation! I like the way you can take a fairly complex topic and make it understandable for a regular dumb guy like me.
I read a squib in a fitness magazine recently about frequency of eating. It’s based on the “eat every three hours to keep your metabolism in high gear” notion. His assertion was that if you wait more than three hours between meals, your body goes into “starvation mode”, your metabolism slows down radically, and the next thing you eat is immediately stored as fat. This makes no sense in light of your discussion on ketones. Any thoughts?Thanks!
Hi Thomas–
Yes, I have a thought. I think the guy who wrote the article you mentioned is severely lacking a grounding in fundamental biochemistry. Everything I discussed in the post on ketosis is not rocket science, it’s basic biochemistry as taught in every medical school in the world. It’s not controversial, it’s just that people who haven’t been to medical school or haven’t studied biochemistry often don’t understand ketosis or where ketones come from or what they do. Which is why I wrote the post. People who write articles such as the one you described should at least make the effort to understand what they’re writing about before they publish this kind of nonsense.
Cheers–
MRE
Perhaps Mr Kaz is implying that cave men and Paleolithic don’t go hand in hand ?
Dunno really but we need enlightening thats for sure; and naturally i’m sure i speak for absolutely nobody when i say ‘we stand gobs agape, our, mine actually, breath held at thew prospect of knowing and the relief it shall bring to our existentially fevered brows’!!!!
How many glycerols does it take to make one glucose?
Never mind the fact that it’s not totally converted. Is it a 1:1 ratio, or something else like two glycerols needed for one glucose to be produced?
Hi Carly–
It takes two glycerols to make one glucose.
MRE
You said that the average person requires about 200 gr. of sugar. And that when the ketosis process is humming along the requirement for glucose drops to about 120-130 gm per day.
What is the reason for the drop in glucose requirements?
Can this help explain why many people doing low carb often lose 10-30 pounds per month the first few months then substantially less the subsequent months?
I am struggling to understand why weight loss seems more and more difficult the longer I am on a low-carb diet. I have lost 80 pounds over 9 months and am 20 pounds away from having having 18% body fat. The first six months were pretty much by the book. At the end of the sixth month, I was losing at a rate of less than 5 pounds per month, 1/6 of what I experienced during the first month. There was a noticeable slow-down during the 3rd month. Any thoughts on why the slow-down?
Hi Daron–
It takes a while to become fully ketone adapted. At first, the body is making the ketones, but the tissues haven’t completely converted to using them for energy yet. The body then wastes the unused ketones (which are highly caloric) in the breath and urine. As time rolls on and the body becomes ketone adapted, it wrings every smidgen of energy it can out of the ketones, so you don’t get as great a loss as you do early on.
Second, as you lose weight, you decrease your metabolic rate. Resting metabolic rate is a function of weight more than anything else, and resting metabolic rate is the largest component of most people’s total metabolic rate. As you lose and the metabolic rate falls, it becomes more difficult to lose more. Sometimes it’s easier to think of weight loss in terms of percentage of body weight than in pounds. As you get smaller, you lose less, but even though you’re losing less, that less represents about the same percentage of your overall body weight as did the larger amounts you lost when you were larger.
The very best way to look at it is by percentage body fat. If you’re a male, then you should shoot for a body fat percentage of around 15-18% irrespective of what overall weight that represents. Which seems to be what you’re doing. Remember, you can decrease body fat percentage without losing any weight if you increase your muscle mass.
Cheers–
MRE
Sorry… I re-read your post and think I get it… some of the body burns the ketones for fuel rather than glucose. Therefore, less sugar is needed by the body. Since ketosis seems to set in for me at around day 3, this probably isn’t related to why the rate of weight loss slows after the first few months.
Dr. Mike,
Have you had any experience with LC diets being unable to provide fuel for intense exercise (sprinting, CrossFit Style Metabolic Workouts, etc.)?
This study:
http://www.nutritionandmetabolism.com/content/1/1/2
seems to suggest that after one has become fat adapted, endurance exercise performance returns to normal, but sprint performance remains poor. The suggested reason is that this type of exercise can not be fueled by fat, it must be fueled by glucose.
If this is true, does this mean that Paleolithic man’s ability to hunt while in ketosis was poor?
Hi Craig–
I’ve seen this same phenomenon reported in a number of papers. In long stretches of high-intensity exercise, performance falls off with a low-carb diet.
But, I don’t think that would impair Paleolithic man’s hunting ability or ability to survive. No Paleolithic man – irrespective of how much carb he consumed – was going to be able to out sprint a lion chasing him or was going to be able to run down a deer. Hunting was a group effort involving long bouts of low-intensity exercise (tracking and locating the game) and very short surges – just a few seconds at a time – of intense effort to bring it down.
I can’t see Paleolithic man indulging in sprints just to keep in shape, so there was really no necessity to evolve a system that would perform optimally under those circumstances.
Another thought…Paleolithic man was on a low-carb diet from birth. Modern man is on a high-carb diet from birth. Some modern men decide to go on low-carb diets later on. And they adapt relatively quickly as far as endurance exercise is concerned. Maybe the adaptation period for high-intensity exercise simply takes a lot longer than we think.
Cheers–
MRE
Dr. Mike,
A lot of low carbers on various forums seem to be almost deathly afraid of protein. They seem to think that any protein not used for bodily functions is instantly converted to glucose, causing an insulin reaction and fat storage. I see comments all the time like “I am not losing anymore. I must be eating too much protein.”
Is there ever a scenario that excess protein is converted to glucose, except for the times mentioned in your blog entry?
Hi Ryan–
This seems to be a common misconception. The only time protein is converted to glucose is when glucose levels in the blood are low. When dietary sources of carbohydrate are minimal, the body converts protein to glucose, but converts enough only to keep the blood sugar normal. Any ‘excess’ protein can be converted to fat and metabolized as fat. But, for the most part, this doesn’t really happen because the cost of protein metabolism is high, therefore a lot of it gets consumed in its own metabolism. It takes about a gram of protein to make 0.7 gm of glucose, so if one is on a low-carb diet requiring an extra 70 grams of glucose production daily, it takes about 100 gms of dietary protein just to keep glucose levels where they need to be. And that’s before the protein is even used for all the structural needs of the body i.e., hair, skin, nails, bone, enzymes, muscle, etc.
Hope this answers the question.
Cheers–
MRE
[...] Postat av arne9 på maj 25th, 2007 På Eades blogg finns ett intressant inlägg om hur ämnesomsättningen fungerar vid ketos. [...]
Dr Mike, after becoming ketone adapted, would taking long walks help Daron at comment #14?
I know that the initial weight loss is mostly due to the process you explain in this post, but I’m wondering if adding long, slow cardio in addition to weight training makes a difference.
Or maybe the question should be, is he doing enough weight lifting? Would increasing that be the way to go?
Hi LC–
First, it requires about 8-12 grams per day of the amino acid leucine to really begin to build muscle. It takes about 100 grams of meat protein per day (or whey) to get this amount of leucine. Muscle is more metabolically active than fat, so more muscle = greater metabolism. So, my first suggestion would be to ensure enough good quality protein to build muscle.
Second, long walks may help a little, but probably not much. Long walks are good for other health reasons, just not particularly effective for weight loss. Weight lifting – especially a Slow Burn style of resistance training – would help more.
It’s simply difficult to get off the last few pounds because these pounds represent a
smallerlarger percentage of overall body weight compared to the first pounds lost. It often requires a reduction in calories along with the carbs to get rid of these hard-to-get-rid-of last pounds. But dietary diligence will ultimately bring about the results.Cheers–
MRE
” It’s simply difficult to get off the last few pounds because these pounds represent a smaller percentage of overall body weight compared to the first pounds lost. ”
Didn’t you mean a larger percentage Dr Mike?
Hi Neil
Yes, I did mean larger. Thanks for the correction.
MRE
Amazing. We really are an amazing creation!
Please, keep posting your “lessons”. I love reading them and I’m learning!! You’ve tackled some pretty complicated processes and made it very easy to understand.
I’ll keep after it as long as my stamina holds out.
Cheers–
MRE
With regard to Thomas’ post and your answer (#11) the trouble is once something is printed people in general take it as ‘gospell’. It’s in a paper/magazine/book – IT MUST BE RIGHT! I really do despair sometimes. This is a great post – gives me a bit more fuel in my constant battle against the low fat nerds.
I went from 131 kgs to 103 on Atkins. I’ve been a bit lazy and crept up a bit (108) but have gone back to it strictly and have to get back to my 5km walks. For me it ended a lifetime of 2-3 migraines a week and other complaints as I discovered I also had a high level of gluten intolerance.
I bless low carb every migraine free day (not one since Sept 2005!)
Hi Odille–
Good luck in your quest to get back to 103!
Cheers–
MRE
I was diagnosed with Type 2 diabetes about 2 years ago and have struggled with the American Diabetes association diet recommendation of 40 to 50% of calories from Carbohydrates.. could never keep the sugar level and kept taking metformin and diamicron and always felt hungry.
About 3 weeks ago, I ran across the South beach Diet. I have cut out all bread, rice, potatoes and fruit 100%. I am eating egg beaters, cheese, chicken, seafood, vegetables… and exercising 5/6 times per week.. trying to still stay around 1500 calories per day. Actually lost about 10 lbs. (195-185). I have been able to get out of all pills for the past week and feel fine. Truly unbelievable.
However, lately, past 2 days, though my blood sugar levels seem to be creeping up to 7-8mmol/L especially in the morning and staying there. Maybe my liver is putting sugar from proteins in and I don’t have enough insulin or it is not effective?
Should I go back to Metformin? (my doctor seems to think I should). Wouldn’t it affect what my liver is trying to do.. i.e. generate glucose from protein?
Thanks for you help.
Hi Guru–
I think you’re on the right track with cutting out the stuff you cut out. I would strive to keep my carbs pretty low. Other vegetables – legumes and corn, for example – contain carbs. I would work diligently to cut my carbs back to no more than 30 or so grams per day to see what happens.
Your liver is indeed converting protein to glucose in the early morning, a situation called the ‘dawn phenomenon’ because it happens in the early morning hours. What happens is this. Your liver converts protein to glucose to keep your blood sugar normal. When blood sugar reaches normal level, insulin goes up just a touch, but enough to shut down the liver’s protein to glucose machinery. If your liver is resistant to insulin (or if, in the case of type I diabetics, there is no insulin) the liver doesn’t get the signal to shut off glucose production and keeps on going.
I’ve found in my own patients that as they continue on their low-carb diets for longer and longer that this liver insulin resistance improves and they end up with normal glucose levels in the morning. It happens in most cases, but not all. Taking metformin (which is one of the few drugs I actually will use with patients) at night help most people keep their sugars lower in the morning. If I were you, I would probably take the metformin as your doctor suggest, keep on my low-carb diet for a month or so longer, then see what happens if I don’t take the metformin. If the sugar comes back up, I go back on the metformin and try again after another month of low-carbing.
Keep me posted.
Cheers–
MRE
After reading the posts and the background research by Dr. Phinney, I’m still confused. I am a runner. It appears that I can preserve my VO2 Max and Aerobic capacity, but perhaps I won’t be as fast on a ketogenic diet. Is that right? And if so, should I be at a suggested carb level or should I just be patient and try to adapt?
Hi Charles–
I think you will be as fast at short bursts as you ever were, i.e., a 40, or even 100, yard dash. And, if you’re a long-distance runner I would bet that you will be as fast there, if not faster because you will be burning fat, not glucose. The problem comes with sustain high intensity exercise, say, running a 440 at full speed. Depending on your aerobic ability to burn glucose you might be a little slower at that distance. If I were running a 440 or doing a high intensity sport in competition I would increase my glucose consumption.
As to how much, I don’t have the answer to that. If I were doing it myself I would experiment around until I found what worked best for me. Maybe other readers will report their experiences.
Cheers–
MRE
I apologize. I should ask my question differently so you can be sure I’m not asking for medical advice.
In view of the Phinney paper on ketogenic diets and physical performance, what should be the stance of the distance runner towards a ketogenic diet after reading this?
I’ve always heard that VO2 Max and aerobic endurance were the usual markers for success at distance running. This would would seem to indicate that distance runners could certainly benefit from the ketogenic diet with ample adaptation. Indeed, it’s well-settled that the Kenyans, who dominate modern distance running, are able to run at a much higher percentage of their VO2 Max much longer than the rest of us.
Dr. Phinney seems to leave the question open as to whether the athlete could adapt his sprint and anaerobic performance with more time. In fact, there are people in your own forum who have said that despite an initial decrease in energy, they have been able to match and even exceed their weight lifting abilities. What’s your take?
Hi Charles–
No problem; I didn’t take it as a request for medical advice. For whatever reason your comment got caught up in the spam filter.
As I mentioned in the previous answer, I do think a ketogenic diet or a diet verging on the ketogenic will increase endurance performance. Phinney’s work along with some other privately published government research shows that high-intensity exercise capacity falls off a little. But that doesn’t mean that short bursts of high-intensity activity results in a decrease in performance. It happens only when the high-intensity work lasts long enough to deplete the glucose stores faster than they can be replenished endogenously, which, like all other physiology, varies individually.
The papers I have that were studies of naval recruits and pigs (of all things) show that with adaptation to a ketogenic diet, the activity of the specific enzymes required to increase the availability of glucose were enhanced. But these studies were done over the short term, i.e., several weeks, whereas in Paleolithic man these adaptations would have taken place over a lifetime. Without long term studies we can’t say whether these adaptations would occur over this longer period.
Best–
MRE
Mmmm, that elephant looks tasty. Doc, I am perplexed. You and Mary introduced me to glucagon. I thought that I read in your book that glucagon is inactive when insulin is high. I thought that when insulin is stable then the pancreas produces glucagon. Then, in turn, glucagon enhances ketosis. Therefore if insulin is spiked then glucagon is low or nonexistant. I now think that I am mistaken in that conclusion. But my main question is, does stable insulin levels trigger glucagon or does glucagon get its stimulation directly from low blood sugar?
Cheerfully.
Mary
Hi Mary–
Insulin and glucagon work like the accelerator and brake pedals on a car. They work in tandem to keep blood sugar in the normal range. If the blood sugar goes too high, insulin predominates in an effort to drive it into the cells and get it out of the blood. When blood sugar is too low, glucagon levels go up, which help mobilize the stored sugar in the cells and drive the liver to make sugar. If insulin goes up, glucagon goes down. Glucagon only goes up if insulin levels are down.
People with type I diabetes can’t make insulin so they only have glucagon. Since the unopposed glucagon drives all the machinery that increases sugar in the blood, victims of type I diabetes have greatly elevated blood sugar levels even if they fast. A little injection of insulin stops the whole process and normalizes the blood sugar.
There. Is it all clear as mud now?
Cheers–
MRE
Dr. Mike
Can fat not supply glucose? If one eats a lot of fat should they not derive glucose from that as well?
Hi Freddy–
It’s a difficult question. Fat, in the form in which we eat it, is made of triglycerides, which are three fatty acids hooked onto a glycerol molecule. Fatty acids cannot be converted to glucose. But, when the fatty acids are stripped away from the glycerol, the free glycerol can combine with another free glycerol to make glucose. This doesn’t represent very much glucose, however.
Cheers–
MRE
Hi Dr. Mike,
A few questions. What happens when one is on a zero- or near zero-carb diet for a long time? Does glucose start to be drawn more from muscle eventually, if stored fat becomes very low?
What effect does fat malabsorption have on ketosis?
And, finally, if ketones passed in one’s breath can have an alcohol-like odor, is there also possibly an odor from ketones passed in urine? I frequently notice what I would call an elemental odor. One doctor proposed this may be from high meat consumption.
Thanks so much for such a great explanation of this subject.
Hi Christy–
If one is on a low-carb or zero carb diet for a long period of time, there shouldn’t be much of any glucose made from muscle as long as there is plenty of dietary protein with which to make the glucose. As long as plenty of protein is consumed, there shouldn’t be any muscle loss.
Fat malabsorption shouldn’t have much of an effect on ketone production.
Yes, ketones in the breath and urine have an odor. It’s more like acetone, which has been described as the smell of overripe apples.
Hope this answers your questions.
Cheers–
MRE
How can protein be stored as fat? When one is low-carbing isn’t it impossible to store fat?
Thanks
Hi Freddy–
It’s converted to fat, but not necessarily stored.
Cheers–
MRE
Hello Dr. Eades,
You’ve mentioned a few times in your books and blog that dietary fat calorie excess in the context of a low carb dietary approach will not ‘tend’ to result in body fat GAIN. But I’ve noticed on many low carb boards that occasional high fat/high calorie proponents will swear blind that they can actually LOSE body fat STEADILY, and not just when very overweight either – at or close to goal bodyfat – while consuming truly heroic amounts of dietary fat.
Your explanation of why fat calorie excess doesn’t usually result in bodyfat gain is very clear, but can futile cycling and/or mitochondrial protein uncoupling ( are they one and the same?), in the context of low carb/adequate protein/ high fat/ high calorie, explain steady bodyfat loss?
Also (and apologies for sneaking in two questions) Robb Wolf recently mentioned a paper by Seyfried (et al) which lookes at the oxidative damage (particularly neurodegenerative) inherent in mitochondrial protein uncoupling. Robb’s observation was: So maybe ‘naturally thin’ folks who can eat any amount of food and not gain bodyfat (like me) aren’t getting a free ride afterall, even in the context of a low carb dietary approach.
Btw. after being inspired by your original Blog entry on IF I’ve been VLC 24/24 IFing for nearly 7 months now after five years of VLC and I feel amazing. So I’m not eating truly heroic amounts of fat since I added the IF to VLC. IF seems really effective at naturally curbing appetite. Any tendency to binge (on low carb fare) on the ‘eat’ days disappeared after the third month.
The reports of steady bodyfat LOSS with low carb/adequate protein calorie excess (ie fat calories) have me really confused.
Sorry about the long query. Many thanks for your time!
Stuart.
Hi Stuart–
Many people do continue to lose fat steadily on a low-carb diet. A few do get into trouble, though, if their caloric intake is way too high. They don’t seem to gain; they just don’t lose.
I’m sure the reason for this is individual variations in futile cycling and mitochondrial uncoupling. Which are different. Futile cycling is when substance A gets converted to substance B which then gets converted back to substance A. Energy is spent, but no real work is done. Mitochodrial uncoupling is a much different process, which is far too complex to go into here. But in simplistic terms the high energy electrons given off when fat and glucose are burned don’t really get the full bang for their buck because of a leak in the mitochondrial membrane (which can be a direct leak or an actual uncoupling protein) dissipates the energy without work being done.
Hope this helps.
Cheers–
MRE
Dr. Mike
When one is eating zero carbs there should not be much insulin in the blood. Some have claimed that protein causes an insulin spike and that fat does too. Is this true? If so, how would that factor in to weight loss?
Also, do certain types of meat cause more of an insulin response than others (beef vs pork vs chicken).
Thanks
Hi Freddy–
Meat doesn’t really cause and insulin spike. I’ve got a couple of great papers and a few charts demonstrating this that I plan to post on sometime soon.
Even on a zero carb diet there will be some insulin in the blood because insulin has many other functions aside from simply regulating blood sugar.
Cheers–
MRE
Dr. Eades: May I burden you with one last question on this topic. Doesn’t the “adaptation” issue concern burning either carbs (glucose) or fat? If that’s true, then the problem, as I see it, is this: You’re burning fat and you want to increase your high-intensity exercise performance. Therefore, you up your carb level a bit, say from 30 to 60. Doesn’t that put you in that uncomfortable “my body needs to adapt” area that you escaped by going through the adaptation phase in the first place? Or are you saying, there’s a bit of a “magic” line there that is the right carb level for your performance level where you get the best of both worlds?
Hi Charles–
I would say it’s a real individual trial and error situation. I don’t know that there is an optimal level of carb consumption that is the same for everyone. Just fiddle with it until you strike a balance that works well for you. I don’t think the difference between 30 grams per day of carb and 60 grams per day is going to make a huge difference in your adaptation.
Cheers–
MRE
Dr. Eades
I am confused. Exactly how much protein is needed to produce glucose each day if not eating carbs. You said 130 grams of glucose were needed daily, ketones supplying the rest. That means that 185 grams of protein is needed IN ADDITION to normal protein requirements. If my calculations are correct, a zero carb diet needs about 250 grams of protein daily. Is this correct???
Thanks
Hi Freddy–
A lot of confusion here. I’ll make a longer post on the subject soon. You can get by on much less than 250 gm protein per day.
Cheers–
MRE
Thank you for clearing the glucagon/insulin dilemma for me. But now I have another q. So if insulin is non existant in T1 diabetic, glucagon just pushes up the glucose to dangerous levels. So these levels become high because there is no insulin to counter or balance the affects of glucagon? Therefore it is glucose that regulates its relationship between insulin/glucagon.
Hi Mary–
No, it’s the other way around. I/G regulates the amount of glucose. Insulin makes glucose go down. Glucagon makes it go up. When there is no insulin (as in type I diabetes) the unrestrained glucagon drives glucose to sky high levels.
Cheers–
MRE
Very enlightening article!
Something that you wrote in the first part of your response to #24 brought up a question in my mind:
Could you elaborate this point a little more in terms of how, or if, a person should help their system replenish glucose while performing sustained endurance activities?
During this kind of exertion would it be OK to have sports drinks/food that are rich in carbs?
How quickly will the system revert from ketosis?
Would the gain in performance be significant enough to warrant the use of sports drinks and the like?
Thank You.
Hi Jason–
I think a sports drink is a good way to do it. As long as you are exercising intensely the glucose will be driven directly into the working cells and shouldn’t affect the adaptation. Just make sure that the drink is sweetened with glucose (the best) or sucrose (which is half glucose) and not high-fructose corn syrup.
You would have to give it a try to see if you experience a gain in performance.
Cheers–
MRE
Thank you for an very informative blogg! You write that if you keep your carbs at for example 60 grams per day, then your liver has to produce at least 60-70 grams of gloucose. To do that the liver needs about 100 grams of protein (se #17). But we also need protein for growth and regeneration. So, the conclusion is that we need about 200 grams of protein (a man weighing about 75 kg) – otherwise the liver makes glucose from muscles. Is this really correct?
Greetings from Sweden
Goran Johannesson
Hi Goran–
I can see from a number of comments that there is much confusion about this issue. I’ll do a post about it soon. For now, though, rest assured that 100 or so grams per day of protein is sufficient for a 75 kg person.
Cheers–
MRE
I know you just set up a policy of not responding to comments in here anymore, so I’m hoping this will result in a new post on the topic.
Your explanation of how ketosis-lipolysis works was one of the best I’ve read, and I think it will help clear up a lot of the misconceptions out there about whether ketones are harmful in the context of a low-carb diet.
I’d like your opinion on one of the branches of this problem – one in which I have seen disagreements frequently turn vicious.
As you explained in your post, ketones in the context of a low carb diet are not just benign, but actually beneficial. They’re the actual fuel we use to power our muscles, rather than depending on the small amount of glucose produced from gluconeogenesis.
If that’s the case, and this is the preferred fuel that our bodies evolved to use (re: your other post a couple of days ago about glucose and evolution), then wouldn’t it make sense that ketones are also the preferred fuel for us in utero?
Certainly, there are differences between unborn children and adults, but surely our basic metabolic processes are the same?
There just seems to be such hysteria over the idea of pregnant women following a low-carb diet, with most of the concern being that we’re somehow poisoning our babies because we’re exposing them to ketones. Why wouldn’t the babies be just as able to burn the ketones for fuel as we are?
It seems to me that if a low-carb diet, even one that puts us in ketosis, is the best possible diet for us in general, then it continues to be the best for us when we are pregnant. Am I missing something that should lead me to a different conclusion?
Hi Karishma–
The medical literature (at least with animal studies; no one could ethically do such studies with humans) is pretty clear that ketogenic diets are NOT good for the developing fetus.
I’m not an expert on this issue as it applies to developing fetuses, so I check with my friend Larry McCleary who is a pediatric neurosurgeon, low-carb advocate, and well read in the nutritional fetal development literature. He says that in the fetal brain most of the lipid synthesis is from glucose and to a smaller degree, lactate. Beta hydroxybutyrate (a ketone) is not a major contributor. In addition, the enzymes in the pathway from BHB to acetyl CoA in the fetal brain are poorly developed. Post natally they activate. Hence, BHB is not a major provider for ATP generation in the fetal brain.
For these reasons he feels that a ketogenic diet might not be the best diet during pregnancy. But having said that, I (and he) don’t think a high-carb diet is the diet of choice either. A moderate carbohydrate diet with plenty of colorful fruits and vegetables along with healthy servings of meat would be ideal in my opinion.
The fetal programming literature indicates that during the first trimester mothers-to-be should avoid a lot of refined carbohydrates because it is during this period that the fetal pancreas is being formed, and elevated sugar levels can possibly cause developmental problems in that organ leading to diabetes later on in life. During the third trimester mothers-to-be should load up on protein and fat. During this stage the fetus is growing like crazy and needs to be provided with the necessary protein, otherwise the fetus cannibalizes it from Mom or simply suffers the consequences.
Hope this helps.
MRE
Dr. Mike, you said that the existing medical literature (and yourself for that matter) consider a ketogenic diet NOT GOOD for the unborn. I was wondering, how did our paleolithic produced healthy babies! since they were following a ketogenic diet. How about other low carb eating traditional peoples such as the Inuit and the Masai? First time post, long time lurker. Love your blog–Thank you
Hi Zeledoc–
I don’t know the answer. And I suspect that the Inuit and the Masai have happy, healthy babies as did, I’m sure, our Paleolithic ancestors. It’s just that putting a mother-to-be on such a diet has no grounding in the medical literature, and the first dictum of good medicine is (or should be) Do No Harm. It’s one thing to put adults on such diets, watch what happens, and make recommendations for other adults. It’s another entirely to put a fetus at risk experimentally. And the work done on animals – even dogs, which are carnivorous – shows that ketogenic diets don’t produce the best pups. As a consequence I wouldn’t put a growing fetus at risk by recommending the mother follow a ketogenic diet.
Maybe some readers have followed ketogenic diets and have had healthy babies. If so, I would love to hear from them.
Best–
MRE
In 1998 I was diagnosed with gestational diabetes (I have since concluded I probably already had diabetic tendencies, but that’s another issue) and I used a very low carb diet to keep my blood sugar level in tight control (much, much lower and tighter than the targets for regular type 2s). Once I figured out which foods messed with my blood sugar, I ate mostly protein, fat, and non-starchy vegetables (just a tiny amount of fruit). I was determined to not have to take insulin to get good control and I didn’t want a 13 lb baby! I ate much, much better on very low carb than before the diagnosis, let me tell you, because I had to make nearly everything from scratch (I didn’t have any LC cookbooks then!). I have no idea if my diet was ketogenic or not (after a while I forgot to check with keto-sticks because I was too busy measuring food, reading labels, and testing), but I only gained a healthy 28 pounds during the pregnancy, had a healthy, 7lb, 9oz baby, a fantastic no-pain-medication L&D (except for being induced with pitocin because the doc insisted once my due date passed). If I was in ketosis during the pregnancy, I haven’t noticed any ill-effects. In hindsight, that experience was a really nutritional eye-opener for me and I am thankful for it (and probably much healthier now, too).
Cheers,
Anna
Hi Anna–
Thanks for the feedback on this. I’m curious if any other moms out there have similar stories.
Best–
MRE
“The fetal programming literature indicates that during the first trimester mothers-to-be should avoid a lot of refined carbohydrates because it is during this period that the fetal pancreas is being formed, and elevated sugar levels can possibly cause developmental problems in that organ leading to diabetes later on in life. During the third trimester mothers-to-be should load up on protein and fat. During this stage the fetus is growing like crazy and needs to be provided with the necessary protein, otherwise the fetus cannibalizes it from Mom or simply suffers the consequences.”
I just reread the final part of your answer to commenter #36 and remembered that the diagnosis of GDM came at about the halfway point of my pregnancy, followed by scheduling delays in seeing the endocrinologist, diabetes nurse educator, and dietician. Then there were the couple of weeks it took to tinker with the diet prescribed to me and lower the carb count even more to get my glucose levels in control, which means that my very LC diet probably just lasted the third trimester. Prior to that, I am sure I was consuming too many carbs (though whole grain and unrefined for the most part, but still too many) and perhaps not enough veggies and fat. And I had just started to rapidly gain at the halfway point, but the high fat/low carb was better for a more moderate and steady weight gain rather than too much too fast.
Whenever someone tells me that my LC diet is so unhealthy and unbalanced, I tell them that was how I had to eat when I was pregnant in order to have a healthy baby, so how can it be unhealthy now? If that doesn’t change their tune, I ask which “essential carbohydrate” I am missing.
Cheers,
Anna
Hi Anna–
Thanks for the informative update.
Best–
MRE
An interesting analysis of ketosis and Eskimos was published in 1928.
http://www.jbc.org/cgi/reprint/80/2/461.pdf
Hey Mike–
It is truly a most interesting paper. Thanks for passing it along. I want to reread and digest, but at first blush it looks like long-term carb adaptation occurs so that ketosis really isn’t a problem.
Cheers–
MRE
I just have a comment that I would like to share. If I had my pregnancies to do all over again, I would not hesitate in engaging in a low carb lifestyle. I mean, billions of babies were born in the past by Inuits and other traditionally low carb cultures. All three of my children have something where research indicates would be best avoided on a low carb diet. My son has ADHD, daughter #1 has asthma,Daughter #2 has serious eye problems.I am glad to read comments from others who actually did this.
You know, Dr. Mike, I wonder what menopause was like for Eskimo women. I am beginning to appreciate the relationship between food choices and how they affect a woman’s body. I began to suspect that there was a relationship between menses and insulin after I began low carbing. After learning about PCOS how my mom and sis became diabetic 2 years after reaching menopause ( sister experienced surgical menopause ). Then I began reading publications on this and discovered that my assumptions were correct. Now I am wondering how, exactly, does a traditionally low carb diet affect symptoms of menopause. I don’t expect a comment but I do hope that there is a blog about it , unless I missed it.
Truly,
Mary
Hi Mary–
Haven’t blogged on it yet. And I don’t know if there is a lot of info out there on menopause and Eskimo women. But, if I stumble across some, I’ll definitely post on it.
Cheers–
MRE
Terrific explanation – I actually understood:)
2 questions:
1) Is there such a thing as too much ketosis? Can one be in Ketosis for too many days? Can one be in too much of a ketotic state meaning can the body go through this process too well?
2)If I’m buying into this Ketosis idea, can you provide a resource for a comprehensive list of permitted foods? (Assume that vegetables are desired as a part of my approach)
Ok it was more than two questions but….
Thanks for your time
Hi Rabster–
In answer to your questions:
1) No, as long as you are not a type I diabetic, you can be in ketosis as long as you like. And your ketones will not go too high.
2) Any list of fruits and vegetables that you can find that show you the carb contents will work. If you keep your carb intake below 30 grams per day, you’ll be in ketosis.
Cheers–
MRE
I heard that ketosis is very hard on the kidneys. I have a friend who was born with one kidney, and her doctors expressly forbade her from doing any ketogenic type diets.
What is your view on ketosis and kidney function.
Hi Doug–
It’s not ketosis that is supposedly “very hard on the kidneys,” but a ketogenic diet. The part of the ketogenic diet that is supposedly damaging to the kidneys is the higher protein content of that diet. Much research has shown that dietary protein DOES NOT have an adverse effect on normally functioning kidneys, even if it just one normally functioning kidney. The idea that protein damages kidneys is what I call a vampire myth, one that keeps coming back to life no matter how many times it has been killed by the light of good research.
If you want to read a good summary paper on this issue, click here.
Hope this helps.
MRE
Thank you for a very informative and well written article. I’m interested in a deeper understanding of the biochemical process of “tissues adapting to ketones” – I can’t seem to find this information. You’ve stated, “It takes a while to become fully ketone adapted. At first, the body is making the ketones, but the tissues haven’t completely converted to using them for energy yet”.
Is the adaptation linear, or does it follow a more parabolic trend? Is it all or nothing? What are the molecules involved? Also, once I’m ‘fully ketone adapted’, does my carbohydrate metabolism change? Would I lose my ketone adaptation if I start eating lots of carbs?
Thank you,
David
Ketone adaptation occurs when the enzymes necessary for ketone use are made in the quantities necessary. We have the code in our DNA to make all kinds of enzymes, but we don’t make them unless we need them. It would be pointless for the body to make and keep in circulation all the enzymes required for optimal use of ketones if we weren’t really producing many ketones. Once we start a ketogenic diet, however, and start cranking out the ketones, the DNA goes to work and makes the enzymes we need to use them properly. This generally takes a couple of days to get the enzymes fully loaded up and working at their best.
Cheers–
MRE
Thanks for your advice Doctor.
I actually followed through on your advice and have for the past 4 weeks been on Carbs
Glad it’s working.
Very informative article – I am in ketosis and have a question…
I have a problem with carbs – My body was reactive hypoglycemic for 3 yrs – During that time I continued to eat bread every 2 hrs to keep the adrenaline surges down. But eventually, my body starting giving adrenaline surges every 15 minutes even after a good serving of broccoli. The theory is that my body said it had enough of the carbs. My endocrine can’t explain it – other than excessive stress.
So I have been on a extremely low carb diet (essentially egg whites, meat, cheese, romaine and caesar dressing) for two weeks. The Ketostix are consistently ranging from small to large every day.
Is this going to hurt me – because I feel I need to continue this way? I don’t have to eat 6-7 times a day anymore but am worried about damaging my body.
Any thoughts?
Hi Tom–
Ketones are normal fuels for the body. I don’t think as long as you’re not a type I diabetic that being in ketosis is going to cause a problem. This is something, however, that you should discuss with your own physician.
Best–
MRE
[...] Metabolism and ketosis » Michael R. Eades, M.D. … as you lose … that I plan to post on sometime soon. Even on a zero carb diet … 13 lb baby! I ate much, much better on very low carb than before the diagnosis, let me tell you, because I had to make … http://www.proteinpower.com/drmike/?p=719 [...]
Thank you for your great explanation on acidity in the blood.
Can you explain *why* lipolysis causes a decrease in appetite? Why does being in ketosis cause this? Is it related to fatty acids roaming around in the bloodstream? It’s fairly common to read about the decreased appetite factor when hitting ketosis, but I don’t think I’ve ever seen an explanation as to *why* it occurs.
Thanks again so much! I *heart* your blog! Have a safe trip home!
Jill
Hi Jill–
There is some controversy on this issue, but I think that it is pretty well established that ketones have an appetite-suppressing effect. Also, and probably more important, when one is in the state of ketosis the liver is controlling the blood sugar, keeping levels stable. A falling blood sugar is one of the most potent stimuli to eat that is known. It’s probably a combination of the two.
Cheers–
MRE
Thank you for your article regarding Metablism and Ketosis. Firstly, I have a concern about losing muscle mass while eating low carb. You mention that the protein you eat is converted to glucose instead of the protein in your muscles. But, wouldn’t the body “eat up” its own muscles first before utilizing dietary protein? Im kinda confused!
Secondly, what causes a person while low carbing to have red, “watery” eyes? Is there something that can be taken (supplement, for example) to relieve this?
I look forward to your comments!
Hi Michelle–
The body will use dietary protein before consuming muscle protein, so as long as dietary protein is adequate, you don’t have to worry about loss of muscle mass.
I’ve never seen the red, watery eyes that you’re referring to as a side effect of low-carb dieting. Maybe some other readers can chime in on this issue because I’m clueless.
Cheers–
MRE
[...] way. That is a brief run down on ketones, if you want to geek out on the topic you need to read Dr. Eades’ post on ketones. I really want to emphasize the point that ketosis is a normal metabolic state. [...]
Hello Dr. Eades,
Long time reader here and health/science student wanting to ask a few questions. I just want to make sure that this is correct first. Protein is integral to the production of ketones- when dietary protein is converted to glucose, ketones are used to fuel the process. These ketones are made from bodyfat when dietary fat runs low. Furthermore, skeletal muscle will never be burnt provided you consume adequate dietary protein.
Hence, for maximum fatloss, would it work to eat close to 0 carbs a day and eat say 60-70 percent of your macros from protein, and 30-40 percent from fats as opposed to the 65% fats/ 30% protein / 5% carb (the typical keto diet) breakdown, whilst eating hypocalorically?
This way the liver will be forced to convert dietary protein to glucose (I weigh about 90 kgs so I will need close to 150 grams of glucose I beleive), using ketones to fuel the energy expensive process. Since there will not be enough dietary fat to fuel this process (I presume), a higher percentage of bodyfat will have to be oxidised to ketone bodies equalling more BODYFAT loss. The high amount of protein (perhaps coupled with some weight lifting twice a week) will preserve muscle mass thus keeping my metabolism running well.
Is there any downside to eating so much protein and so little fat? I beleive it is a myth that if you eat lots of protein you are training your body to “burn” protein as your number one fuel source…It IS a myth right? I really see no need to eat so much fat as is prescribed in other “keto” diets. And how low can you drop your calories before leptin and hypothyroid issues come into play?
Thanks for reading! I look forward to some enlightening answers =).
Hi Khapz–
As I read it, your premise is incorrect. Dietary protein is converted to glucose via gluconeogenesis, which is carried out in the liver. The liver cells don’t use ketones as fuel, so ketones don’t fuel the process of converting protein to glucose. Also ketones are not necessarily “made from body fat when dietary fat runs low”; ketones are produced from fat when carbohydrate intake runs low. A low carb intake stimulates the production of ketones in an effort to replace glucose with another water-soluble fuel.
Reducing carb intake makes the body burn fat and produce ketones. The substrate for gluconeogenesis is protein, and, like the bones are the reservoir of calcium, muscle and other protein structures are the reservoir for glucose. So maintaining an adequate protein intake ensures that you have plenty of substrate for gluconeogenesis without having to catabolize muscle mass to make sugar.
Hope this helps.
MRE
Just to let you know my experience with pregnancy and ketosis. I eat a lower carb higher protein diet in general but during the first six weeks of my pregnancy I would say 3 to 4 weeks of that period I was being very strict and only eating 20 – 30 g carb per day. I never at all experienced morning sickness. I had a healthy baby girl who is now a normal albeit lean 3 1/2 year old.
Though this is off topic but when my daughter turned 3 we started to give her Nordic Naturals DHA for kids (normal suggested dose) and within 4 weeks she started to stutter only about three times during the day when she was with me but when she was with her father who would get her all riled up she would stutter alot. We took her off of the DHA and she stopped stuttering altogether about 3 weeks after that. Ever heard of that?
Mmmm
Hi Mmmm–
No, I’ve never heard of that problem with fish oil. It is interesting. I think that for every product that exists there is someone somewhere who will have a strange reaction to it.
Best–
MRE
You mention somewhere that for those experiencing some constipation on a low-carb diet it helps to add fat.
Could you talk about that a little more? Is there a time of day, for instance to eat the fat? (Such as, should I swallow a spoonful of sour cream at bed time if I usually move my bowels when I get up in the morning?)
Since fat moves fairly slowing through the GI tract, it probably doesn’t much matter when you eat it.
Cheers–
MRE
I know that I am very late on this but I also wanted to chime in on my experience with pregnancy and ketogenic diets.
I had 3 pregnancies at advanced maternal age (35, 37, 39).
Several years before the first PG, I lost about 25 pounds on PP and was maintaining it fairly well.
The first 5 months of each pregnancy I was so nauseated and I existed on mostly carbs. However, at the 5 month mark, I began to feel better, and promptly resumed a 30g or less per day LC eating plan. To make matter worse, there is something about the way I carry that, after about 6 months gestation, I am unable to eat more than a few bites of food without feeling like I’m going to explode–and I would sometimes vomit if I ate too much. I tested negative for GD in all three pregnancies.
First pregnancy (age 35) I was at my ideal weight when I conceived (130 pounds) I gained 25 pounds in the first 5 months and then lost 3 pounds the rest of the pregnancy for a net gain of 22 pounds. My son weighed 7 pounds 6 ounces, 21 inches, was and is (now 7 years old) quite healthy overall, although he does have mild asthma (as I did when I a child) and I also suspect he may have ADD w/o hyperactivity (as I also have)–time will tell. He is very slim 7 year old, average height, and is on grade level for everything. I was at pre-PG weight 7 days after the birth.
Second pregnancy (age 37) I was at 140 pounds (gained some weight between the 2) when conceived. Again, I gained about 22 pounds in the first 5 months, and lost 3 pounds over the rest, for a net gain of 19 pounds. My daughter weighed 8 pounds, 3 ounces, 20 inches, was and is very healthy. She gets over a cold faster than any of us. She’s now 5 years old, very verbal, and her teachers project that she will be gifted. She is 100 percentile for height and weight for her age. She looks perfect…she is just the size of normal-slim 6 year old, even though she is 5. I was at pre-PG weight 7 days after the birth.
Third PG (age 39), I was at 170 pounds when conceived (don’t ask…it was a hard year after the 2nd one!) I gained 10 pounds over that PG. My son weighed 9 pounds, 21 inches and he was a very big, healthy, happy baby. Now at age 3, he is very slim (30 percentile) and very tall (100 percentile). Everyone thinks he is 4 when they look at him. He is slightly less verbal and more introverted than the other 2, but is otherwise normal. We figure there is so much noise around here, he just gets tired of it and goes and plays by himself sometimes…kinda like his mother! 7 days after he was born I weighed 20 pounds less than when I conceived!
I don’t know if this account is helpful, since I didn’t really LC during the early months of my PG, but thought I would share.
Thanks for posting your interesting gestational history.
Best–
MRE
I’m a 200 lbs, 22 year old man (bodybuilding enthusiast), and I’ve been on a weight loss cycle for approximately 9 months now. I’ve lost 47 lbs while maintaining my strength and even gaining lean mass through weight training. I’ve just switched to a Targeted Ketogenic Diet in which I consume small amounts of carbohydrate (40g from whole oats) pre-training. I was wondering how much protein I should consume in order to preserve or even gain lean mass while on a Ketogenic diet; currently I’m consuming a little over my weight in grams (between 205-210 grams of protein per day. I’m concerned that the amount of protein I’m eating isn’t enough to preserve muscle tissue on a Ketogenic diet, so I was just wanting to make certain that this is sufficient for my purposes.
If you figure that you need 200 grams of glucose per day under normal circumstances, you can assume that 70 grams will be replaced by ketones on a ketogenic diet, which leaves you with around 130 grams of glucose that must come from somewhere. You’re getting 40 grams from the oats, leaving a deficit of 90 grams, which must come from protein via gluconeogenesis. Since it takes about one gram of protein to make 0.8 g of glucose, you will use about 112 g of protein to make the sugar you need. Since you’re consuming 205-210 grams protein per day, you should have sufficient to use for glucose production with plenty left over for muscle repair and building.
Cheers–
MRE
Hello Dr. Eades
In 1999, I purchased your protein power book and in following your program and rigorous exercises I lost 50 lbs in about 4 months.
Once again I am forced to use this program again! All I can say is how incredible the boost in athletic performance is. At the moment I weigh 245 and am about 5′10 I have a very high BMI but pepole can’t believe my workout routine. I run 4 miles to the gym, climb 45 flights of stairs in 12 mins on the stepmill, lift weights for an hour have a protein shake and then run 4 miles home. When on higher carb, I could not run home and didn’t climb the stairs. The weight lifting has suffered a little, but I feel as if my endurance has doubled over night!
I also do not need as much sleep. Why does a higher carb diet make you more sleepy?
Bruce
There are many answers to the question of why a high-carb diet makes one sleepy. Probably the most common reason has to do with elevated levels of insulin in the blood (driven by a lot of carbs in the diet) creating a relative abundance of the amino acid tryptophan, which then converts to serotonin, a sleep inducing substance.
Cheers–
MRE
Greetings Dr. Eades,
Earlier, you explained that “the body will use dietary protein before consuming muscle protein, so as long as dietary protein is adequate, you don’t have to worry about loss of muscle mass.” In addition to preserving muscle mass, is it possible to build muscle while eating low-carb? Will the extra dietary protein be solely used in the process of glucongenesis? Will some of the dietary protein go towards building new muscle?
Thanks in advance!
Michelle
Hi Michelle–
Yes, the dietary protein (as long as there is an adequate supply) will go to building new muscle. Only the protein required to maintain appropriate levels of blood glucose will be shunted to gluconeogenesis. The rest will be used to build and repair tissue including muscle. Any extra will be broken down and excreted.
Cheers–
MRE
Hi. Great post. However, I have a question. PLEASE answer. I saw a study (http://www.ncbi.nlm.nih.gov/pubmed/16037240?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum)
that said that ketosis is dangerous for people because it produces nervous system damaging acetones! I would be very helpful if you could explain this study for me and my family.
Thanks a lot,
Stacey
Hi Stacey–
I’ve answered this question in the comments at least four or five times so far, which is one of the reasons that I want to quit spending so much time on comments. A lot of people don’t read them and the search option doesn’t really search them. Unless you are a comment reader you wouldn’t know, so don’t think I’m taking you to task for asking the question. I almost never read the comments on the blogs I read, so I figure a large number of people don’t read the comments on mine. It’s much better to put this kind of info in a post so that all can read it and newcomers can find it by using the search option.
If you go to this post and scroll down through the comments to the four or five comment exchange I had with Tim Lundeen (it’s near the bottom of the comment list), you can find my thoughts on this issue.
Cheers–
MRE
This is in response to Michelle Flint’s question dated September 9, 2007:
“Secondly, what causes a person while low carbing to have red, “watery” eyes?”
That question is the reason I found this site. Over the last few years I will go on and off a no/low carb diet. It finally hit me this time, that the red and burning eyes I have experienced as well as a “chemical smell” has coincided with my ketosis. The constant assault to my olfactory and burning of eyes is VERY uncomfortable. My doc has put me on high-dose prednisone before to get the chemical smell to leave and clear my eyes, but we never looked at the possibility that my ketosis was going on at the same time.
I would definitely love to know if there has been some research done on this. Carbs are not a friend to my body, so I love being on a low/no carb diet. But I am concerned I won’t be able to continue with the diet if my symptoms continue.
~Pali
Hi Pali–
As far as I know there hasn’t been research on this issue. Ketones are normal fuels for most cells and our bodies produce them all the time. Even people on high-carb diets go into ketosis from time to time. I can’t imagine that ketones could be causing the symptoms you’re experiencing.
Best–
MRE
Hi, excellent post, one of my favorites on the site. Quick question about an answer to a comment, are carnivorous animals such as dogs, cats, lions, tigers, etc. in ketosis at any time? if no then what keeps them from being in ketosis?
I’m not an expert in carnivore physiology, but I would expect that these animals would be in ketosis part of the time. Any one out there know for sure?
Hi Mike.
When I first tried to switch to a low-carb diet (getting rid of pasta, bread, pizza and so on) I
lost about 7/8 kg. in some weeks (from 65 to 57/58 kg.).
I’m 175 cm. tall, therefore I wasn’t very fat, even before starting the diet.
After a while, I started to skip a meal now and again, but the problem is that I began to experience bowel and/or gastric problems, constipation and sometimes diarrhea.
In spite of this, I’ve no sleepiness and I feel more energic than when I ate dishes full of spaghetti and 2/3 slices of bread for lunch.
I was wondering if losing some muscular mass while NOT eating sufficient protein/fat could lead (together with other problems) to intestinal problems (IBS, Crohn, colitis, etc.)?
What does happen to your digestive tract if you stay on a low/no carb diet and don’t eat sufficient quantity of proteins?
Why is it that many low-carbers experience constipation, IBS and so on?
Is there any relationship between loss of muscular mass and gastro/intestinal problems?
As glutamine is the most abundant aminoacid in the muscle tissue, could these problems may be due, for instance, to a lack of glutammine in the intestinal tissue (eating less than sufficient protein)?
Less muscular mass (and not sufficient protein or skipping a meal a day) = Less glutammine?
Less glutammine = Less health of your intestinal tract?
What do you think about.
Thks.
Marco
Hi Marco–
I don’t see how a low-carb diet is a low-protein diet. You write that low protein intake is a problem on your low-carb diet. You should be getting plenty of protein if your following a good, whole-food low-carb diet. Any problems you may be having I wouldn’t attribute to low protein, unless you’re trying to cut the protein as well. If you are, why?
Best–
MRE
Great info!! Oh, and I GET the relevance of the cave man photo unlike “unknown” above!!
Hi, I’m well read on low carbing. I did Atkins years ago, I think in 2001, and lost 70-80 pounds, but wasn’t able to keep it off because actually, I’m not fond of eggs, cold cheese, and big pieces of meat, so needless to say I went back to my old ways of eating and gained back the weight. I started looking into intermittent fasting and Johnson Up Day Down Day Dieting and have started losing weight doing this. I’ve been reading about ketosis and low carbing again and am thinking of going back because I’m 29 and husband is 33, and it seems that heart disease is now occuring in our generation and I am so terrified of that happening. Anyways, before rambling too much more, would you think it be safe to combine IF with low carb? Mainly meaning 23 hour fasting every day, only eating supper, and having that supper be really low carb. I thought it would be easier for me to only have to eat one low-carb meal a day instead of 3 or more. But, since I’m not a huge lover of meat, I’m concerned – will I get enough protein in my one meal? I certainly don’t want to lose muscle mass. If I have to eat 3 meals a day, I know I can’t make it low carbing for a lifetime. Also, I was originally planning on trying to stick to below 40-50 grams of carbs a day to be mildly in ketosis, but one webside was pretty much saying stay completely away from even fruit, yogurt, cottage cheese, potatoes and everything because anything that makes insulin go up is bad. It that true, I don’t like feeling guilty about having an apple or half a potato. Thanks for any thoughts.
I do think it is safe to combine low-carbing with intermittent fasting. That’s probably the way Paleolithic man did it.
Hi Dr Eades, sorry I guess I got ahead of myself. I blogged here earlier today asking questions and afterwards found your blog on IF, which sorta answered more of my concerns. so now my main questions are, if I’m eating just one meal a day, should I be concerned about meeting a minimum amount of calories in that meal so as to not lower my metabolism? what if I’m eating less than 1300-1500 a day for a while, won’t that lower my metabolism? And then regarding carbohydrates. I’m really striving to find that perfect number that I can eat/enjoy a day and yet prevent, as much as humanly possible, heart disease and cancer. Do you have a number in mind? Less than 100 g, less than 50g?? I even read on some website today that this one website believes carbs cause cataracts, among other things. Interesting, but scares me about even thinking of eating an apple. I would really appreciate your ideas. also, since I started a few weeks ago of hardly eating during the day, I find that I get so hungry that I crave “healthy” foods, like today I’m wanting eggs, which from my previous comment earlier today, I pretty much hate eggs and eat them a couple times a year. and the other day I was craving tomatoes and cottage cheese. Is this normal? And I was just wondering if you knew biologically why I’m craving healthy foods instead of bad things like fast food, my usual craving. Just curious. Thanks so much. I’m re-reading your books right now by the way.
In practice I usually started my patients on a diet of about 30 g off effective carbohydrate per day. As patients neared maintenance, their carb intake could go up to 100-120 or g of carb. If you limit your carbs to somewhere below 50 g per day and make sure you’re getting plenty of protein and fat, you shouldn’t have to worry about your metabolic rate falling.
Hello
Great article. I have been doing a ketogenic diet on and off (majority on) over the last 5 years.
I really like it, and can stick with it to a T. I’m a avid bodybuilder, and carb up on the weekends. I have a question, I am considering playing football this year. Now I now extended ‘all out’ activity might suffer, but short bursts will not. Now would about a football game, of 2+ hours of short bursts? Usually when I carb up I’m a bit sluggish, so it probably wouldn’t be a good idea to carb up right before, but I don’t know what the best approach would be.
Thank you for your time in helping everyone.
I would carb up with something liquid – Gatorade Lite would probably be my choice. You want glucose, not fructose, so anything with glucose in it would work.
Good luck.
Hi Mike.
You say we need about 200 gr. glucose a day.
By staying in ketosis this need will drop to about 125 gr. glucose.
If you eat 20/30 grams of glucose a day, you will need 100 gr. glucose, that is 125 gr. protein.
The problem is that skipping a meal a day could reduce the daily protein intake to about 80/85 grams.
Example:
BREAKFAST
2 eggs (15 grams protein)
50 gr. bacon (6 grams protein)
3/4 small tomatoes
E.V. Olive oil
Coffee
DINNER
Lettuce
200 gr. Chicken breast (60 grams protein)
Half avocado
10 almonds (2.5 grams of protein)
E.V. Olive oil
A little piece of dark chocolate
Supposing my calculation to be right, if you stay on this regimen for a long while (some months) your body will compensate your lack of protein by getting it from your muscle.
My question is about glutamine:
if, after a while, you have no more muscle mass to lose (because you’re very thin), could you experience impaired gastro/intestinal function due to lack of glutamine?
Let’s try to change the question:
If you’re very thin and you haven’t so much muscle mass to burn for protein, gastric/intestinal problems (IBS, Colitis, etc.) during a low carb diet could mean that your protein intake is too low?
I read that, during several conditions, a lack of glutamine may occur and that this will result in functional disturbances of the immune system and/or the gut.
I wonder whether gastro/intestinal diseases could hide a message like: “Hey… I’m running out of my stock of glutamine (muscle)… Please eat more protein!”.
Thanks a lot.
Marco
p.s. – next question in Italian, ok?
I don’t really think the glutamine is the issue, but it’s easy to test. Simply get some powdered L-glutamine and take about 6-10 grams of it per day and see what happens. If everything gets better, then it may have been an issue with the glutamine.
If you do this, let me know what happens. In English.
I have been on a low calorie diet for 1 wk, have lost 9 lbs, but am not in deep ketosis as of day 8. What would be the cause of ketosis not happening, if I have been very strict and have eaten onlyt the required amounts of lean protein and veggies? How long does this normally take? LOL, your earlier post made me laugh because I am trying not to be obsessed with being out of deep ketosis, but do I need to be in deep ketosis to be successful… And I am really interested in the reason why I would not be in deep ketosis.. This new information is so interesting.
Are you on a low-calorie diet or a low-carb diet? If, as you wrote, you are on a low-calorie diet, that’s probably the reason you aren’t in ketosis. Most low-calorie diets are high-carb diets, and high-carb diets prevent ketosis.
I’ve searched high and low for an answer to this question, but couldn’t find one.
Assuming an overweight person is restricting carbs to the extent required for gluconeogenisis, will the body first use dietary fat or stored body fat to power the process? If it is the former, does it then make sense to restrict the percentage of calories from dietary fat?
I assume you mean restricting carbs enough to cause gluconeogenesis to occur. Yes the body probably does use dietary fat first then stored body fat. When carbs are restricted to the degree necessary that gluconeogenesis is operating, insulin levels are low allowing fat to easily come out of the fat cells. But there is no real need for the fat to come out of the fat cells if there is enough dietary fat to meet all the body’s energy needs. So, if the object is to lose weight, one needs to limit calories (which in a low-carb diet are primarily fat calories) to create a deficit so that stored fat is used for energy.
Hope this helps.
Hi Dr. Mike:
Great article, as others have noted.
I have been on LC for one year exactly. As many others have experienced, my weight loss went from 3 lbs/wk. to 2 to 1 to 1/2 over the course of about 6 months, which was fine. I dropped 20 lbs. in 6 months, and hoped to drop another 10. I stayed on Atkins induction for about 4-6 weeks, then gradually increased carbs to maybe 40-60 grams a day. I don’t restrict calories or particularly pay attention to them.
Over the last 3 to 4 months, I have put back on about 8 lbs, slowly. I had an idea that that might be due to ‘adaptation,’ or my body becoming more ‘efficient,’ which I think your blog bears out. However, I am wondering ‘what’s a brother to do?’ My inclination is to either a) reduce carbs or b) reduce calories. Would either or both of these approaches be better/effective? My ketostrips show ketosis infrequently or possible very light pink at this point, but occasionally a more obvious purple.
Frankly, I hate being hungry, which is one of the advantages of LC dieting — I lost the insulin resistant roller coaster which left me hungry and distracted a lot of the time when I went LC. Therefore, I’d rather reduce carbs, but I’m not really sure what, physiologically, is going on. I don’t know, offhand, my BMI at this point, but I do know that my weight should probably be around 150-155, but is now closer to 170.
Thanks.
Hey Jeff–
I received an email yesterday from a doctor who has a couple of patients whom he says are compliant with the low-carb diet he has them on and who are not losing. Here is my response to him:
Hope this helps.
MRE
Hi , Dr. Mike,
I have been on a diet with average 600 Kcal from Monday thru Friday, and 1500 Kcal for Saturday and Sunday (low carb and high protein food), with the hope by doing so to restrict the overcall calorie intake under 900Kcal/day. I weigh 125 lbs, and resting metabolic rate is about 1340 Kcal/day. I heard people say if you keep your very low calorie diet long enough (lower than 1000 Kcal); your body’s metabolic rate will plummet, to where you will gain all your weight back as soon as you go back to your normal diet. IS that true? If I want to stay on a low calorie, how low can I go without mess up my metabolism?
I really appreciate your site and blog. They are truly educational!
Joy
Your question is a difficult one. You will drop your metabolic rate on a very low calorie diet. Of that there is very little doubt. What is in doubt is how much it will drop and what is the calorie limit under which it really plummets.
I plan a post on this issue soon.
Dear Dr. Eades,
My question is regarding ketosis. Is it an all or nothing state, e.g. you are in ketosis or you are not? And if so, does the amount of ketones “spilled” into the urine matter, is a large amount better than a trace amount?
Thank you!
Very informative blog!
We are all going into and out of ketosis all the time. Those of us on low-carb diets are more in than out, but it’s a cyclical thing. If you are trying to lose weight and are losing, I wouldn’t obsess on the levels of ketones. As long as you’re there most of the time, you should do fine. And the urine isn’t the only way the body gets rid of ketones. It uses them for fuel and it gets rid of them through the lungs. Maybe you are so well adapted that you are burning them like crazy and therefore don’t have a lot that spill into your urine.
Okay, all of this makes perfect sense. That’s wonderful. I also see that it’s supposed to be okay on not tearing down muscle. However, I am kind of hesistant, because I’m training for figure competitions at the moment. I trust my trainer, but I just want to make sure that my strength and size won’t suffer. I understand that a ketogenic diet is okay for the average person trying to lose weight or live healthier, but what about for someone in my position?
It should be fine as long as you allow an adaptation period. Read this article for a thorough discussion.
Hi,
First of all thank you for posting this and for posting all of the comments. It has answered a lot of my questions.
My question is, how many grams of fat should someone eat if they are trying to burn body fat with a low carb diet?
I weight 68 kg and my ideal is about 52 kg. I have never eaten the number of kcals that supposedly is needed to maintain my current body weight, eating only 1300 on days when I’m doing good and rarely going over that number. I’m doing the low carb diet to lose body fat and not weight so I don’t mind gaining muscle mass.
If I’m understanding your previous answers then I need to eat roughly 51 grams of protein a day, and 0-30 carbs. So how much fat should I eat?
Also I read somewhere that dietary fiber doesn’t count as a carb in a low carb diet. Is there in basis in fact for this statement?
Thanks!
On a low-carb diet the fewer the calories you eat – while maintaining adequate protein intake – the more weight you will lose.
I’m doing a post on this very subject in the next few days.
It is true that fiber doesn’t count as a carb because it isn’t absorbed like carbohydrates and, consequently, doesn’t raise insulin levels. It does provide calories, however, because the bacteria in the colon convert the fiber to short-chain fatty acids, which are absorbed.
Cheers–
Hi Dr Mike,
I have been following a VLCD in the form of lighter life for the past 24days and as of day 21 had lost a total of 19.68lbs which I am very happy with. I am not at all hungry am in ketosis and come monday have only 10 more wks of abstinence. My question is that I am going on holiday in 5 wks for 5 days. My plan at the moment was to have 2 meal packs during the day and in the evening have a very low carb meal with my husband and a few vodka’s that I know are low carb. Can you advise if I am in ketosis what would be the likely hood of me staying in ketosis during those 5 days or am I very likely to gain weight? I know that during atkins you are in ketosis if you stick to 20grams of carbs per day and it will only be 1 meal. I would really appreciate your advise as I am becoming a bit apprehensive about eating but I do not want to sit in a restaurant with my husband for those 5 days and have a little something to eat. Many thanks
Hey Shelly–
Hope this gets to you in time. I think you’re likely to stay in ketosis as long as the mix you use with the vodka doesn’t contain a lot of sugar. If you are going to drink vodka tonics, for example, make sure you use diet tonic. That sort of thing. And when people are on holiday, they seem to increase activity levels enough to compensate for the slight increase in carbs.
Good luck and have fun.
Cheers–
But, then, why do people have such intense carb cravings and side effects while eating low-carb, i.e. being weak and shaky. (And please don’t claim they’re psychological.) If it’s normal/preferable/no big deal to be running in ketosis, why are so many people physiologically compelled to get out of ketosis as quickly as possible, i.e. driven to consume carbs?
Because they don’t hang in there long enough to make it through the adaptation period. And they probably don’t take potassium supplements during the adaptation period.
And a lot of it is psychological. If you don’t really want to cut carbs or you’re afraid to cut carbs, then when you do and you feel fatigued or shaky or any of the other symptoms, it confirms your fears and you bolt.
Dr Mike ~ I have tried many different nutrition tactics and the Paleo ways of eating have produced the best results for me. Second best is a fasting and feast cycle. However, while in fasting mode I have noticed the mind does not respond as quickly, which is not optimal for a hunter, business person, athlete, etc. It seems it is better to maintain a consistent low-carb diet to “feast and starve all at the same time”. a) Is it best to accomplish this by eating every 3 hours or so or to be instinctual and eat when hungry? b) do larger meals later in the day or evening have an impact on the fat burning ability of the body (i.e time of day impacts of low-carb dieting). Great article good blog.
Hey Sean–
I don’t really know which is the best. I, myself, more or less eat when hungry. A number of studies have shown greater weight loss on an equal number of calories when the main portion of the caloric intake is skewed to the morning verses the evening. But none of these studies used low-carb diets, so there is no data to go by. I fiddle around with my own diet to find a combination that works best for me in terms of social and familial obligations (as to meal timing) yet maintains my weight.
Cheers–
MRE
Thanks so much for the posting – very informative. I just recently started LC, mostly due my diabetes. I was diagnosed T2 at age 34 (seven years ago), with no overt symptoms besides fatigue. Although I’m now taking metformin (500mg) 2Xday, I still have unstable glucose levels (especially fasting glucose due to the dawn phenomenon). I recently read an article about Dr. Mary Vernon and have since started doing more research on LC and decided to give a try. It’s only been 5 days, but my fasting blood sugar went from 170 to 114 and seems much more stable throughout the day. I’m very interested in lowering (and perhaps eliminating) my meds… I keep looking for more information – especially concerning ketosis vs. diabetic ketoacidosis. I’m assuming that if I’m in ketosis, but my glucose levels are within appropriate range that I’m doing well. Can you confirm this for me? Thanks!
If you are in ketosis and your blood sugars are normal, then, yes, you are doing well. That’s the situation I’m in myself most of the time. As long as you don’t have type I diabetes you won’t go into diabetic ketoacidosis, a life-threatening condition.
I gave up smoking and went low fat to prevent putting on weight, unfortunately it didn’t help and well yes made things worse i balooned by 3 stone in about 4 months and became a carb addict even though i was doing 2 hours of exercise up the gym and in theory eating less than i was burning it never shifted. I have been low carbing for about 6 weeks and have not managed to make it into ketosis (Sticks have never changed at all!). I haven’t lost anything, sadly all i have done is put on a couple of Kgs.
As far as carbs go, I have a salad and perhaps spinach with my evening meal and that’s it (well it’s protein and fat i eat too!!) i’ve calculated the overall carbs to be averaging 15-25g a day… so how can i not be in ketosis or loosing weight?? I understand all the physiology and anatomy and so on, just can’t work out why my body won’t play ball…
I can’t comment without a whole lot more information.
Sorry.
Here is a quote rom http://www.lowcarbportal.com
“There are also other anomolies: A figure often used is that one kilogram of body fat represents about 3500 calories. But according to the United States Department Of Health, Education and Welfare:
‘On a high-fat diet, 4703 to 8471 excess calories were required for each kilogram of added weight. On a low carbohydrate VLCD [very low calorie diet], replacing fat calories with 8g/day of equivalent carbohydrate calories reduced weight loss by 1.68kg, corresponding to 3300 calories of carbohydrate/kilogram, possibly 2500 calories per kilogram for carbohydrate alone.’(Department of HEW Publication: NIH 75-708, Government Printing Office, 165-86.)
Are they are saying that it takes 4,703 to 8,471 excess calories of fat to add a kilogram of weight, yet it takes only 2,500 to 3,300 calories of carbohydrate to add the same amount? If so ‘a calorie is a calorie is a calorie’ is not so meaningful after all: a carbohydrate calorie is obviously much more fattening than a fat calorie. So do calories count? Well, perhaps — but some don’t count half as much as others.
Actually, excess fats aren’t stored in the body. Any unused fat calories are excreted in urine and faeces. (Endocrinology 1962; 70: 579. Experientia 1963; 19: 319. Metabolism 1964; 13: 87-97. Proc Soc Exp Biol Med 1964; 115:424. Nature 1964; 201: 924)”
Questions:
I would like to hear what you have to say about the idea that it takes more calories from fat to gain a pound than it takes calories from carbohydrates, and if this is the case do you know of any explanation for this?
Also, is it true that exess dietary fats are not stored, but excreted?
I’m coming out with a post on this very subject within the next few days; I’ll address all these issues then.
I have one more question, I have become interested in Low Carbohydrate Diets not for weight loss, but for other possible health benefits. I eat a fairly balanced diet, but I believe that the ammount of carbohydrates I eat may be causing damage to my health, although I have no weight gain problems. I am 27 years old and I still weigh the same I did in high school, approx 155 lbs. Is a low carb diet ok for someone like me, and if so should it be a modefied version. Thank you!
Kenny Williams
A low-carb diet is fine for one in your situation. You’ve got youth on your side right now, but you won’t always have. The low-carb diet should prevent a lot of problems in the future.
Cheers–
MRE
With reference to my earlier post, i’m happy to provide any information you require! So
please let me know what more you would like to know and i’ll happily oblige!
Many thanks
K
Hi K–
Problem is that even if I had all your information, I couldn’t give specific nutritional and/or medical advice online. I hope you understand.
Cheers–
MRE
I am wondering if another ketosis “symptom” is having a metallic taste in the mouth…. if so, can you explain the physiology of this.
Thanks!
CJ
I know that for some people this phenomenon exists, but I don’t have a clue as to the physiology.
Cheers–
MRE
Hi Dr Mike
I posted a question to you back in April and you very kindly repsonded to be before I went on holiday. I wanted to let you know that during my holiday had a few light protein only meal, drank vodka & coke light and swam 30-50 lengths every morning came back and had lost 4lbs. I am now on Monday 11wks into Lighterlife have lost 46lbs as of last monday and was possibly planning on doing the programme for an extra couple of weeks. This is where the next area of my life starts do I continue to do route to management whereby they introduce foods back in over 12wks and try to find your trigger foods, or do I follow a low carb diet which I know I can lose weight on. Is it healthy longterm to follow a low carb diet obviously I do not want to go without them totally but am happy to continue my life with not having alot. Hope you can advise me on my forward path and look forward to hearing from you.
Hi Shelly–
Glad to hear that you did so well on holiday. You will have to make the call about what you do for maintenance. But, were I you, I would go the low-carb route. The evidence out there suggests that a long-term low-carb diet is at least as healthy as a long-term low-fat diet. Neither has been studied for longer than a few years.
Cheers–
MRE
I am on a supervised LC diet with B12 and B6 injections. The diet is very low in calories with potassium,calcium,magnesium supplements.
If excersise does not factor into the amount of fat lost. What does make you lose more fat ?
A higher protein diet, low in fat, low in calories. So the more protein you consume with low calories the liver will require the energy from fat cells to break down the protein ? So lets say if possible a 800cal diet consisting of 300g of protein. All of the protein will be processed and excess will be discarded. All of the ketones created to break down the protein into glucose if not used up will also be discarded as long as you are drinking enough water.
So would the amount protein eaten directly relate to how much fat is lost as long as the calories are low ?
Could you not just substitute your meals with something like NATURE’S BEST PERFECT LOW CARB ISOPURE which only has 210 calories 50g of protein 3 carbs. If taken 4 times a day that would put you at less than 1000calories a day and 200g of protein. Almost seems like the perfect way to loose weight.
I would never suggest completely replacing all meals with this stuff but lets say using at intervals like every weekend to completely replace meals for 2 days. Then back to regular LC diet.
Great article by the way very informative
First, you couldn’t possibly have an 800 cal diet containing 300 g protein because 300 g of protein contain 1200 cal. Protein requires a little more energy to metabolize than fat and or carbohydrate, so increasing the amount of protein will increase energy expenditure to some extent. The supplement you refer to would be fine for a meal replacement from time to time or even daily.
Hi Dr. Mike,
I am a 42 year old female. I weigh 280 lbs. I have a hypothyroid and take 125 mcg of synthroid a day. For the last 5 weeks, I have been eating only meet. No sauces, no veggies, no salad, no nuts, nothing but meet and eggs. I drink 1 cup of coffee in the moring with heavy cream and no sweetner. I drink at least a gallon of water a day and nothing else, other than the cup of coffee. Most days, when I check my ketosis level, my levels are small or none. About a week ago, I started walking 45 minutes a day. What am I doing wrong? I have not lost anything. Why am I not loosing weight and why if I am not eating carbs at all, can I not get into ketosis and stay there?
Thanks,
Denelle
I can’t possibly understand what’s going on with you without going into a lot more detail. But if what you report is true, you need to be evaluated by a physician competent in the use of low-carb diets for the treatment of overweight. When someone goes on a strict program such as the one you report and has no success, underlying problems need to be explored.
It’s funny how you keep on repeating that ketosis is dangerous if one has type 1 diabetes. As a person with type 1 diabetes myself I feel to expel that notion. When ketosis is formed due to a LACK of insulin, i.e. forgetting to administer an insulin dose a few times in a row, that would cause Diabetic KetoAcidosis (DKA), which is indeed dangerous. However when a type 1 follows a low carb diet (think Dr. Bernstein) and will develop Ketones along the way, that is NOT at all dangerous.
I am sure you also meant the same thing, but the way it came across annoyed me.
You are correct. It is diabetic ketoacidosis that is dangerous in people with type I diabetes, not the mild to moderate levels of ketosis they may have from following a low-carb diet. Thanks for the heads up. I’ll try to be more careful in the future.
Hi,
It was interesting to read your post and the responses for the comments. It is very informative indeed.
I have a query here. I am 37 years, Type 2 Diabetic for 10 years, vegetarian eating dairy and eggs.
I was on Metformin 500 for 3 years till year 2007 and that gave me diarrhea and I lost 15 lbs. My BG levels after food was around 140-170 while taking the medication. I stopped that medication and started on Low Carb diet. Now, my BG readings after meals are 95-105.
My worry is, I am 110 lbs currently and very slender. If I am on LC diet, I will lose more weight. What can I do to increase my weight?
Thanks for the help.
If you are on a low-calorie diet and you keep your calories high, you shouldn’t lose weight.
Thanks so much for this…Everything else I’ve read has been thoroughly confusing, and you explained it quite simply while still remaining very informative.
Thanks a bunch!
Hi Dr Mike further to my last post in June. I have today reviewed my VLC diet and am going to do 2 more wks. I nearly stopped today as I am starting to feel sick of the packs but wanted to finish with the others in my group. I have spoken to my councellor today and she feels that I should then introduce the food on their route to managment programme. My thoughts as previously advised are to follow either atkins or a low gi diet. In the past when I have followed atkins I did induction would you recommend as I am already in ketosis that I keep my carb intake as low as 20 or slightly higher. I can maintain the 20 it is not a problem and considering that I have not been eating more than 500 calories a day anything is better than nothing. Obviously too I do not want to over do it even with the protein etc. Do you think I should still consider what I do start eating and would you have any recommendations. Many thanks your advise would we very much appreciated.
Hi Shelly–
I think you should start eating more than 500 calories per day. You can keep your carbs at 20-30 g per day and easily consume more calories and still lose weight. In my opinion most VLC diets fail because the people who administer them move people from the low-carb, low-calorie, high-protein fare to a low-fat, high-carb maintenance diet. I always moved my own patients onto a low-carb maintenance diet. You should discuss this possibility with your counselor or physician.
Best–
MRE
Dr. Eades,
There is some discussion in one of the low carb forums regarding conversion of ‘excess’ protein to glucose on a zero carb or very low carb diet. The assumption is that the resulting glucose production from the ‘excess’ protein raises insulin levels and thus prevents weight loss as insulin is the gatekeeper for fat loss. Along the same lines there is the question, can there be unnecessary gluconeogenesis from ‘excess protein’ in a overweight person? Metformin is given to diabetics to reduce gluconeogenesis for example. Is there any factual basis for the aforementioned?
In addition, in another post Dr. Barry Groves sent the following to a poster regarding the brain’s need for glucose:
“In the past was the belief that the brain couldn’t function properly without glucose. However, a study published in May 2003 showed that the brain can use ketones made from fats just as other normal cells do.[1] It was also shown nearly 70 years ago that ATP is delivered from the liver to the brain by red blood cells.[2] So there is absolutely no need to worry about the brain being starved of energy if we cut carbohydrates out of the diet.
References
1. Takenaka T, et al. Fatty acids as an energy source for the operation of axoplasmic transport. Brain Res 2003; 972, 1-2: 38-43.
2. Hockerts T, Hingerty D. Medizinische 1937; 289. Cited by Werner E. Mschr f Kinderheilk 1960; 1: 5.
So the question is, is he implying that the brain needs no glucose and therefore on a zero carb diet protein is not converted to glucose for the brain? This would imply one needs less protein for gluconeogenesis than one is led to believe.
No, excess protein is not turned into glucose. It’s converted only when the body needs sugar, not simply because the body has ‘too much’ protein. I really need to do a post on this because I get asked this question more than any other. I’ve probably answered it at least 20-30 other times in other comments.
There is absolutely no need for worry about the brain being starved for energy during a low- or even zero-carb diet. Ketones step up to the plate to pinch hit for a lot of the glucose and the body converts protein into glucose for the rest.
I have always accepted the value of ketosis and the importance for ketones from a diet aspect. This year, however has been an eye opener in truly definig the importance of ketosis. Ketosis actually keeps us healthier and stronger. After reading this particluar blog-entry, Dr. Mike, I have come to realize that ketosis is the starvation mode.
Also, while I am fasting, I do include fats such as the ketogenic cocktail found in the Brain Trust Program. I have the cocktail and cream in my coffee. I have increased my fats in my meals also. I want as many ketones in my body that I can possibly get. I also eat very healthy low carb meals, doc. I have been doing IF fast continuously since April of 2007, which should also help to keep me in ketosis. Any comments?
Thanks,
Mary
Ketones are considered to be a part of the starvation response, but just because you’re in ketosis doesn’t mean you’re starving. You can be in ketosis and be well fed as you are on a low-carb diet. Ketones are normal fuels used by almost all of the cells in the body. They are nothing to fear.
im diabetic and having ketones can be fatal even if u dnt have diabetes it starts to close all ur vital organs down this cud put u in a coma or u cud die and a low carb diet is dangerous as u need carbs to keep blood sugars stable
Nonsense.
Very interesting.
I’ve got a little question regarding carbs in general, however. I’m severely overweight, and I’ve recently developed an odd little system… I eat one sort of food each day of the week based on color. (Apples, red peppers, etc on Sundays, oranges and carrots, etc on Mondays…) I use only fresh vegetables and fruits, and I also eat a little bit of seeds, tofu/meat alternatives, a little bit of cheese and only the occasional whole grain product. I keep my calories around 1,000 per day, never under that though. I drink about a half-gallon of water per day, and do lots of walking. Within five days, I’ve lost an astounding eight pounds– the most weight I’ve ever lost since I was about twelve years old.
I’m wondering if this is a good system in general for weight loss, as a few people have expressed concern at the low calories and have this idea that I’m going to starve to death (ignoring the fact that I’m rarely if ever ‘hungry’). A few people even warned me against ketosis, saying it’s going to eat my muscle (?!) and that overall, such a system is unhealthy (again, ignoring the fact this is the best I’ve eaten in my entire life and haven’t had a single ice cream craving since I started it).
Thoughts?
Thank you~
Lost weight is made up of a number of things – water, muscle, organ weight, various tissues, glycogen and fat. What you want to lose when you are overweight is fat. Eating a diet that you described is fairly low in protein and typically results in some muscle loss, which is less than optimal.
Ah! I forgot to ask my main carb question:
Is there much of a difference between the sort of carbs you find in breads, pastas and the like, and the carbs you find in say… carrots, apples, and such?
Thanks again,
William
Basically carbs are carbs. It’s the other stuff in the bread, pasta and fruits and vegetables that makes the difference.
If have been pondering another consideration. When I began low carbing, it was always discussed that pregnant women should not be in ketosis because the increased ketones could harm the baby. Well, from what I have read, shouldn’t carbohydrate-restricted ketosis be the ideal state that a woman should be in while she is pregnant. The reason I am thinking this is all of my kids seemed to have had learning difficulties especially my son who was diagnosed with ADHD. Although they say that kids grow out of this, which he seems to have done, I think that he would not have had this if I had been consuming a healthy low carb diet. My oldest suffers from asthma and my youngest has had dislocated retinas in both eyes. Now having said that, I am sure that a low carb diet would not guarantee a healthier pregnancy. However, deep down inside, if I had my pregnancies to do all over again. I would not change anything that I am doing right now.
Hello and thank you for the wealth of knowledge presented here. I am doing the low-carb lifestyle, but one concern comes to mind: with respect to saturated fats and unsaturated fats, is it inconsequential which are eaten and in any quantity on the low-carb diet? Or, would it be a better idea to stick to unsaturated fats when cooking (other than the fats naturally found in meats), i.e. olive oil, vegetable oil, etc? Thanks in advance.
I’m a kind of the-more-saturated-fats-the-better kind of guy. I don’t think anyone should be using unsaturated fats for cooking. Saturated fats are heat stable. There are no carbon-carbon double bonds to break. Unsaturated fats can become oxidized in the heating process converting them from good fats to bad, dangerous fats.
Hello, I had a quick question about my first few days on the low-carb diet. I’m restricting my intake to 20 net carbs a day and approximately 1,200 calories. I run 3-4 times a week prior to the diet. During days 3 and 4, I have felt weak. My normal 5-mile run just drained me. Is that a normal response in the beginning or should I be worried? Thanks-
It’s normal to be a bit fatigued at the start while you’re body is converting from carb burning to fat burning for its energy. You may want to add a little potassium to your diet. You can get it at most health food stores. Each tab typically provides 99 mg of potassium. I put my own patients on about 500 mg of potassium when they switch to the low-carb diet.
Hi, I have started on the Low Card diet about 2 weeks ago and then I got to learn more about the cyclical ketogenic diet which required super no carb for 5-6 days and then carb up on the weekend. I am kinda in between this 2 diets….
I have bought the ketostix and tested. I am currently in mild to med ketosis. I am interested to know if there are anyway that I can boost me into deep ketosis in order to burn more fat and loose the weight quicker. Or you do not need to be in deep ketosis in order to loose weight?
And when comes the time I hit a platue and stop loosing weight? what do I do?
Mel
In my experience there is very little difference in weight loss whether in heavy ketosis or mild ketosis. The body can get rid of ketones through the breath as well as through the urine, and some people get rid of more that way than others. I’ve seen far too many people obsess over the level of ketones in their urine. If you’re following the diet properly, you should lose weight just fine irrespective of what your level of ketosis is.
Thanks for the comment. If I am not mistaken, I think taking the ketosis test before and after workout also makes a difference? Apparently, you will “use up” the ketosis during exercise and therefore those dispose in the urine are whats left of it. Is that true?
ANd I want to know if urine changes color when you are in Ketosis. Because I found that mine change to bright yellow, while I am drinking pretty of water thorought out the day.
Mel
You will use ketones during exercise. They are normal fuels. And you will dispose of the remainder in the urine and breath. As far as I know, ketones are colorless, so I don’t think they are what makes your urine more yellow. Heavy ketosis can bring about a little diuresis, which can lead to a little dehydration, making the urine more concentrated and therefor more yellow.
One of the best web sites I’ve ever found. It is amazing the amount of time you spend and information you share. I can’t thank you enough.
Very kind words, indeed. Thank you.
MRE
I agree with the previous poster. This is an incredible website. There are definitely people who actually are reading all of the comments and all of your responses and learning so much as a result. So, thank you for taking your valuable time to answer and educate the public. I so completely appreciate it and you!
Thanks very much for the vote of confidence.
Cheers–
MRE
Thank You for all the info its great I have a question regarding blood pressure i am currently taking the med hyzarr for my blood pressure when i wake up inthe morning i test for ketones and the stixs read purple approx 20 mins later after taking the med the stixs turn to trace or neg and itakes me a couple of hours to get back to ketosis does the med have a negative affect on weight loss.
I also read that you can change the color of the sticks to deep purple by increasing your dietary fat intake, does that still mean that you are burning stored fat or dietary fat or both.
That You DR
You don’t need to be in deep ketosis to lose weight. I encourage my own patients not to focus on the ketones strips and instead focus on sticking carefully to your diet. If you do that, you will lose fine whether you’re always in ketoses or not.
Hi Dr. Eades.
I feel much more energetic on the lc diet which I love but I think at times it may be crossing the line to more of a state of anxiousness that is not good. I sometimes get the racing heartbeat and that can’t relax feeling. I also have been getting insomnia quite a bit although not all that unusual for me. I have read that a low carb diet increases cortisol levels. Is this true? Could it be the increased energy from ketones is due to an increased cortisol level? Or could is it possible that insulin production reduces cortisol levels?
I am aware of the potassium need. I have taken 1-2 99 mg. a day sporadically. Is this still necessary after initial water weight loss? I have been on diet for 3 months now. BTW I wrote to you previously about a weight loss stall. I lowered my carbs, cut out dairy and peanut butter (don’t know why I was eating that) and it worked like a charm. Not sure which one did it.
Also I wonder if you would like to comment on the following excerpt I took from a site that appeared to be promoting the Zone Diet. I would have thought it was Barry Sears himself but there was no mention of him. I have read many criticisms of lc diets before, but this was a new one on me:
“However, on the Atkins diet you are almost certain to regain the weight because continual ketosis gets used to your fat cells to become “fat magnets”. In addition, the high saturated fat consumption boosts the thickness of your cell membranes so that over time your insulin receptors become less responsive resulting in an increase in insulin levels. Net result: Fat recovery is expected. Furthermore, some very nasty enduring health risks like the increased risk of heart disease due to increased lipid oxidation also occur in continued ketosis.” (…blah, blah)
Thanks.
In some people the state of ketosis induces a sort of euphoria and, often, insomnia. This state usually passes once one adapts to ketosis. No, low-carb diets don’t cause an increase cortisol. In fact, recent studies have shown just the reverse.
I don’t know uttered the statement you quoted, but whoever it was needs to bone up on some basic biochemistry and physiology. It’s total nonsense.
Hi doctor, I’m 15 yrs old and I’ve been yo-yo dieting for the past 5 months trying to find the right diet, the problem is that I’ve stoped working out about 2 weeks ago and I’ve honestly become a little lazy but been able to keep my weight just fine with the exception that my inactivity has lead me to gain a good 3-4 pounds, but that’s okay with me (before 143, now 146.5). Ketogenic diets have always really catched my interest but unfortunately my last experience with one (about 3 and a half weeks ago) wasn’t good, I restricted my carbs completely (less then 3 grams a day only coming from the small trace amounts of sugars and starches found in meats and sauces which from what I’ve heard luckily don’t really cause much of an impact on your insulin which of course supposidly means no fat stored in ketosis). One thing left to another and I guess I was bingeing and overeating on most of my meals with meats, cheese, mayo, creams, vegetable oil, and eggs. Up to day 4 I knew I had hit ketosis and was running on fat energy, but what I seemed to notice was that I gained some weight, and I’m not sure wheather it was fat or muscle or both, because my waist line was getting thick and I had a bit of a jiggly chunky fat belly (which wasn’t there before) that wasn’t too noticeable but stuck out just a bit which was enough for me to realize that something was wrong (I gained about 3.5 pounds). Then out of fear I immediately stoped the diet out of fear and went back to a 1700 caloric intake when in my ketogenic state I was eating around 3000 calories daily (I also have lost 60 pounds in the last 8 months during the time that I was exercising but I did it with a high carb, low fat diet, I don’t know if such weight loss in the past could have effected my adaption to ketosis or not). I really don’t know what could have gone wrong because from what you’ve said and from what I’ve heard also is that on a ketogenic diet no fat storage is possible if no carbs are being eatin and calories don’t matter because fat is being constantly burned or released through urine and breath, never stored.
4 Questions:
1. What could possibly be the case here? This has made me wonder if maybe ketogenic diets could have an impact in some on weight gain which at the same time sounds crazy because no carbs are present and there’s no possible way to store fat.
2. Also, what confuses me is what you wrote on one of your post early stating that even if you consume excess calories on a ketogenic diet no weight gain is possible while at the same time no significant weight loss should be expected because you’re obviously getting enough calories to meet your energy needs throughout the day and that any weight gain should be primarily more lean body/muscle mass, how does this apply to me in my earlier experience with a ketogenic diet?
3. You said early that this is false but I keep hearing it it’s true, could excess protein during a ketogenic diet cause at some point or another enough insulin impact to make your body store the excess as fat?
4. I take a chromium picolinate supplement daily (800mcg, high potency), could this positively or negatively effect me on a ketogenic diet or even on a regular moderate carb-moderate fat diet?
I couldn’t possibly begin to analyze what’s going on with you without a lot more information. But, I’ll go through your questions anyway.
1. A reality that must be grasped when dealing with anything medical is that nothing works for everyone because everyone works a little differently. Although the vast majority of people don’t or can’t gain extra fat on a no or very-low carb diet, there are probably a few who can. You may be one of them. But, after being in the biz for a lot of years and treating thousands of patients, I have trouble understanding how the diet you described could give you a “jiggly chunky fat belly” in 4 days, especially in one who is 15 years old.
2. We don’t know what your weight gain was composed of because we don’t have a body comp analysis, only your observation that your waistline seemed to be thickening. (See answer to previous question)
3. I doubt that the excess protein would cause an insulin surge. It does increase insulin, but at the same time in increases the release of glucagon, insulin’s counterregulatory hormone, which offsets the effects of insulin.
4. Studies have shown that chromium improves the sensitivity of the insulin receptor, meaning that one needs to make less insulin to keep blood sugar steady. Less insulin means less fat storage, so chromium picolinate has been used as a weight-loss supplement. It shouldn’t have a negative effect on a ketogenic or moderate carb-restricted diet.
Hope this helps.
Hi doctor, your information was very helpful and I’m so glad I came to you for help. I still have a few more questions regarding ketosis and dieting because in the last week I have gotten back into the diet after being on a diet lower in carbs for the last 3 weeks and noticed that my body is now getting well adapted after entering the first week with no carb intake at all. I was hoping you could help with the following questions as well, and thank you so much. =)
1. I’ve recently heard that chromium picolinate can damage the chromosomes in DNA and can lead to cancer in the future, and I don’t know if it is true or not, what do you think?
1. I’m sure at first to you it may seem a bit odd that a 15 year old who is now at a normal weight is doing a ketogenic diet lol. The reason is because I believe that carbs are not needed at all and should not be eaten because recent scientific studies have shown they are only harming us and making us age faster. I only eat fat and protein and soon in about a week or so I will start adding a few veggies to my meals once my body fully adapts to the state of ketosis. I’m doing this because I just want to live a healthier life and I believe this diet is the key to that life, my parents just don’t understand that and I’ve tried to make them see what I mean but they just think I’m nuts while they go off eating their high carb meals which totally bugs me out just by the site of it lol (and they can sure use a low-carb diet, believe me lol). I take a multi-vitamin along with chromium picolinate and vitamin c in the morning. Would you have any tips, suggestions, or advice you can give me while staying on this diet?
3. Has there been any recent new studies or anything on ketosis and the diet? (Just wondering)
The deal with chromium picolinate is overblown in my opinion. But, if you’re worried about it, you probably don’t need to take it. At 15 years old your insulin receptors are probably in pretty good shape.
Sounds like you’re doing well on your diet. I can’t think of anything I would add except maybe a little magnesium and some vitamin D if you don’t get a lot of sun exposure or during the winter even if you do.
Check out this journal. It’s free and keeps up with all the literature on low-carb and ketogenic dieting.
I read the above comments regarding ketosis and pregnancy with interest. I’m wondering about nursing mothers and ketosis. The only thing I’ve found on the subject is from La Leche League and it’s several years old. It basically states that since there have been no studies on the subject, it’s best to avoid ketosis while nursing, just to be safe for the baby.
Is there any evidence of which you’re aware that suggests that ketones are passed into breastmilk, and if so, do they have a detrimental effect on a nursing infant?
I’m nursing a 3.5 month old, and have been improving my diet (lots of grass-fed protein, for example), but I am hesitant to allow myself to go into ketosis. I definitely need to lose weight and would love to be stricter with my carbs. Any light you can shed would be much appreciated!
As far as I know, there aren’t any studies looking at this issue. So, I guess, I would have to go along with the recommendation to be careful. You can lose weight and keep on the cusp of ketosis so that you don’t have to worry about it. I would make sure to keep my fat and protein intake up to ensure that your production of breast milk doesn’t rob your body.
1. In ketosis, how is dietary fat AND protein not stored in the fat cells of the body even when aten in large frequent portions exceeding a person’s caloric needs? Just how is it possible? (I’ve heard many different answers to this question, what’s your say on it?)
2. Is there any vitamin/supplement that can flush you of any trace of carbs on induction to ketosis? (Knowing now that chromium picolinate increases insulin sensitivity, does that mean it helps flush carbs too? I also have seen a supplement called “Carb Erase 1000″ with white kidney beans, would that help?)
3. While in ketosis, can you lose more body fat by drinking a lot of water knowing that you’re flushing ketones out which in turn I think means that your body will switch from burning the dietary fat you’ve consumed (say you’ve aten 1 hour ago) to burning your fat reserves? Or am I mistaken? (I’m not sure lol)
Thank you… =)
1. Would an occasional sweet, say, a milkshake, do that much harm even if you’re body had fully adapted to the state of ketosis? How does the body react after it has been deprived of carbs for so long and then suddenly out of nowhere, an inbalance, like a milkshake or a piece of cake, enters the body? What happens to your body? If the person still wants to stay in ketosis how long will it take that person to reach ketosis again after the sweet (carb, any form) has been consumed? Would it effect your body in a bad way?
Thank a lot =)
And breastfeeding moms should pay attention to their Vit D because there is very little in breastmilk. In Scandinavian countries it is customary to give vit D drops to infants, but that doesn’t seem to happen as much in the US (our San Diego pediatrician assured me that Vit D deficiency wasn’t possible here, but this year I am learning otherwise, from my own testing and person after person telling me they were tested recently and their levels were too low. Many hours indoors daily, clothing, and “prudent” sunscreen use really cut the sunlight exposure and Vit D production (not to mention age reduces it), even in “mild, sunny” climates.
Carlson is one brand I know of that makes Vit D3 drops in an infant dose (also in 1000iu and 2000iU doses). I find the drops an easy way to supplement Vit D for my son, just a drop or two in his whole milk or any food (or he chews a gel-oil cap and spits out the gelatin cap). One can’t rely on the D2 added to some dairy milk products, as it isn’t the Vit D the body makes and isn’t used as effectively. The non-profit Vit D Council (www dot vitamindcouncil dot org has some good information based for children’s Vit D doses, based on research.
I concur. All kids should get vitamin D supplementation as should breastfeeding moms.
I am currently in ketosis and eating less than 4g of carbs per day (please be descriptive and detailed),
1. will excess calories from fat make me gain body fat?
2. will excess calories from protein make me gain body fat?
specifically, why or why not?
cause I love fatty foods and I was wondering if I’d gain body fat if I ate over my calorie limit, I don’t need to lose weight, I just don’t want to put any more because I’ve already lost enough weight on this diet, would an increase in calories make me put the body fat back on?
1. In ketosis, how is dietary fat AND protein not stored in the fat cells of the body even when aten in large frequent portions exceeding a person’s caloric needs? Just how is it possible? (I’ve heard many different answers to this question, what’s your say on it?)
2. Is there any vitamin/supplement that can flush you of any trace of carbs on induction to ketosis? (Knowing now that chromium picolinate increases insulin sensitivity, does that mean it helps flush carbs too? I also have seen a supplement called “Carb Erase 1000″ with white kidney beans, would that help?)
3. While in ketosis, can you lose more body fat by drinking a lot of water knowing that you’re flushing ketones out which in turn I think means that your body will switch from burning the dietary fat you’ve consumed (say you’ve aten 1 hour ago) to burning your fat reserves? Or am I mistaken? (I’m not sure lol)
Thank you… =)
why won’t u answer my question?
1. In ketosis, how is dietary fat AND protein not stored in the fat cells of the body even when aten in large frequent portions exceeding a person’s caloric needs? Just how is it possible? (I’ve heard many different answers to this question, what’s your say on it?)
2. Is there any vitamin/supplement that can flush you of any trace of carbs on induction to ketosis? (Knowing now that chromium picolinate increases insulin sensitivity, does that mean it helps flush carbs too? I also have seen a supplement called “Carb Erase 1000″ with white kidney beans, would that help?)
3. While in ketosis, can you lose more body fat by drinking a lot of water knowing that you’re flushing ketones out which in turn I think means that your body will switch from burning the dietary fat you’ve consumed (say you’ve aten 1 hour ago) to burning your fat reserves? Or am I mistaken? (I’m not sure lol)
Thank you… =)
Somehow you’ve confused this – my personal blog – with a doctor’s question and answer column. I can’t spend hours answering personal questions from everyone who writes me. I answered a list of your questions previously.
I had gastric bypass surgery (roux en y) on January 18, 2008 and tomorrow it will be nine months to the date. I started at 370 pounds and have lost 150 pounds now!! I have added some berries to my diet because of the small amounts of food (1/2 cup three times a day) have caused some problems with constipation. I also added Cheerios for breakfast three times a week (1/4 cup cereal with 1/2 cup skim milk). I had a kidney stone and gallbladder attack last month and had the gallbladder removed after the stone was passed. I saw the urologist today and was happy to find that I am still in a high level of ketosis (ketones were above 80 in my urine).
I loved your post because it was the first time ketosis has really been explained well to me. I was worried that adding in some fruits and the small amount of whole grain from cereal after eight months would get me out of ketosis. It makes sense that it couldn’t possibly increase my carb intake over 60 per day with such a small amount.
I had a few questions for you if you have some time:
1. do sugar alcohols affect ketosis or are they used because they do NOT affect this process???
2. I am still at only about 500-800 calories a day and workout for about two hours daily (yes, I’m now addicted). A nurse practitioner told me today that because I am in chronic high ketosis I will naturally be tired on a general basis. I have noticed tha twhile I feel great with the weight loss and new active lifestyle. . . my legs feel sluggish. Is this normal after being in ketosis for nine months??
3. I have noticed some orthostatic changes recently and wondered if it could have anything to do with ketosis?? Is it just drastic weight loss that does this? The good news is that before I lost weight my resting heart rate was 130. . it is now 57!!!!!
Thank you in advance for your time. I would appreciate any information you can provide.
Sounds to me like you’re doing pretty well. Sugar alcohols affect ketosis depending upon how well they are absorbed. Those that are absorbed more will tend to decrease ketosis whereas those that aren’t won’t. You’ve got to fiddle with it yourself to see. Being in chronic ketosis does not necessarily make one tired. Usually tiredness in the face of ketosis comes from a potassium deficiency. People go into ketosis because they are cutting carbs, cutting carbs reduces insulin levels, reduced insulin levels encourage the kidneys to get rid of excess fluid. As this excess fluid leaves the body it carries potassium along with it, often causing a potassium deficiency. Replacing the potassium usually solves the problem. I’m not sure of what you mean by ‘orthostatic changes’ so I can’t really tell if that’s ketosis-dependent or not.
Good morning, I was wondering what to recommend for a TII diabetic who does weight training as a sport. She has been following a low carb diet for sometime. Her trainer wants her to eat more carbohydrate for energy. Is it necessary to have carbohydrate consumption with anaerobic training? If so, when should she have the CHO, how much should she have, and is it possible to consume less than 60 gm/day and still stay in ketosis? Also, she had mentioned to me that when she eats any CHO at all her BG spikes regardless of the kind of CHO consumed, any thoughts? She refuses to take oral medications recommended by her doctor. Thanks in advance.
Tricia
No, it is not necessary to have CHO for aerobic training. Fat burns aerobically just fine. If she is training, she can probably consume 60 g of CHO per day and stay in ketosis. Many people have a problem with blood sugar spikes when they eat carbs.
I may have missed it ( I read for a long time), but can you comment on how a menstrual period affects ketosis? I was into moderate ketosis for 3 weeks, then no ketosis at all during my period.
I’m not sure because I’ve never really thought about it nor have I read anything about it, but I wouldn’t think that the menstrual cycle would have a lot to do with ketosis. Other readers may have more experience than I and are welcome to chime in.
SO let’s say I live on a very low carb diet (under 50g per day-regular basis) and all the sudden binge on carbs for a day or a week. What is the affect on the body? And would I go back into ketosis easily or would it take a while? How long?
Thanks for your informative posts and responses. This has been an answer to prayer!
I don’t want to encourage carb binging, but, yes, you can get back into ketosis easily when you get back on the program.
Thanks so much for the information. What are your thoughts on the efficacy of a ketogenic diet to combat an aggressive brain tumor (grade IV). Could it be done in addition to chemo?
Read here and here.
Hi, I would like to know :
1) can consuming wine ( a small glass a day ) put us off ketosis? I have checked that carb in a glass of red wine is only about 4-5g, but would like to know your opinion on it.
2) Does our body absorb and store carb faster after we are in ketosis, hence ppl tend to put back on the weight once we go off the diet… and sometime put on more than before.
Mel
Typically a small glass of wine shouldn’t take one out of ketosis if other carbs are kept to a minimum.
I don’t know if there is any experimental data showing whether or not carbs are absorbed more rapidly after a period of ketosis. My own hunch is that they’re not.
How does being in deep ketosis affect your blood alchohol levels? Do you absorb the alchohol faster, and does being in ketosis make your blood level higher.
Jacki
I don’t know that ketosis affects blood alcohol or not. That’s not saying it doesn’t – it’s just saying that I don’t know.
before the summer, i was 160, and without exercise and being on the zero simple carb diet, i lost 10 lbs in a month. if i had exercised during the month with the zero simple carb diet, would i have gone maybe past that 150 mark or would i have just reached it in say 2 weeks? starting today i am resuming that diet except i am starting from 170 this time, along with a good exercise routine which will be incremented daily. should i probably be able to drop 20 lbs in a month this time due to the quickness of that 10 lbs loss????
According to the data as evaluated by Gary Taubes, there is no evidence that exercise will make you lose weight any more quickly. Read about it here.
Dr. Eades,
Working backward still on your blog, and haven’t seen mention of MCT oil:
http://en.wikipedia.org/wiki/Medium_chain_triglycerides
http://www.bodybuilding.com/fun/issa23.htm
(Sorry, these aren’t great links, most of my information comes from printed sources.)
Anyway, several people commenting on this particular entry, concerned about lack of energy during workouts, might benefit from MCT oil. I use it all of the time, probably “eating” around 30 grams daily total. I especially use (10-12 grams) it before lifting weights (which I do quite intensely, not like most people lift weights), and never feel a lack of energy. It’s a relatively cheap supplemental oil if bought in a pure liquid form. Another good/healthy source is EV coconut oil, composed of ~60% MCT.
Curious if you have any thoughts/experience with MCT oil?
A recent study indicates that MCT supplementation may be beneficial to mitochondrial function, perhaps by generating less waste byproducts: PMID: 18582445
I have had some experience. MCT are absorbed directly into the bloodstream instead of going through the lymphatic circulation first as do the longer-chain fats. Consequently, MCT provide a more instant source of energy, much like carbohydrate, but without raising insulin. And MCT converts easily to ketones, which is a good thing since ketones are a great fuel.
The only problem I’ve encountered with MCT oil is that it makes many people nauseated when they take it. It doesn’t bother me, but I’ve heard that complaint from many.
i read the article, and your right. i would only have to disagree with you in accordance with the last section of the essay when it is stated
“To be sure, this is the same logic that leads to other unconventional ideas. As it turns out, it’s carbohydrates—particularly easily digestible carbohydrates and sugars—that primarily stimulate insulin secretion. “Carbohydrates is driving insulin is driving fat,” as George Cahill Jr., a retired Harvard professor of medicine and expert on insulin, recently phrased it for me. So maybe if we eat fewer carbohydrates—in particular the easily digestible simple carbohydrates and sugars—we might lose considerable fat or at least not gain any more, whether we exercise or not. This would explain the slew of recent clinical trials demonstrating that dieters who restrict carbohydrates but not calories invariably lose more weight than dieters who restrict calories but not necessarily carbohydrates. Put simply, it’s quite possible that the foods—potatoes, pasta, rice, bread, pastries, sweets, soda, and beer—that our parents always thought were fattening (back when the medical specialists treating obesity believed that exercise made us hungry) really are fattening. And so if we avoid these foods specifically, we may find our weights more in line with our desires.”
this gives some reasoning to my theory that as i am in the zero simple carb diet, along side a good, let’s say 30 minutes of running, i should be able to lose weight faster. i would agree with you if the case were that i was instead doing a regular carb intake, which by today’s standards is a horrendous illusion.
i will report my results after 2 weeks from yesterday of this experiment and see how close i have gotten to 150 lbs
I tend to agree with you on this. I think that exercise along with a good quality low-carb diet promotes the fastest weight loss. But is the desire to exercise driven by the low-carb diet? That’s the question.
Dear Dr Eades
Thanks so much for all the information you have printed here on your blog. After 4 weeks on low carb I have lost appox 10 pound, but yesterday after nearly 4 solid weeks of sleep deprivation I resumed eating normally. I just cant cope with only 2 – 4 hours of sleep (sometimes NONE!) , broken into 30-60 minute batches. Time in between anything up to three hours. My whole body seems to jerk somewhat like restress leg if i stay in bed, and i cant lay still. I tried Melatonin and Unisom but it was worse as i couldnt sleep or wake-up. My energy levels seem fine during the day, and i dont ever feel hungry.
I put up with it, but after 4 weeks it is worse rather than better. I know LC Diets can effect your sleep but why? Also i am still in Ketosis and slept very badly again last night. Any suggestions? How long before I am out of Ketosis, which i think is causing the sleep issues.
Ketosis does caused disturbed sleep in some. Try taking some herbal tea with a little sugar (yes, a little sugar – maybe a teaspoon) at bedtime. The small amount of sugar will knock you out of ketosis for a few hours and allow you to sleep yet won’t really affect the good things that are happening with your low-carb diet.
Fat the preferred form of fuel? OMG!!!!! Let’s increase our already drastically high cardiovascular/cancer disease rates. Please of all you do more reading before you believe this charlaton. All forms of fat are known to increase cancer and heart disease rates. Wanna increase your cholesterol? Do it this way. Wanna increase your acid load in your body? Do it this way. Want to further along your osteoporosis progression? Yes Yes do it this way!! This is nothing but a money making scheme. Low carb diets contribute to very poor health outcomes. After all, it’s biggest proponent died of heart disease and obesity himself. Glowing representation I’d say!!!!
Welcome aboard. Glad to have you as a reader. You may learn something, but somehow I doubt it.
incidentally, dear fake nutritionist, a person cannot gain 17 lbs of muscle within 5 weeks. Man nor woman. You’re nuts!
And, I survived for 37 years with a kidney transplant on a very low protein diet! Know many transplant patients that survive that long with NO osteopenia?
You are absolutely nuts!!!!! Go back to medical school or where ever you came from. You are a profit hound. I feel sorry for the people following your advise.
Mr. Fakee, you can’t even address my comments. We do not want to initiate questions of doubt, I understand. I think you like all this attention, as a pretend authority. It’s transparent to me, although others fail to see it. You are an expert in falsehood. Do you EVER worry about the bones and vascular systems of your poor pitiful followers?! Somehow I doubt it…….
So sorry Slow Burn hooked up with you. I shan’t be back, gratefully.
AMF
Holy cow! I wouldn’t even know how to cope with a loony like Dawna H. Ignoring is certainly the best approach. But she seems to be quite deranged, sending 3 messages within 17 minutes and waiting for a response on a moderated forum, is quite stunning.
Methinks her lack of good fats has somehow impaired her brain function. You know how those angry vegetarians are.
I have a question about how ketones get from my belly fat to my cell to be used as energy. You mention ketones are water soluble, but do they need any helper molecules to get across a cell membrane the way glucose does? If so, what helper molecule is that?
Thanks
M
I haven’t gone back to the books to check, but as I understand it, ketone bodies diffuse across cell membranes without a transporter.
By 60 grams of Carbohydrates is that the total amount of carbohydrate rich food or the carbohydrate content within? For instance would I eat 60 grams worth of Apples?
Great Stuff
60 grams is 60 grams. And as far as what happens metabolically, it doesn’t much matter where it comes from. 60 gm worth of apples would be fine. Most people like to spend their 60 gm wisely so that they get maximal nutritional density from them, but metabolically it doesn’t much matter.
Hi,
really interesting article. 1 question though:
I am currently on a diet that composes of All fats, All Proteins, and vegetables (fiberous ones, non starchy).
Do i still have to keep an eye on the vegetable carb amount( 0g net carbs) or 30g of starchy carbs is the limit?
thanks
Elmir
Depends on what you’re trying to do. But, yes, you should keep an eye on the vegetable (and fruit, if you eat it) carb. If it’s 0 g net carb, you’ve got nothing to worry about, but I don’t know any vegetables that are 0 g net carb. If you stick to under 30-40 g net carb per day you should do fine.
What do you think about a Cyclical Ketogenic Diet? The idea is to be eating nothing but Protein and Fat from Sunday through Friday at 6pm and then nothing but Protein and Carbs (and really loading the carbs) from Friday evening until Saturday night. The theory is that you will be refueling your muscles with extra glycogen(?) from the carbs so that you can get in two heavy lifting days on Sunday and Monday.
Apparently this is fairly common with bodybuilders.
Your thoughts? Does that carb-loading period matter?
I’ve been asked about this a zillion times. I really haven’t looked into it in depth, but it does seem to work for some.
HI again, I have a question about Ketone testing:
I have been testing mine each day at different times to be sure I am burning fat but I cannot find any info on what the test range means. I get it that it tells me trace, small, moderate and large but I don’t know what those ranges mean. What is happening during trace/small that is different from moderate/large? And am I burning more fat if my ketones are higher? Less when they are lower? I want to understand the meaning of the range and shoot for the proper weight loss target every time, can you please explain?
Thanks so much, and Love your books by the way!!!
Typically the amount of ketones is proportional to the amount of fat being burned. But not necessarily always. You can be making ketones like crazy and burning them and releasing some in the breath and because you have been drinking a lot of fluids your urinary ketones are slight. So, I guess the take home lesson is that the amount of ketones doesn’t tell you a whole lot unless you know what else is going on. Which is why I don’t particularly monitor ketone levels.
Dr. Eades,
If the body tends to resort to gluconeogenesis for glucose during a short-term carbohydrate deficit, are those who inconsistently reduce carb intake only messing things up by not effecting full blown ketosis? If the body will still prefer glucose as main energy source unless forced otherwise for at least a few days, is it absolutely necessary to completely transform metabolism for minimal muscle loss?
Also, if alcohol is broken down into ketones and acetaldehyde, technically couldn’t you continue to drink during your diet or would the resulting gluconeogenesis inhibition from alcohol lead to blood glucose problems on top of the ketotic metabolism? Would your liver ever just be overwhelmed by all that action? I’m still in high school so hypothetical, of course haha…
Sorry, lots of questions but I’m always so curious. Thank you so much for taking the time to inform the public. You’re my hero!
P.S. Random question…what’s the difference between beta and gamma hydroxybutyric acids? It’s crazy how simple orientation can be the difference between a ketone and date rape drug…biochem is so cool!
P.P.S. You should definitely post the details of that inner mitochondrial membrane transport. I’m curious how much energy expenditure we’re talkin there..
Keep doin your thing!
Your Fan,
Trey
No, I don’t think people are messing up if they don’t get into full-blown ketosis. For short term low-carb dieting, the body turns to glycogen. Gluconeogenesis kicks in fairly quickly, though, and uses dietary protein – assuming there is plenty – before turning to muscle tissue for glucose substrate. And you have the Cori cycle kicking in and all sorts of things to spare muscle, so I wouldn’t worry about it. And you can continue to drink while low-carbing.
A simple orientation can indeed work wondrous changes in how a substance affects us. Even a mirror image of the same substance (an optical isomer) makes a night and day difference in how the body handles (or even if the body handles) a particular molecule.
I’ll get to the inner mitochondrial membrane in due course.
Thanks for such a prompt and dilligent response.
Upon further thought, I found myself with a few more questions I was hoping to get answered before I pursue a ketogenic diet.
I realize you’re a busy M.D. so feel free to ignore or simply answer yes/no to any questions.
1. If I am consuming lots of protein to maximize weight lifting and that protein is converted to glucose with 58% efficiency, am I counteracting my objective of ketosis, or is my body just going back to ketosis as soon as that glucose is used up?
2. Is it possible to avoid gluconeogenesis to prevent your body from breaking down hard earned muscle mass in the absence of sufficient dietary protein since it doesn’t differentiate between the two? If not, what’s the minumum protein/weight ratio to restrict calories but keep muscle?
3. Post-workout whey? Best to get a zero carb shake or would a 13g carb>>5g sugar work?
4. How would a p.m. protein shake (e.g. casein) play into a ketogenic diet?
5. Can high-intensity cardio on an empty stomach help induce ketosis? (just personal theory)
6. Because of the resulting low insulin in such dieting, is one sacrificing the anabolic potential of insulin?
7. Is there any risk of ketoacidosis in non-diabetics?
8. Can cheeses and milks be tolerated in a ketogenic diet or should they be cut out?
9. How long does glycogen hang around before being finally stored long-term as fat?
10. If I mess up on carbs on a snack have i blown everything for a few days? I’m not sure I understand the timeline of transition between metabolic pathways. (I know you’ve said that only a little sugar will end ketosis)
Broad sceme, I’m simply trying to cut weight quickly over 90 days without sacrificing too much muscle mass. I realize that in moderation my typical ‘carb down’ cycle will work over time, but I’m always interested by the sucess of others.
Thanks so much for your devotion to teaching and tolerance of ignorant people like me.
-TC
I have a question related to ketosis in the morning. I have been on a low carb diet for approx. 2 weeks. I measure the ketones in my urine (using Ketostix). and at the end of each 8 hr workday I am measuring either a moderate or high level of ketones in my urine. However, when I measure the ketones first thing in the morning I have no ketones (as measured by the Ketostix) in my urine. Does this mean I am not using ketones for energy as I sleep?
No, it means you are using ketones. That’s why you don’t see them in your urine. You are burning fat during your sleep and using it as you need it. During the day, you are eating fat as well as burning it, giving you the extra ketones that you see then.
I’ve just started a Low-Carb Diet and i’m in my third day and i am shocked that i’m already in Ketosis !! I havnt followed a strict plan like Atkins … , i’ve just stopped eating Bread, Pasta etc . I have not been counting my daily Carb, but i’m sure i’m below 60g. I’ve been eating loads of salted peanuts, tinned hotdogs, low sugar ketchup and salad cream over the last three days and my ketostix are saying i’m in Ketosis. I’m i just lucky or will i get a shock ?
Thank you in Advance !!!
You’re consuming a lot of fat, and since you aren’t eating many carbs, your insulin is low. Which means you will have trouble storing that fat in the fat cells. If you can’t store it, you can do only two other things with it: burn it or turn it to ketones. I’m sure you’re doing both. Your degree of ketosis should subside over time as your body adapts.
Wonderful, informative post! It’s amazing that you found the time to answer most of these comments (and, yes, I read them all).
Keep up the great work!
Diana
Hi Doc, Am on a VLCD and i dont check my Ketones level at all with the Ketostix to avoid being discouraged. However I know am in ketosis ‘cos am losing weight 3-6lb a week… however I want to know the implications of coming out of ketosis and how long it will take to get back on it..
Thanks.
There are no implications to coming out of ketosis – people do it all the time, every day. How long to get back in? Depends on how rigorously you follow a low-carb diet. If you do it right, you should be in ketosis within a few hours.
Regarding the early stages of LC when you get into ketosis and lose a lot of fluids — the last time I did LC (yes, I fell off the wagon; very happy to be back on) I had terrible calf & shin cramps. Shin cramps were a new & amazingly painful experience.
This time I’m taking three 99mg potassium caps a day. As long as I don’t have leg cramps or dizziness I guess that’s an OK amount but should it possibly be higher during the first few weeks until I get ‘used to’ the different fuel? At what dosage is it dangerous?
Thanks –
I put my own patients on a daily prescription form of potassium that is equivalent to 5 of the 99 mg OTC supplements.
Wow. I am so thankful that this thread has been continued for so long. I’m sure you’ve heard of carb cycling. My trainer/physician recommended this. Well, I gave it a shot, despite feeling pretty good about the size of my body while on low carb. I was looking “skinny” but was upset because my muscles looked flat and I looked kinda sick. Well, I could only stuff down around 60 carbs within the day, but it’s been a week since I’ve done this, and I’m having serious problems with constipation. Why does everyone else gets results from more fiber except me? It just backs me up even more (I took both soluble and insolible, plus I have flaxseeds with my salad). You see, I feel my bodyfat % has still been going down, my my WHOLE body seems to be holding in the toxins, and looks puffy (especially my midsection, although my waist is still 26″ – only 1/2 inch widder than normal).
So, is there any way to speed up my transit time? I feel my body looked best when adding a little oatmeal post-workout, but I enjoyed my two weeks of feeling “thin” during ketosis. Come to think of it, I don’t think I was even going #2 that much before the carb-up, but I just know that if I had a couple of good BMs, my body would look 10X leaner. Perhaps I should lemon – fast for a day or two? This used to make me feel better.
I must have Googled my situation 100 times, and even my trainer told me to eat more carbs on the carb up – like 500! I refuse to blow up like a balloon again. Your advice will be sincerely appreciated.
I’ve always found that fat increases regularity better than fiber, and, unlike fiber, fat doesn’t damage your GI tract. If you are eating low-carb, try some really fatty cuts of meat, and I think you will see a difference.
I’m quite impressed with your understanding of the metabolic issues involved in a low carb diet.
I would appreciate it if you could weigh in on two commonly debated issues:
1) Fasted cardio. Given the plethora of well-educated opinions on both sides of the coin, my “broscience” guess is that fasted cardio (medium instensity…for example, just below the point of increased breathing) is slightly more beneficial to people on ketogenic diets due to our bodies being less likely to break down protein. The debate is rarely framed in terms of people on ketogenic diets, so I’m curious to hear your opinion.
2) PWO Dextrose. My limited understanding suggests that by adding 15g of dextrose in your post workout whey shake, two things of benefit happen: 1) The rapidly absorbed protein is spared for rebuilding rather than consumed in gluconeogenesis and 2) The dextrose, which (apparently) doesn’t need to be processed by the liver in order to be stored by muscles, is thus more readily stored as glycogen in the muscles rather than in the liver, thus providing glycogen for your next lifting session that doesn’t interfere with ketosis in the interim.
That all seems to make sense to me, but I would love to hear your opinion and clarifications.
Thanks!
I’m not sure that people on ketogenic diets are less likely to break down protein. I would assume they are a little more likely to break it down to provide the substrate for glucose via gluconeogenesis.
If you add the dextrose to a post workout shake it should spare some muscle tissue and allow the protein to be used for anabolic purposes. Dextrose is glucose, so the body handles it as it does glucose.
Dr Mike,
Thanks for this post. However did you had a chance to check this link on ketosis
http://patrifriedman.com/writing/journal/expat/975ketosis.html#message
This one lists the benefits of Ketosis and also bad things about Ketosis. It specifically lists that prolonged ketosis is dangerous for kidneys. Is that so? Please enlighten.
Thanks
Venkat
I don’t believe long term ketosis is bad for the kidneys. People who are in long term ketosis tend to adapt to it, and ketone levels actually drop somewhat. Don’t worry about it.
Dr Mike,
I am not the first to say it, but what a wonderfull site. I have learned a lot. 2 questions though.
1. Will the ‘futile biochemical processes’ influence thermogenesis (produce more heat)?
2. I read that vitamine C helps in losing weight. Is that nonsenses or can it influence the biochemical processes needed for fatburning?
Kind regards.
1. Yes, futile cycling will increase heat loss. Futile cycling is how we maintain our body temperature as it is.
2. I’ve never found vitamin C effective as a weight loss supplement. I think the idea that it does to any measurable degree is hype.
Dr Eades,
Thanks for the swift reply. This inspires me to ask another one. This time it’s about coffee. I read different things and I am aware a lot of it may be BS. Main points:
- cafeïne enhances insulin resistence
- digesting coffee induces insulin release.
I know coffee is more than just caffeïne. Should I stop drinking it when trying to lose weight?
Kind regards (from holland)
I’m a big believer in the virtues of coffee. Enter coffee into the search function of this blog and you’ll find a number of posts on it.
Dr. Mike
Can ketones cause you to become intoxicated. Does it cause high breathalizer results. What type of doctor do i need to go to for a checkup to see my ketone levels in my blood.
Here’s a post you may find of interest. Any doctor can check your ketone levels, but it’s pretty pointless because they change moment by moment. You can buy ketostix at the drugstore and check urine ketones yourself.
Dear Dr Eades,
You said that the low carb program is not rocket science but basic biochemistry, obvious to anybody that went through class 1 in med school. And I believe you. But it gets confusing when other MD’s give radically different advise. It concerns dr Gabe Mirkin. He states:
“Meat contains a molecule called Neu5Gc that humans do not have, so the immune system of humans attacks this protein as if it was an invading germ and eventually attacks the host itself to destroy the blood vessels and increase risk for heart attacks and strokes.”
See : http://www.drmirkin.com/public/ezine110908.html
To be blunt : is Dr Mirkin MD a moron?
Kind regards.
I don’t know that he’s a moron, but he’s certainly not a critical reader nor (probably) a critical thinker. He states that he gave up eating meat a few years back, so now, I’m sure, he’s ready to jump on any theory that confirms his bias without giving it much thought. Plus, he gives the wrong citations for one of the scientific articles he cites, which gives him a major black mark in my book.
If Neu5Gc is present in ALL mammal tissue other than human, why is it only red meat that causes the problem? Why not chicken or fish or whatever? It turns out that the problem occurs – if it occurs at all, which is speculative at this point – when Neu5Gc is consumed along with a toxic form of E.Coli. Since E. coli often contaminates meat, this could conceivably cause a problem. But E. coli contamination typically happens only with ground beef that’s undercooked. Searing steaks or other cuts of beef destroy any E. coli that happen to be on the surface (the only place E. coli can be on anything other than ground beef), so even if Neu5Gc were problematic – which I seriously doub’t – it wouldn’t be an issue with steak or any meat that is cooked.
I think my question is already answered :
“Dr. Ajit Varki and colleagues, reporting in the Proceedings of the
National Academy of Sciences, say it is too soon to make any recommendations
based on their findings.”
This is the research Dr Mirkin (and thousands of other useless sites) refers to. He is jumping to conclusions! Apparently we are under continuous attack from vegetarian fundamentalists.
I’m having steak tonight!
Cheers, André
Dr Eades,
Just a thought:
I found this article.
http://www.eurekalert.org/pub_releases/2006-04/foas-vcd040306.php
You should be able to verify the mechanism : carnitine is needed for fatloss (to make fat available for burning). Vitamin C is needed to produce carnitine. Hence, low vitamin C levels means no fatloss.
A lot of people may have not enough vitamin C. Smoking is one problem, but a small cold will wipe out all your vitamin C if you stick to RDA levels. Could this be an explanation for people sometimes not being able to lose weight? I think so (but I am an ascorbate junkie
)
It’s true that ascorbate is need to produce carnitine, but you can get plenty of carnitine from meat, especially wild game. Remember CARNItine, from meat.
Thanks so much for your time and effort. I’m deeply impressed by your knowledge and continuous efforts to educate us/me.
Cheers,
André
Dear Dr. Eades.
re CARNITINE I remember this.
When I was a child my mother, worried about my thinness, used to drag me to a doctor.
He game me this product:
http://www.medicinelab.net/farmaci/co-carnetina-b12.htm
It seems it contains CARNITINE, COBABAMIDE and Vit. B12.
Taking this made me put up some weight in a very short time and my mother was finally very happy… till the next period of thinness, obviously.
I’ve always read CARNITINE to be needed for fatloss, but I didn’t know it’s useful for weight gain too.
Could you explain the way in which these three ingredients together provoke a rapid weight gain?
Thanks in advance.
Marco
The product you are referring to is basically vitamin B12. If you gained weight on it, then you were vitamin B12 deficient before you took it.
Currently, my goal is to get in better shape, tone up and lose some fat flab that has accumulated over the past 8 years. Each time I try to return to eating low carb anymore (eating 30-40 grams of carbs each day), I encouter uncomfortable symptons including: slow mental function; red, watery eyes; and lower blood pressure. When I try to get back into eating low-carb, I usually last a week into it and have trouble continuing on . Why does this happen? Maybe I’m not eating enough protein. (Back when I had my friend completed my measurements to determine my minimum protein needs, my figure was 57 grams/day. So I try to consume between 60 and 70 gram of protein per day. Maybe this is not enough protein to fuel gluconeogenesis? Also, I consume two to three 99mg potassium supplements per day.
As an aside, do you recommend a low-carb eating lifestyle for one who was born with congenital heart issues? You mentioned earlier that ketones are the preferred fuel of the heart muscle.
Thanks in advance for your response! I greatly appreciate any input you may have.
I suspect that you are not getting enough protein to both meet your protein needs for tissue repair AND for gluconeogenesis. Try adding more protein to see what happens. And make sure you are taking a potassium supplement.
Ketones are the preferred fuel of the heart muscle and a ketogenic diet would probably be good for one with a congenital heart problem, but I couldn’t recommend it without knowing a lot more.
Hello, Doctor!
Thank you for a wonderful article. I’ve done a lot of reading on ketosis, but your explanation is the most accessible – thank you.
I have three questions:
What is the proper carb to protein (to fat) ratio? Should I just, in general, look to keep carb intake below 40 grams daily, or can I eat more carbs if I eat more protein?
Am I looking forward to an avoidance of carbs…forever? What happens if you’re on a LC-based diet and eat a fruit salad washed down with a soda and a chocolate donut as dessert? I have a tremendous addiction to bananas and orange juice – two big no-nos on an LC. Do I have to kiss those good bye?
Finally, I am experiencing pain in my back (kidney area). Us this because I am not getting enough water?
Again, thank you,
~Ocean
There is no proper protein to fat ratio. If you’re on a LC-based diet and consume a bunch of carbs, you at least temporarily lose the metabolic advantage a low-carb diet provides. I have no idea why you are experiencing back pain. You should get it checked out.
Dr. Mike,
One more quick question: in my never-ending quest for true nutritional health, I came across another doctor’s website….only, his info is directly opposite yours. Both of you genuinely believe you’re giving readers the correct information and neither of you would intentionally want to give thousands of people erroneous (or harmful). How do I know who to believe?
Dr. Snyder’s site can be found at http://www.snyderhealth.com/foodash.htm. I was particularly struck by his lists “Foods You Can Eat Freely” vs. “Foods You Should Never Eat!”
I eagerly await your thoughtful response!
Thank you,
~Rev. O
My thoughtful response is that you’ve got to make a choice based on the evidence available to you as to which dietary regimen you wish to follow. Were I you, I would give each diet a few weeks to see which one works best.
Dear Dr Mike,
Yet another question. As I understand it, glucose stored in muscles is not available for maintaining bloodsugar levels- it can only be burned in the muscle. Only glucose in the liver can do that.
I also understand that muscle can hold roughly 350 grams of carbs and the liver 100 grams.
No here is my point; when I have been in ketosis for a while and I have been working out 2 or 3 times, my muscles should have depleted all glucose reserves. Now if I have a party, eating all those nice – high carb- things, the first 300 grams of glucose must surely go to muscle tissue (assuming there is no fructose in the carbs). So even when I eat up to 400 grams of carbs, I will stay in ketosis except for a brief period when insulin has to put all the glucose in my muscles. And if I keep my total calorie intake below 2000 I would still be losing weight.
Would this reasoning be correct?
Kind regards,
André
You may be losing weight, but you won’t be in ketosis. When you eat the carbs, blood sugar rises. When blood sugar rises, ketosis shuts down.
HELP HELP! Insulin resistance?? Last year i started a diet unknowingly it became a low carb diet. I used to weigh 500 pounds. I was 31 when i started 8-2007 my diet im now 33, and 1.5 years into my diet. As you can imagine i used to eat a high carb high fat, high everything diet. Anyways it was taking its toll and from one day to next i started. I slowly went into this low carb diet unknowingly. After a couple weeks i was completely on vegetables and meats only, poultry, no suagrs or fruits. I was feeling great. In the first 3-4 months i lost almost 100 pounds. At this point i started adding fiber one bars and kaishi bars which contain probably the same amount of carbs i was eating for the entire day. I started getting hypoglycemic reactions, heart palpitations headaches, but they went away as soon as i got back on my strict diet. Anyways by 3-2008 i haded back 4oz milk and 4oz oj, a bit of fruits like 1 big fruit per day. By end 4-2008 i was down to 350 pounds. I was happy. I said to my self i taught myself ow to et i can eat normal again. If i want pancakes, anything i know its moderation. Low and behold i started getting hypoglycemic reactions rapid falls of my sugar level, which has lead to adrenaline reposnes to those rapid sugar drops. Im going from Dr to Dr and they says its just anxiety, stress etc. BUt im confused and cant seem to go back to my low carb diet. I think i came out of my low carb diet to fast. I need help and advice. Any help will be greatful. please email me at willyq12@pibschool.com or call me 626-255-5218
For medico-legal reasons, I can’t give medical advice over the internet or over the phone to people I haven’t seen as patients. I don’t know that you came out of your low-carb diet too fast, I think your problem is that you came out of it at all. Why don’t you go back on it and see what happens? It worked to get you where you are weight-wise, why wouldn’t it continue to work?
Hi there. Your explanation is very clear. I have some questions though:
1. How many lbs do people lose in a week, average?
2. Actually how many lbs we can lose in a month (healthily)
3. How can I test ketone other than strip test? nobody sells that product in my country..
Thanks a lot!
Average weight loss depends upon the starting weight. Larger people are going to lose more than smaller people. In our practice, men lost an average of between 3-5 pounds per week, women 2-4. Again, how much you can lose safely depends upon starting size. I would say on average that 15-20 pounds per month is find.
I don’t know where you can find ketosticks other than maybe online.
I love this blog and this was a great post. I read all the comments & answers too – thank you for taking the time to post all this wonderful information.
BTW, for those who have trouble sleeping at night, I have had success with ZMA (zinc/magnesium supplement). Sleep like a baby.
Keep up the great work!
-Michelle
Great information. I am recently diagnosed with type 2 diabetes. I began a low carb diet and added some exercise, lost 38 lbs in 3 months, feel absolutely terrific but am recently experiencing some gastrointestinal distress and gastropareses. I think it’s from the animal protein and concentrated fat contained in animal tissue ? The Metformin, low carb diet and exercise have reduced my blood sugar levels to average 100 – 115 from nearly 360. Who knew ? Just wondering how long is it safe to eat a low carb diet. Read “Dr. Bernsteins Diabetic Solution” which highly promotes low carb dieting but he makes no mention of it being dangerous in any way.
Susana,
Metformin delays stomach contents emptying and can create GI distress. The ER (extended release) is less likely to cause GI problems, or at least reduce them.
I also highly recommend you read Jenny Ruhl’s websites. You can learn a lot more about oral diabetes drugs there. Her blog is Diabetes Update and her information website, Blood Sugar 101 (formerly titled What They Don’t Tell You About Diabetes) are priceless. You’ll easily find these sites with google. Jenny has also self-published a very good book, Blood Sugar 101, in response to requests for a non-online version of the Blood Sugar 101 website. The content is mostly the same, though of course, the website is easier to update regularly. Jenny scours the research literature and is more up on diabetes than most endocrinologists, I’ll wager.
You are on the right track by restricting carbs to manage diabetes, IMO. Bernstein’s book and methods are excellent, not just for diabetics, either. I am not diabetic, but I have Impaired Glucose Tolerance and history of gestational diabetes, but I have used carb restriction (with an emphasis on Real Food, not low carb fake foods, and a paleo/stone age oriented diet – minimizing neolithic foods like grains, especially wheat, corn, and beans) for more than 5 years to lose the 20 pounds I gained after I bought a bread machine! , then to maintain my weight and manage my BG. I avoid soy, especially. By keeping my BG steady and in normal range with a low sugar/low starch diet, I hope to avoid progressing to diabetes altogether, or at the very least, delay it. I already seem to have some loss of insulin production (little to no first phase insulin response) so I’m very protective of my beta cells and don’t want to kill off any more with high blood glucose spikes from dietary indiscretions (otherwise known as “treats” by some people).
This isn’t an unsafe way to eat. The Drs. Eades are onto to something. I’ve done a lot of reading up on human diets, biochemistry, and physiology in recent years (I’m an information junkie) and I’m quite convinced of this (though I always try to stay open to information which challenges my beliefs). But the more I learn, the more the pieces fall into place. Protein Power way of eating is much closer to the way humans ate until about 10,000 years ago, when agriculture changed diets dramatically. IMO, dietary changes in the past century towards increasingly industrial foods, especially cheap industrially processed grains and refined vegetable oils, are very detrimental to human health. I had to follow a carb-restricted diet 10 years ago when I was pregnant (gestational diabetes) so if it’s great for making a healthy baby…I have a hard time thinking it can’t be good for all humans.
And I now feed my family this way, too – very little or no grain, little concentrated sugars, and no refined vegetable oils. I try to source most of our food directly from the source instead of a supermarket. We eat a LOT of natural fat (not industrial refined veg oil). My husband is better for it (he lost the weight he gained when I was baking bread and pizza a lot) and my son is thriving and growing well. My son has a bit more access to carbs than we do, but not nearly as much as his peers eat. I see no downsides to a lower carb diet for him, too, only upsides. He has no cavities (despite abysmal brushing habits), he’s very active yet isn’t hyperactive, his weight is just right (not too thin nor too much), and overall he’s a happy well-adjusted, healthy kid with a relatively adventurous palate. We hardly ever get sick and when we do it’s mild and gone quickly. So if my family’s experience is any guide, I think this is a much better way to eat long term than the SAD (Standard American Diet). Just my two cents…
Good luck to you.
Dr. Eades,
Some of the food that I am eating contain very small amounts of sugar (i.e.whey protein powder, ranch salad dressing, etc) usually 1 gram or less. Is sugar strictly prohibited in the intervention phase of the diet? I have read Protein Power and have not been able to find an answer to this question.
Also, will whey protein powder mixed with water raise insulin levels?
Thanks for you help. By the way, I loved your book. Read it from cover to cover in one day.
Glad you enjoyed the book. The small amounts of sugar in the foods you listed probably don’t cause much of a problem. Yes, whey protein powder mixed with water will run your insulin up a little, but it doesn’t matter because it runs glucagon up as well. Glucagon is insulin’s counter regulatory hormone.
Dr. Eades,
I have recently (as of this week) embarked on a high protein, relatively no carb diet to achieve significant weight loss. I am eating 3 high protein meals per day (staying with fish, chicken, eggs and vegetables), with 1 Atkins protein shake while drinking Metamucil 3 times daily to curb my appetite. I am planning to stick with it for 2 – 3 weeks, depending on my progress. I’m doing research now to investigate what possible risks, if any, I incur with this diet. This is how I discovered your site, which has been the most informative in my last 3 hours of reasearch.
For the past three years, I have been challenged with losing weight. I love working out – working out 5 days per week, 2 hours most days, and 4 hours one day (I will continue my work out while on the diet). Eating has always been a challenge for me as I often “forget” to eat, and end up eating one huge meal a day. I work almost incessently and I often lose myself in my work until a very angry stomach reminds me that I have to eat. I also have a sweet tooth, and sometimes turn to cakes or sweet breads first on days that I’ve waited too long to eat and find myself starving. When I was younger, I could eat whatever I wanted as long as I worked out. Now at 31, I find working out alone is no longer helping.
I have a lot of muscle mass – at 5′3″, 180 lbs, I wear a size 8 dress – 31″ waist, 43″ hips, 37″ bust. To get back to what is my ideal body – a size 6 dress, 27″ waist, 40″ hips, I estimate I must lose 20 – 25 lbs (I weighed 154 lbs four years ago with these same measurements and was my ideal size 6).
I discovered recently that my continuous level of high stress may be the culprit to my inability to lose weight – it was four years ago that I started my own company. I am now on a stress management program, and have incorporated this high protein diet to help me “jump start” my weight loss. I do plan to re-introduce low carbs into my diet at the end of the 3 weeks, eating foods low on the glycemic index chart – I’ve discovered that foods high on the chart tend to make my thinking fuzzy and unfocused after eating them.
Anyway, I tell you all of this to give you a picture of where I am. I have no medical issues, and no history of medical issues in my family. So having said all of this, are there any risks I should be aware of with this diet? How long can I eat a high protein diet balanced with Metamucil before it becomes necessary for me to reintroduce carbs (in the form of fruits and brown rice) back into my diet? What side effects should I be cognizant of?
Thank you in advance for your counsel.
Lilian
I’ve taken care of thousands of patients on the kind of diet you describe. There are no risks that I know of if you are healthy going in. Many people – myself included – stay on this kind of diet for life.
I just read this entire thing in one sitting!! Couldn’t stop! Thank you for your very informative work and lucid explanations.
RE: Protein Power and Congenital Heart Defects
Hi Dr. Eades,
Would you recommend a ketogenic diet like Protein Power for one who was born with subaortic stenosis and coarctation (narrowing) of the aorta?
Thanks!
Sigh. I would have to know a whole lot more to make any kind of specific recommendation. Plus medico-legal considerations prevent me from making specific medical/nutritional recommendations online to patients who aren’t under my care.
Hi Dr. Eades,
I recently bought some “sugar-free” hard candy. The label says it has 15gm carbohydrate per serving (15gm of sugar alcohols), but notes that “for those watching their carbs, count zero grams, as sugar alcohols have minimal impact on blood sugar.”
If I am on a serious low-carb diet, can I really ignore the carb content in these candies and eat them without spoiling my hard-won fat-burning metabolism?
Thanks!
Depends on the sugar alcohol – some are worse than others. Most studies show that about half the sugar alcohols are absorbed or, at least, have a carb-like effect. Most act differently on different people. Try a few and see what happens, but don’t overdo it or you will pay with mega GI distress. For my money, erythritol seems to work the best, followed by xylitol.
Layperson here, new to this: is it correct to say that any time a person loses weight by losing fat, that they’ve been in ketosis? Or is fat more commonly burned by the body for fuel in other ways? Thanks. I’m learning a lot from your posts.
It can be lost either way. People can lose weight on high-carb, low-calorie diets, and they’re almost never in ketosis.
Do de tox diets like the mastercleanse , lemon juice/maple syrop, provide enough carbs to keep one out of dietary ketosis? if so, is this a good thing? Isnt ketosis necesary to metabolize fat and de tox the system?
(very informative blog! Thanks!)
George
Anything with maple syrup in it is going to halt ketosis. I don’t know what’s in the other de tox diets, so I can’t comment on them.
Fat can metabolize while in or out of the state of ketosis.
how does ketones affect the body’s metabolism?
I guess I don’t understand this question in view of the post you just read.
Hey, i don’t know if youve already answered this, but i need it answered so ill ask it either way. im a high school sophmore, and ive always been been skinny (sometimes unhealthly so) but this school year ive been skipping breakfast most mornings (i have an early workstudy) and school only has lunch 3/5 days a week and i almost never remember to pack lunch (ill blame the adhd). And on top of that its lead to a sort of binge-eating on the weekends. i know its not healthy, my moms an ER nurse and she just lectured me telling me my diet’s whats been making me so cranky, since the ketones are acids and i havent been doing it intentionally so im not taking any vitamins to make up for the ones lost in ketosis. what i want to know is what i can do to fix it.
im always tired, sometimes dizzy when i start to move suddenly, and im so cranky so often that my dads starting to hate me. also i dont knok if its related, but ive always had a great complexion, but its recently started to get bad. im perpetually stressed, have NO atention span (even for me), and my grades are down the toilet.
please tell me what i can do to fix what ive done to myself!
I’m sorry, but due to medico-legal reasons, I can’t give individual medical advice over the internet.
Dear Dr Eades,
I am currently doing a 7 day detox cleanse in Thailand. I am not eating anything for 7 days. The only thing I am ingesting is about 1 cup of watermelon juice, young coconut water, and 2 bowls of vegetable broth. Currently its day 4 for me, I may be in ketosis, and I know my muscle protein is being used right now. I figure 7 days is not going to impact me too much, and once I get off my fast I can try to introduce veggies / protein / fat to send the rest of my diet into LC.
My question is that while I may be hitting more than 50 cals of carbs currently with the juice, I am also using a lot of energy to do yoga in the mornings, swimming, sight seeing, etc. So if a person goes slightly above the 50 cal threshold but is rather active can they still hit ketosis or its basically a certain number of cals the body registers and remains out of ketosis?
Depending on the above answer, would it make sense to eat the carbs I am going to eat right before or right after an activity to ensure its used as dietery fuel instead of stored as fat?
I am doing this fast with my mother, and since starting I have been reading a lot about it and somehow ended up on your website. Your information is amazing and very informative. Its so hard to find good, unbiased information with data to back it up. Thanks for the service!
If you are more active, then you can get by with a few more carbs.
Dr Mike,
This diet is almost the exact opposite of what I always believed was the ideal diet!! ie: vegan mostly raw food. Though Ive never really done it fully, Ive felt a bit guilty over the years that I couldnt! Now after fasting for 6 days to clean out my system, I came across your blog and feel like my dietary world has been turned upside down!!!
One similarity however, consistent with my former beliefs is the refined sugar thing… As a hippie in the 70s I got into natural foods, organic, back to the land and all that..(I was involved in starting the first natural foods store and restaurant in Toronto) Anyway, white sugar was the biggest ’sin’ if you will, back then, and in that I think we we right (meaning most all forms of sugar really)
So, after my fast and getting my system ‘up and running’ I am experimenting with the low carb idea. One question I have, which I think has mostly been answered is, how will this affect my BPH? Lots of health folks, doctors etc say saturated fat is totally bad for this!! I dont know if I believe it anymore after reading what you and others say about it all…I have been on Flomax (tamsulosin) for 5 years or so and hope to get off it someday…
Thanks for such an informative, well researched and honest blog!!!
George
If anything, it should make your BPH better. Don’t worry about the saturated fat.
Hi Dr eades,
Great site and fantastic advice, easy to understand from a laymans point of view.
Thanks very much
clint
Dr. Eades, I use this particular blog to support my low carb/IF lifestyle. It is my Ad ha moment. I think that it sums it all up in a nutshell. It would be nice if I could get a tee shirt with this picture on it. I will use it when I run in an upcoming 5K run.
What picture?
Dr. Eades,
I like to use the Ketostix to test my urine and see if I am in ketosis. You answered a question for me awhile ago about whether or not it was an all or nothing situation, and that you either are or are not in ketosis. It still seems like the darker the test strip the better, but mine are not turning very dark like they did when I was on Atkins a few years ago. I bought a fairly large container of them then which I still use but the exp date is in 2005. Would that make them less effective?
I don’t really know anything about the shelf life of ketostix, so I can’t help you on that one. But people who are in ketosis for a while as a result of following a low-carb diet seem to adapt, and end up in lower levels of ketosis as time goes on.
Hello Dr Eades
I was wondering whether you have looked into the possible role of NEAT (Non-Exercise Activity) in regulating excessive levels of free fatty acids (induced for instance by overeating fat)? Studies like [url=http://cat.inist.fr/?aModele=afficheN&cpsidt=1693048]this one[/url] have shown a great individual variation in their tendency to stave off fat gain through such spontaneous activity.
I had a thought about such variations in NEAT possibly being linked to insulin sensitivity and how much your levels of free fatty acids decrease as a result of insulin release when overfeeding, but haven’t found any research studying such a possible link.
Any thoughts?
/Colldén
I’ve read most of the papers on NEAT and do believe it burns calories. The problem, though, is that it is an almost unconscious behavior, so I don’t see any way to harness it to help drive weight loss. I’m sure that those who eat a lot of low-carb calories increase their NEAT to get rid of those not needed for normal living.
Dear Dr. Eades,
I am 50 years old women who has been overweight for a while now. I have followed your diet exactly, for 10 weeks but I cannot get into ketosis (as per strips), nor am I loosing much weight. I am not eating many calories either and I am not cheating. I exercise regularily and am strong (weights and biking). I am metabolically healthy (as per blood tests) but have high leptin and low cortisol. My doctor thinks that I probably lack enzymes to metabolize fat.
I have tried Atkins before, also no results. I have lost weight only once in my entire life, that was when I was exericising about 4-5hrs a day and eating LC diet with 1000 Kcal per day, not something I can repeat now (I was astudent at that time and had different schedule and energy level).
I carry all my weight in my belly, my sister (who has been an athlete all her life and my mother also have the same body composition and problem, and we all gained weight after pregnancies, all of was had them late in life, in my case after 38).
Any suggestions as to what to do and what could be the problem ??
Kind regards, Ellie
The idea that you lack the enzymes to metabolize fat is a strange one. I don’t think that is your problem, but without knowing a whole lot more, I can’t really make a recommendation. Plus, for medico-legal reasons, I can’t provide individual nutritional counseling via the internet.
You said:
“biochemistry textbook authors call starvation the ‘normal’ metabolism.”
Can you give me some sources and authors, please?
Thanks,
Miguel
Look at any decent medical biochem text.
Hi Dr. Eades,
You write really well – and on so many topics. Regarding ketosis, as a dairy veterinarian I encounter ketotic cows not infrequently. Sometimes I see primary ketosis, when they are making so much milk and not taking in enough energy (negative energy balance). Mostly I see seconday ketosis due to digestive problems, such as a displaced abomasum and the cow simply has no desire to eat. If ketosis is let go too long in a cow (or other ruminant) they get “nervous ketosis” with symptoms of bizarre behavior. Basically the brain has been getting ketones too long and not its preferred energy source, glucose. My question is this: can “nervous ketosis” occur in humans that are too severely ketotic for too long?
Second question is this: I was born with a bicuspid aortic heart valve (only 2 of the 3 leaflets). Very slight enlargement of heart right now, due to the murmur. Transesophageal echo showed a moderate-severe, eccentric murmur. This was found out when I went to my local doc to see how I could get into better shape and lose 20 pounds, without keeling over since I knew I had the murmur. You cited that ketones are the preferred fuel for the cardiac muscle – would this be good in my situation? (no coronary blockages at all, just the congentital heart valve issue).
Thanks so much. I look forward to following your blog. I’ve never read anyone’s blog before, but lead an interesting life!
I’ve never heard of ‘nervous ketosis’ in humans, so I doubt that it occurs. At least not as it does with cows. In my experience, most people on a ketogenic diet tend to decrease the levels of ketones in the blood after a while. I believe they become adapted to ketosis and are efficiently using ketones for fuel in many tissues.
I’m not sure the ketones would make a great deal of difference in your situation since what you have is a mechanical problem and not a cardiac-cell energy problem. Following a low-carb, ketogenic diet would, however, help greatly in your efforts to lose 20 pounds. But I would caution you to check with your own doctor, who knows you and your condition much better than I, before starting such a regimen.
Oops – I should read my writing more carefully before I hit click. Yes I know how to spell “write” (usually!). And I meant to say that *you* lead an interesting life.
By the way, your take on observational studies is right on (i.e. the red meat / colon cancer study).
Incidentally, folks should eat grass based dairy products and grass based beef products, local and organic if at all possible. Agree?
HJK
Not to worry about the typos. I try to correct those as I post the comments. The comment screen doesn’t have a spell checker but my moderation screen does, so I catch most of them.
hi I aim to run a marathon end of sept…I am 5ft 3 and weigh 11 stone.my ideal running weight is 8 stone.my current fat mass is 40% and i want to half this…can i do a low carb low fat diet and still train for a marathon
Sure. A lot of people do. It may be a little fatiguing at first, but once you adapt you may find you have more endurance.
Great blog, thank you so much for all the information posted on your blog. I just bought 2 of your books from Amazon.com, Protein Power and the High Protein Low Carb diet one. I can’t wait to receive them as I am eager to read already! I am currently at a plateau for losing the last 7-8 lbs of body fat. I’m a 36 yr old female, 5′3″, and weigh about 117 lbs. ( I currently smoke about 1/2 pack ciggarettes a day)
I believe I have adequate lean muscle mass and am not looking to gain additional muscle weight, only to maintain it. My workouts only consist on low impact stuff like speed walking with small incline on treadmill and beginner mat pilates about 3 times a week. For the past 6 weeks I’ve lost 10 lbs total while having 4cc lipo B-12 shots and taking phentermine daily to control my junk food cravings. I’ve been on a 1000 cal day diet during this time, consisting of about 40 g. protein and the rest in vegetables, fibrous grains/bread and 1/2 c. fruit a day. I am considering to begin a ketosis diet by increasing my daily protein and decreasing my carb intake.
Would a diet of eating 2 dozen egg whites, 2 yolks, 4 oz chicken breast, 1 slice of wheat bread or equivalent carb value in vegetables and 1/2 c. low glycemic fruit (berry types) induce ketosis for me? How long would I need to do this to jumpstart ketosis? If this were to induce ketosis for me would it be helpful in burning off the last 7 lbs of fat for me?
Thanks so much !
I would imagine that the diet you describe would induce ketosis. In fact, I would be surprised if it didn’t. If you keep the calories at a deficit level, the ketosis should help some by a variety of mechanisms.
Dr Eades, Very interesting & Informative .. Thanks.
I am wondering if you are aware of a study that was done on survivors of concentration camps during WWII. The gist of the study suggested that the camp survivors, barring permanent physiological damage, went on to have longer life expectancies than ‘average’ persons.
Your thoughts on this possibility, as related to permanently altering ones metabolic systems through extended near starvation would be much appreciated. Thank You.
I’m not aware of the studies you mentioned, but I would love to read them if they exist. Anyone out there have a citation?
I don’t know that one can permanently alter one’s metabolism after a bout of near starvation. I’ve never read any studies that even mention that, but that doesn’t mean they’re not out there. I just haven’t come across them if they are.
The picture of the cave men attacking a mastadon…love it Dr. Eades. Makes me wanna hunt!
Dear Dr Eades,
I have been on the low carb diet now for about 3 months and i have been constipated so i sometimes take laxatives. Well this affect my diet and ketosis? Also I looked on the back at the inactive ingredients and saw that it had sugar in one and the other laxative contained corn starch. Would it be a big enough amount to affect ketosis?
As long as the laxatives don’t contain a significant amount of carbs, it shouldn’t matter. Most people who are constipated on a low-carb diet can cure the problem by increasing their intake of fat and don’t need laxatives, however.
Dear Dr.
ive been low carbing for about 2 weeks and im down over 6 pounds already. Im drinking a ton of water and i am a runner so i havent slowed down on my running. My question is if i have one day a week where i have some “bad carbs” like bread or god forbid Pizza will that ruin everything i have accomplished. I dont plan on doing like a major high carb day just one day a week where i can satisfy my cravings. Also, what is your opinion on carb cycling. Would going in and out of Ketosis harm anything as opposed to constantly staying in ketosis. I realize there will be some water weight gained but im talking about true damage.
thanks,
Probably no permanent harm, but it will slow down your weight loss. I’ve not had any real experience with carb cycling other than with patients who cheat now and then on carbs. It generally slows down their progress, so based on that experience, I don’t recommend it.
It probably does work for young people, especially young men, but I don’t think it works as well – if at all – for middle-aged people.
in addition to the previous post: Basically im curious about carb cycling. What are your thoughts? My main concern is that i know eventually i would like to be able to add “good carbs” back into my diet. I have read so many articles on how if you do low carb that as soon as you start adding carbs back you gain all the lost weight back and then some.
Your thoughts?
Does fiber matter or not? I know some people say you go by net carbs but which one matters for ketosis? Im asking mainly about Boca Burgers because they say 6 carbs but 5 of them are fiber so only one net carb. Which one matters for ketosis?
Fiber has no influence on ketosis. If the label is correct, the burgers shouldn’t affect ketosis since the actual usable carb is only a gram.
This is an excerpt from “Integration of Metabolism, Energetics, and Signal Transduction”, by Robert K. Ockner
http://www.amazon.com/Integration-Metabolism-Energetics-Signal-Transduction/dp/0306484714
“Unfortunately, mitochondrial oxidation of ketone bodies is
energetically less favorable than that of glucose in that they may exert an
uncoupling-like effect on oxidative phosphorylation (ATP biosynthesis), and
may predispose to the generation of ROS and therefore oxidative stress.
Accordingly, in pre-empting neuronal glucose utiliztion by the neuron,
ketone bodies may compromise neuronal energetic efficiency and, together
with both endogenously generated and diffusible ROS exported by the fatty
acid-oxidizing astrocyte, promote cell injury.”
Chapter 10, page 208
This author states that even ketones are prefered by the brain, they are not efficient and can promote different systemics disorders.
I have been my self in a low carb diet for a while and feel great. I am trying to look deeper into the science of this kind of diet.
Can I receive your opinion, on this, and also about the book?
I’m not familiar with the book so I can’t really comment on it. As to the quote from the book… One of the reasons being in ketosis helps bring about weight loss is that the oxidation of ketones is energetically less favorable and ketones do exert an uncoupling effect, which allows energy to be dissipated. When energy is dissipated, fat is consumed.
I disagree that ketones cause systemic disorders in the levels found in fasting or while following a low-carb diet. Read the book The Brain Trust by a good friend of mine who is a brain surgeon to learn about ketones and the brain.
Dear Dr. Eades,
WOW! This is the first time I’ve been to your blog, and I am hooked… I’ve been browsing now for almost an hour! This article is incredible! LOVE IT! My question is, once you decide to stop the ‘low carb’ diet, would it be safe to say that you should add your carbs back in slowly? Oh, and do you have a personal opinion about the optimum distribution of calories? Say 40% Carb, 40% Protein, 20% Fat or something like that? Hmmm… I’m going to go back and keep reading, see if the answers are already here! Thanks Again!
Glad you’re enjoying the posts. My optimal would be more like 30 percent protein, 5-10 percent carbs, and the rest fat.
Hi Dr. Eades:
I would like to know if you are planning to answer my post from 9. July 2009, 13:02.
Thanks
Miguel
Just did.
Hi Dr. Eades:
On June 2, 2008, 18:07 you answer to Kenny Williams:
“I’m coming out with a post on this very subject within the next few days; I’ll address all these issues then.”
Can you tell me which one is?
thanks
I think you’re looking for Low-carb and calories I and II.
Thank you Dr. Eades! I am basically reiterating what others have already said: this post is incredibly insightful and helpful. It is clear and concise and well written for the laymen (like myself). Thank you.
However….I am very confused. I keep reading different things from different places. For example Wikipedia and other sites says that in starvation mode fat is consumed first then (when there is no more fat remaining) then muscle is used. In your post, though, you are saying that fat is burned to liberate the fatty acids so that muscle protien can be converted into amino acids (then subsequently converted into glucose). Yet other sites say other things.
Am I missing something or are other sites just incorrect?
Thank you for any guidance you can give!
Sad to say, but if Wikipedia says what you say it says (I didn’t check), Wikipedia is dead wrong (as are any sites that agree). During a long-term fast, the body breaks down fat for energy and protein for sugar. And it does it at the same time. Ketones, which are partial breakdown products of fat, replace some of the sugar in an effort to spare the muscle tissue. That’s what any medical school biochemistry textbook will tell you, and it’s true.
Dr. Eades,
Very good post. But I am having trouble with the ketosis Math.
If an average person requires about 200 grams of glucose per day to meet all his needs. And if, after ketosis, this requirement drops to 130g grams of glucose per day. We can conclude that the ketones replace 70 grams of carbohydrate (or 280 calories) per day. Is that correct?
That’s pretty much correct.
hi dr
Again just wanted to say thanks for this post, I have read it all,
I just wanted to know, is high fat needed to enter ketosis?? For
Example eating a low/ no carb diet with average fat?? Or is more
Dierty fat needed?
Also if I did calorie cycling, would that stop my metabolisming
Dropping on low calorie & low carb together??
Thanks again
Tundet
A lowered carb intake (or fasting) is what it takes to get into ketosis. If you eat a ton of fat along with a lot of carb, you won’t get into ketosis. The restriction of carbs is more important than the amount of fat.
Hello Dr,
Is there a calculation that i can use to see how many calories i need to create a calorie deficit so stored fat is used for energy?
Thanks for your time
There are many calorie counters on the web. Here’s one that looks pretty good. Just give it the info it asks for and calculate. Reduce calories from there.
I do not believe we evolved. The body is a wonderfully designed machine. It’s no wonder then, to those of us who know there IS a God, that ketosis exists. God is good.
War, disease and human suffering are terrible. It’s no wonder then, to those of us who suffered disease or the loss of loved ones, know that there is either no god at all or a god that is vicious and cynical. Let’s face it; we are on our own. Nobody other than us look after us. The universe is a very hostile environment, never meant for life. Life on earth is a happy accident. Unintended, but great. Just enjoy the ride.
“I do not believe we evolved. The body is a wonderfully designed machine. It’s no wonder then, to those of us who know there IS a God, that ketosis exists.” (Sandi Penn)
Ketosis exists in ALL creatures’ bodies that have a brain, heart, liver and blood–it is NOT a strictly human condition. That said, this discussion belongs elsewhere…Andre.(Mr. War, disease and human suffering)
I do agree that this discussion belongs elsewhere. But I don’t need it. It’s just that Sandi Penn tried to turn it into a religious one and I couldn’t help but react. Using the phrase ‘those of us who know’ is arrogant. Guess that’s what triggered me. Sorry.
When your body is in the state of ketosis does it have any negative effects on the kidney and liver or any other organs?
No, not if it’s normal ketosis such as that produced by fasting or a low-carb diet.
Hello and thank you for such an informative site.
A low carb diet/lifestyle is so opposite to the things we have been taught. I am grateful for the clear descriptions of the physiology of how and why LC works.
I am 10 days in (and have lost 7 pounds) on my LC diet with a goal of losing 40 pounds. Once I got past the first 3 days of transition it has been easy.
It has been a pleasure reading the posts and I am sure it will be a source of reassurance as I progress.
Thanks again
J
My pleasure.
[...] is the perfect fuel, Dr. Michael Eades wrote on his blog. “Part of it provides energy to the liver so that the liver can convert protein to glucose. [...]