Nutritional Ketosis and Weight Loss
The other significant intentional use of nutritional ketosis has been for weight loss and weight control.
To be clear, nutritional ketosis is just one tool that can be used to assist with weight control. It is not suitable for everyone. Even for the people who do find it useful, the benefits will not be limitless. Many factors are involved in weight control, such as sleep and stress - it does not all come down to diet.
OK, Now for the Stories of Happy Campers -
Yes, I do have some stories for you – two in particular make for very interesting reading. The most fascinating is the personal story of Dr. Atkins himself. I will get into these stories, but first it is important to discuss some areas of confusion.
It is not such a simple matter to find stories for the topic of weight loss as it was for the previous topic of epilepsy control. Why? In the situation of ketogenic diets for epilepsy control, nutritional ketosis has been the agreed-upon target from the beginning (although this is changing with some of the less strict dietary regimes of the past decade). The people were following strict diets that would clearly induce ketosis and these were consistently maintained over time (in those who had success with their seizures). They were all under the guidance of professional expert teams and meaningful research data was collected and published. When considering nutritional ketosis in the context of weight loss, the situation is much less clear.
Isn’t following a low carb diet about the same as being in ketosis?
Don’t we know all about this from the wide use of low carb diets over the past decades?
When people follow a very low carbohydrate eating plan, such as what is commonly thought of as “the Atkins Diet”, most of them will be in nutritional ketosis. (I put “the Atkins Diet” in parentheses as often people are following some concept of their own of what the Atkins Diet is, rather than truly following Dr. Atkins’ actual recommendations.) Some people will not be in ketosis – for various reasons their metabolisms are resistant to going into ketosis and/or they may be consuming an amount of protein that is too much for them. Some people may be testing to monitor over time whether they are in ketosis or not. Some are not. As people start to eat more carbohydrates or more protein, individual people will move out of being in ketosis at different amounts of carbohydrate or protein intake.
Therefore, everyone who is in dietary ketosis is eating a low carbohydrate diet (unless they are taking a ketone-producing medical product or eating high amounts of medium chain triglycerides). However, not everyone eating a very low carbohydrate diet is in dietary ketosis. It is now very clear that you can be carefully following a very low carbohydrate diet – for example, staying below 20 grams of carbohydrates a day – and yet not be in nutritional ketosis to any meaningful degree.
Unfortunately, the two things seem to have gotten somewhat mixed up together in many people’s minds. I think somehow being in ketosis – turning the urine test strip purple – has come to be commonly viewed as just the far end of the low carb spectrum. In reality, being in ketosis is a metabolic state of its own with effects and implications that go beyond just leveling out the blood sugar levels, or lessening swings in insulin or other benefits of lessening the strain on the body from carb intake above an individual’s tolerance level..
What’s the big deal? Why does this matter?
- being keto-adapted can help weight loss and weight control
- the changes that happen with ketosis, if not understood, can interfere with weight control by causing confusion and discouragement
How can being keto-adapted help with weight control beyond a low carb lifestyle?
(1) Being in sustained ketosis provides some degree of lessening of appetite (more below). This knowledge has faded from awareness or not been appreciated for the invaluable tool that it is.
(2) Some people might have a benefit to their brain function that results from their keto-adaptation. (See previous post in this series.) We don’t know enough about this yet, but many people report improvements in mental energy, focus and mood – these effects could be expected to improve a person’s ability to control their weight. Scientifically, these effects are quite plausible and I hope the current interest in research on ketosis and brain function will expand quickly. This is just speculation, but it is even plausible that being in ketosis may favour improved function of the appetite/satiety control centres of the brain if these centres might be (hypothetically) metabolically compromised in their function?? This topic is particularly interesting in view of the current concept of “Type 3 diabetes” (see the second post in this series).
(3) There may be other aspects of being keto-adapted that might be helpful in weight control – for example, some people feel that their muscles function better when in ketosis and then find it easier to be active. Some athletes are now using keto-adaptation as a high performance strategy. See HERE and HERE and HERE.
How can ketosis cause confusion during weight loss?
If you are transitioning into ketosis and you are not well informed about what that means or how that can be expected to affect your body and your energy metabolism, you could be very confused or even distressed by changes you experience. Without proper information, you might not even know you are going into ketosis. You might not even understand that the way you are eating has made ketosis a possibility.
The same is true in reverse if you are in ketosis (intentionally, knowingly or not) and you unknowingly move into a slight degree of ketosis (where you are not really running substantially on ketones) or fully out of ketosis.
(1) rapid weight changes not related to changes in fat stores
When transitioning into ketosis, there is a rapid drop in body stores of glycogen, which causes a rapid drop in body weight from the weight of the glycogen and the water that had been associated with the glycogen. There is also a increase in sodium excretion, with some drop in body water from that, as well. None of this weight is actually loss of body fat stores. This can lead to false expectations of continued rapid weight loss.
Over time, the body adapts to the state of ketosis and there is some re-balancing in the body. In terms of any regain of that body water, I don’t think there is much definitive to say at this point and it is bound to be highly variable between individuals. However, to the extent that there were a slow regain of some of that water over the first 2-3 months, this would show up on the scales and falsely appear to be lack of progress in reduction of body fat. The more dramatic the initial drop in body weight as water, the more chance that some return of that body water could, soon thereafter, give an impression of lack of progress in fat loss.
It can be very easy to move out of the ketotic state. One substantial serving of carbs can mean that the next day your body weight shoots up just as rapidly as it initially fell. Only a very little bit of this would be actually fat – almost all of it would be water and glycogen. This causes people great unhappiness and confusion and can precipitate a dark mood that then brings even further “off-plan” eating.
(2) changes in energy and sense of well-being
When you are transitioning into nutritional ketosis, you can feel quite “low” and tired for a few days or even a week or two as your body adapts to the new fuel mix. Some people even call this “the Atkins flu”. It will pass and there are ways to lessen these effects (such as increasing sodium intake – see Resources below). The real problem comes if this is happening to you and you don’t understand why. Once the transition period is well underway, people often feel better than they have in some time. Imagine how confusing it is if these changes come and go unpredictably and with the real cause unknown and thus uncontrollable. If the person moves out of ketosis for a few days, they may suddenly feel a real change in their sense of well-being. If they then shift back into ketosis, it will take some days or a week or two again for them to get back to a keto-adapted state.
Without knowing the real cause for there mysterious changes in how they feel, they may incorrectly blame the problem on something else and start making other changes in their diet or lifestyle or health practices that can then lead to other confusions. None of this bodes well for finding their best personal happy healthy stable eating pattern
(3) changes in appetite and cravings for starches and sweets
- loss of the appetite-suppressing effect of being in ketosis
- suddenly the brain is not getting the ketones it is adapted to, so it quickly starts using much more glucose than the liver has been used to supplying, potentially drawing down the blood sugar level. When the brain gets hungry, it sends out signals to supply it with its emergency fuel – glucose.
- when coming out of ketosis, for a few days the body is not fully adapted to glucose intake again and the blood sugar will go higher than it normally would, risking an exaggerated eventual insulin response which would compound the problem by causing an unusually sharp drop in blood sugar. Remember that starch is pure glucose, so it isn’t just sugar that causes a flood of glucose into the body. The rapid drop in blood sugar would bring more hunger and a craving for carbs to bring the blood sugar back up. Repeat. Repeat again. By the time this roller-coaster settles down, several days have passed and the person has regained glycogen (and therefore a number of pounds) and can be very discouraged and also not understand what just happened to them.
Imagine a person who had become adapted to being in a sustained state of ketosis who then shifted their diet so slightly that they did not notice or did not think it was a significant.change. Imagine that person thinking that they were still following the diet, but they were no longer in ketosis. They would not understand why suddenly they were both more hungry and having craving for carbohydrate foods. They would just feel that “the diet stopped working” or “I don’t have the will power to stick to the diet”. A bit of extra hunger or craving, if due to being close to moving out of ketosis, can bring “a little nibble”, which would then be sure to bring a bit more hunger or craving. As the ketone level then fell further, a few “nibbles” more would again cause more hunger, not relief of hunger. This hunger leading to more hunger is often the path that leads a person fully out of ketosis – and into a sharp spike and drop in blood sugar, as well, depending on the foods and amounts chosen.
There are many happy stories of sustained weight loss while eating low carb.
But very few that include (adequate) details about the topic of ketosis – although this can be expected to change dramatically over the next months.
Over the decades and until very recently, relatively few of the people who have reported their experience with low carbohydrate diets have included in those reports enough (or any) detail on their experiences with ketosis itself in order to be able to understand the impacts of nutritional ketosis on their experiences – both good and bad.
Thus, the stories of those people who actually experienced a sustained period of nutritional ketosis are, for the most part, not clearly separable from the stories of people who undertook low or very low carbohydrate diets without a period of being adapted to nutritional ketosis. Generally, the stories of people who had problems with weight loss on low carb diets – or who found staying on the diet too difficult – do not contain information on whether they had attained keto-adaptation and what was going on with their ketosis situation during the time when they were having difficulties.
Stories of experiences with nutritional ketosis can be suspected within stories of people who have followed low carbohydrate eating plans.
When you hear or read stories of people’s experiences – good or bad – with following a low carbohydrate eating plan, keep in mind how their encounters with ketosis may have been a factor in their experiences with low carb.
Stories That are Clearly About Nutritional Ketosis for Weight Loss
(1) Patient Number 1 – The original Happy Camper using nutritional ketosis as an aid in his own weight loss – Dr. Robert C. Atkins. Unfortunately, this post is getting too long already, so I will have to leave as this teaser – from how I read it, Dr. Atkins’ original focus was just as strongly on the vital role of nutritional ketosis as it was on the problems of carbohydrate intolerance.
(2) The story that is creating Major Buzz is Jimmy Moore’s recent experience, which he has been documenting in detail since the spring. It should be pointed out that each person’s needs and medical situation is different, so his story is not intended to imply that his approach is for everyone or is the most healthful way for you to proceed.
I include it here because it highlights the difference between a very low carb diet and a targeted ketogenic diet.
I expect that few people would have an outcome as dramatic as Jimmy’s. He obviously is able to go into a strong level of ketosis and feel very well while doing so. People are very different in how readily they go into ketosis and how they respond to it. As I’ve said before, ketosis is not right for everyone. Jimmy’s response is in keeping with his earlier experiences of dramatic weight loss when he first went on a very low carb eating plan in 2004. His results then were similarly “not typical mileage” – with a much more dramatic weight loss than many people achieve with the same diet changes.
- Jimmy Moore’s n=1 Experiments: Nutritional Ketosis Day 121-150 (livinlavidalowcarb.com)
- Before And After Pictures Of My 50-Pound Weight Loss On Nutritional Ketosis (livinlavidalowcarb.com)
(3) Jenny Ruhl’s recent experience - You have to scroll down to the comments section below her post to see where she reports that she did test positive for urine ketones throughout the trial 2 weeks, after the first couple of days. I include it here for some balance. Also, it reflects some other people’s experiences that I have read about in the past months where the person has done blood testing for ketones and not had substantial weight loss when eating to satiety. Note – in Jenny’s trial she did lose weight, but she remained hungry as she kept to a calorie cap.
What you eat is only part of the whole picture when it comes to what is determining your body weight (unless being in semi-starvation or putting up with chronic hunger, neither of which are tenable long-term).
Jenny is an extremely happy camper when it comes to a “to the meter” individually targeted lowering of carbohydrate intake as an essential aspect of controlling diabetes and glucose intolerance (see her other web site, facebook and books).
- Final Update: My Experimental Diet (diabetesupdate.blogspot.com)
- interview and call-in podcast with Jimmy Moore Sep 22/12 for more background on the problems she encountered with living very low carb/ketogenic over years
- Ketosis in a Nutshell – Part 5, A Hunger Haven (itsthesatiety.com)
- Ketosis in a Nutshell – Part 6, A Hungry Man (itsthesatiety.com)
(4) Tommy Runesson in Sweden - very impressive weight loss, now stable at healthy weight. Recently doing blood ketone testing and reporting this in detail on his blog. Great blog for seeing the very tastey-looking food he photographs daily.
(5) More stories with testing of blood ketone levels are bound to be appearing in increasing numbers over the next months. We really know only tidbits of info so far about this whole topic.
Places I would suggest to keep an eye out for more stories over the next months:
Jimmy Moore’s blog http://livinlavidalowcarb.com/blog/
Dr. Andreas Eenfeldt’s blog www.dietdoctor.com
Dr. Jeffry Gerber’s blog http://denversdietdoctor.com/dr-jeffs-blog/
- my blog http://www.myketohaven,com is intended to be a place to collect stories. I have only recently set this up and I hope to get more posted on it once I get another few posts done that I have been trying to get to.
- I am sure other people will post and collect stories as well.
To be continued … this post has gotten too long.
Next: more on the topic of appetite reduction in nutritional ketosis and a look back almost 5 decades ago to the insights that started it all for Dr. Atkins.
Resources – Link to my page Resources – Low Carb and Ketosis
- Ketosis in a Nutshell – Part 1, What’s Up? (itsthesatiety.com)
- Ketosis in a Nutshell – Part 2, Crazy Little Things (itsthesatiety.com)
- Ketosis in a Nutshell – Part 3, Happy Campers Galore (itsthesatiety.com)
- Ketosis in a Nutshell – Part 5, A Hunger Haven (itsthesatiety.com)
- Ketosis in a Nutshell – Part 6, A Hungry Man (itsthesatiety.com)