Ketosis in a Nutshell – Part 5, A Hunger Haven

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Being in nutritional ketosis reduces hunger.

Just that.

It is worth taking a full pause and letting that sink in if you are not already well familiar with this.

You don’t have to be overweight for nutritional ketosis to have this effect:

- you don’t have to be trying or wanting to lose weight

- you don’t have to have metabolic syndrome

- you don’t have to have blood sugar problems

- you don’t have to have insulin problems

- you don’t have to have any problems with carbohydrates.

You don’t have to be a person who would otherwise be interested in a low carbohydrate diet in order to have this response to being in nutritional ketosis.

As mentioned in Part 2, this is simply a normal usual aspect of how your body functions when adapted to being in a sustained state of nutritional ketosis – that is, when “keto-adapted”. (list of terminology is at the bottom of Part 1 of this series)

In any situation where persistent hunger is interfering with achieving health goals, consideration can be given to a careful trial of nutritional ketosis. This would also likely be true in many or most situations where the urge to eat was felt or interpreted as “cravings” rather than as “hunger”.

It won’t be appropriate in all situations and it will not suit all people.

“Reduces” hunger  – not “eliminates” hunger

  • nutritional ketosis is part of our normal physiology, so we can adapt to different food availability situations. It would not be very pro-survival if it made people totally disinterested in finding or eating food. Your body doesn’t want you to be so disinterested in food that you become malnourished, start to waist away or starve.
  • in nutritional ketosis, if you ignore or over-ride your body’s signals to eat or to consume fluid you can go into an unhealthy state of higher ketones and dehydration that can be associated with loss of appetite (and vomiting, nausea and sleepiness) – but this does not happen under normal circumstances where a person is not fasting or skipping meals. It has been noted to happen sometimes during the initial transition to ketosis in the treatment of epilepsy – but this transition has traditionally been done with an initial period of fasting. Under “normal circumstances” you are responding to your body’s signals for food and water – not refusing available food when you are hungry (no surprise if this turns out to be not a good idea).

We don’t know a lot about this so far:

  • people vary in how easily they go into ketosis (how much they need to restrict carbs and whether they need to consciously restrict protein)
  • people vary in the level of blood ketones they have on similar food intake
  • people vary in how they feel at different levels of blood ketones, even when there has been a period of adaptation
  • people vary in how much they have a lessening of hunger when keto-adapted, although there tends to be more appetite suppression at higher ketone levels
  • people vary in how much their bodies use their own body stores of fat for fuel

As we understand it for now, the lessening of hunger and the use of body fat stores go hand in hand.  If body fat stores are being mobilised from the fat deposits, and being burned for energy, there will be less hunger signals saying “eat more”.  If, for some reasons (or many reasons) the fat stores are not being mobilised, the body will signal for more food intake.

Contrary to rumour, there is nothing about being in ketosis that guarantees weight loss.  You can be well-established in a state of keto-adaptation and not lose weight while eating to satiety.  You are still in a state of burning primarily fat for fuel, but it is fat from the food you eat, rather than from your body.  Having ketones in your blood or urine does not indicate where the fats are coming from that you are burning.

I don’t think there has been any research on this, but it seems pretty clear from people’s experiences that you can be in at least a mild state of ketosis and gain body fat stores.  I really don’t see a reason why not.

Using Nutritional Ketosis as a Tool in Weight Control

  1. Context is everything – best health requires an individualized holistic approach.
  2. What does it look like when this is going well?
  3. What is going on when things are not going well?
  4. Concerns? – There are always concerns.

(1) Using Nutritional Ketosis within a Satiety-Oriented Approach to Weight Health

(I digress  – I can’t brush this close to my bug-bear topic without touching it – if this is not of interest to you, please skip ahead ’till you see #### .)

There are two types of harm associated with high amounts of body fat stores:

  • what we usually think of – the harms from high body fat itself, from visceral fat, from associated conditions both as causes and consequences of obesity/visceral fat, from emotional impacts, from prejudice and discrimination, and so on.
  • the harms caused by what people do in their efforts to avoid weight gain and reduce body fat stores

I think this second type of harm has been underestimated as a major driver of the current obesity epidemic – and I mean this separately from the topic of diet composition in terms of carbs, fat, etc. I am particularly concerned about the potential for harm when the public has the impression that the medical community and policy bodies view putting up with sustained hunger as benign, as effective and as an advisable strategy for weight control.

I consider that calorie-restricted dieting, which intrinsically includes the instruction to not eat when hungry if the calorie limit has been reached, should generally be reserved for situations where a satiety-focused approach is, for some reason, inappropriate or not effective or not effective enough.

What does a “Satiety-Focused Approachmean? (see also Overview)

  • General health, individual circumstance, over-all quality of life and individual goals take precedence over total body fat when considering body composition targets, as is true in all situations where there is consideration of body fat stores.
  • If reduction or stabilization of body fat stores is desirable and this is not occurring, interventions are chosen that don’t require restriction of food intake in the face of sustained hunger (no imposition of a calorie cap). 
  • The interventions are designed to facilitate achieving satisfactory satiety with no excess hunger (i.e. hunger other than in the pre-meal period) while undergoing weight loss. 
  • Failure to meet the chosen goal (whether weight stabilization, reduction of body fat stores, more food “peace”, etc.) over time is a valuable feedback from the body that more needs to be done to reduce appetite drive and facilitate satiety. 
  • Any attempt to impose a calorie cap will ruin this essential feedback and risks sabotaging progress towards a successful long-term strategy (which will actually be composed of a combination of strategies).

The most ideal outcome is to have the appetite/satiety control system performing its proper function of maintaining a healthy body weight and, if the body weight is too low or too high, nudging the body towards reaching that person’s best body weight.

Things that favour improved functioning of the appetite/satiety control system are intrinsically things that favour health in general and the over-all best functioning of the body. There are countless things that can disrupt appetite/satiety control.

Just to give a few examples, for some people, simply resolving one of the disrupters below might be enough allow recovery of appetite/satiety balance:

  • getting enough sleep
  • dealing with stress
  • re-establishing regular eating patterns, including breakfast (avoiding restrict/rebound patterns)
  • becoming able to safely reduce, change or stop certain medications that may be interfering
  • avoiding high-sugar liquids.

One of the most important and effective things that can be done to favour proper functioning of the appetite/satiety control system is to consider whether the person is under any form of harm or strain from the amount and/or type of carbohydrates in their diet.  At the present time, in Canada and in all the “developed” nations of the world, the biggest cause of ill-health in the area of nutrition or metabolism is carbohydrate intake in amount/type that is beyond the individual’s current ability to handle without adverse impact (what I think of as “glucose load strain“) – causing metabolic ill-health and its consequences. I think this is having more ill-health impact than obesity itself.

An individually tailored change in type of carbohydrate, with or without a reduction in total amount of carbohydrate, will help many (not all) people who struggle with their weight or who are normal weight but have excess visceral fat. This strategy can help the appetite/satiety function by:

  • lessening swings in insulin and demand for insulin, thus lessening exposure to high blood levels of insulin
  • lessening swings in blood glucose
  • making control of blood glucose much easier in diabetes or pre-diabetes
  • thus helping to preserve health (which helps preserve future ability to control weight) and reducing requirements for medications – with their potential for side effects
  • avoidance of trigger foods in those with sugar craving/addiction or food craving/addiction that involve sweet taste, starchy foods and/or foods that mix sweetness, sugars or starches with fats.

It’s not all about the carbs. However, your carb intake is something that you have control over, whereas you might not be able to do as much as you would like about your sleep, your stress, the medications you require, your level of chronic pain, and so on.  Still, long term results are best served by the broadest possible effort to maintain your health. (Remembering that carbs are not just about weight and, in fact, the impact of carbs on metabolism is much more important.)

With a satiety-focused approach, improving weight control rests on improving general health, including burdens on body function and regulation. Doing the most possible to promote appetite/satiety function equals doing the most possible to promote health and un-burden the person and the body.

This will not always be enough. There may be disruptors that, at the present time at least, cannot be resolved.  There may be essential medications that can’t be safely stopped, there may be unresolvable sleep problems, there may be long-term consequences on body regulation that have been brought about by high body weight or by losing substantial amounts of weight, and so on.

If it can’t be “fixed”, find a “patch” or “work-around”.  ####

When a person’s appetite/satiety control system needs a little extra help, from my point of view the first choice “work-around” to give consideration to is taking advantage of the appetite-suppressing effects of nutritional ketosis. (Recognizing that there are other weight control or “obesity management” interventions that derive all or a major part of their effectiveness through their impact on appetite/satiety balance including obesity management medications and surgeries.)

A very high exercise level could be considered to function as a “work-around” in those individuals for whom it results in reaching a balance point of calorie expenditure versus appetite.

Calorie restriction remains an option in considered situations and for some people this can be very useful and become their favoured, successful and long-term intervention. It should certainly be tried before obesity management surgery and should be at least considered and offered before obesity management medications.

(2) What Does it Look Like When Things are Going Well?

I refer you back to two of the stories I link to on the previous Part 4, near the bottom of the page.

  • Jimmy Moore’s story is the best that I have seen in terms of demonstrating the difference between his experiences with a very low carb eating pattern and his experiences with nutritional ketosis. Not everyone will feel the difference between the two as profoundly as he has and certainly most people will not have such a dramatic weight loss. (links below)
  • Tommy mentions in one of his blog posts that he was starting to have a little weight regain after holding stable for years. He took advantage of blood ketone testing.  He tightened his diet, succeeded in increasing his blood ketone levels and this helped with his weight.

(3) What is Going on When Someone Who has Plenty of Fat Stores is Keto-adapted and Not Losing Weight?

We don’t know. The short answer is that they are not having enough suppression of appetite to allow their food intake to drop down enough to allow weight loss.

I know that’s not much of an answer, but it is the state of the art at the moment.

As I see it, there would be at least these four things to consider:

(1) The body may be defending the fat stores that are present because of some signalling that is giving the message that the body fat stores are getting low or for some other reason need to be defended:

  • this might be considered “appropriate” – for example, a woman of 5′ 2″ who is finding that her weight loss is stalled at 120 lb. when she wants to get to 115 lb. I sympathise, but her body “has a mind of its own”
  • or “inappropriate” – for example, someone who’s weight loss stalls when they are still 50 pounds above the “normal” weight category – perhaps the body is getting erroneous signals that fat stores are low or for some other reason need to be defended

(2) There may be something (or many things) interfering with mobilising fat from the fat stores. In this situation, the person can still be in ketosis as long as they satisfy their hunger by mostly eating fats, and keep their carb and protein intake low enough.  This can still be very valuable in helping prevent weight regain, helping prevent cravings and “unintended” eating, and other potential benefits.

(3) The level of ketosis may not be enough for that person to have enough appetite suppressing effect in order to allow food intake to fall enough to achieve weight loss.

  • there may be something interfering with the ability to burn enough fats (whatever the source of the fat) to meet the majority of body energy needs – whether due to a disease, toxic influence, medication or a rare genetic metabolic problem.
  • the intake of carbohydrates and/or protein may be too high to allow ketosis for that person at that time.
  • the internal supply of carbs may be too much – continued next paragraph.
  • if the internal supply of carbs can be too much, I wonder if the internal supply of protein can occasionally briefly be too much – such as when tissue is being broken down after an injury or after very intensive exercise or when there is bed rest, particularly in someone who has developed and maintained large muscle mass through regular exercise. I haven’t heard anyone comment on this and this is just speculation on my part.
  • if the person is not very active and has a relatively slow metabolism (generally people’s metabolism slow a bit with the passing decades and people who have lost weight can have a slowed metabolic rate long term) they really may not need to eat very much. They still need their protein for their body lean mass. Once they have that protein and a bit of carbs in their veges and possibly a few nuts or cream or cheese, they may not actually be burning a very high amount of fat to counter-balance that.

The internal supply of carbs being too high is what is happening in the first couple of days when transitioning into ketosis, as the liver’s supply of glycogen is depleted.  The liver produces glucose from glycogen, certain of the amino acids (components of protein), as well as a bit from fat molecules. The glucose is sent into the blood stream to prevent the blood glucose level from falling below normal range. The liver does this mostly under the direction of glucagon and the stress hormones — that is really a rough account, I can’t say I’m really up on the details.

If the blood glucose level is falling and the liver is not keeping up with need, a sudden surge in hormones can bring a surge in glucose output.  This most often happens with exercise and during the night, especially in the early morning and pre-dawn hours. When a sudden surge in hormones is triggered, this is not a finely calibrated response.  The resulting glucose output is generally more than what is needed. In someone with diabetes or glucose intolerance, this may show as a rise in blood glucose above normal, and insulin secretion will go up if their body has the ability to do so. In someone with normal insulin function, the rise in glucose will not be above the normal range, because insulin will go up to handle the glucose. Any rise in insulin inhibits ketone production.

Besides sudden surges of stress hormones, many people have raised stress hormone levels at various times of the day and night.  Many people have chronic elevations of stress hormones, particularly as they get older, and particularly at night.

I wonder if this has a bit of a role to play in why it is so famously difficult for post-menopausal women to lose weight.  This is a very large topic and this suggestion is not meant to over-simplify the picture, but, as a general group, post-menopausal women are famous for having poor quality sleep – and even more so if they have hot flashes or night sweats.  Some women in this situation may be producing enough glucose at night to trigger enough insulin to suppress ketone production.  This would not be detected by blood glucose testing if insulin function was normal.

Also, insulin resistance of the liver is common.  In this situation, the liver may produce substantially more glucose than is needed to maintain the needed blood glucose level.

(4) due to insulin resistance, when starting the diet insulin levels may be quite high and may take a while to come down to lower levels. Besides this, if the person has been habitually having a large amount of quickly-absorbed carbs at their meals, there body is adapted to this pattern. When they first adopt a low carbohydrate eating plan, this may take a few days to settle down, and in that time the person will be hungrier  and hungrier more often.

And … there is always the unexpected unknown.  As mentioned in Part 4, Jenny Ruhl has had some difficulties with very low carb diets, despite being unusually well informed and experienced.  We do know that Jenny has an unusual metabolism in that (1) she has an uncommon form of diabetes and (2) she had a very unusual (though very pleasing) profound response to Co-enzyme Q10).  The thing is, unusual metabolisms happen, and you might not know about it until later life.

Addendum Oct 18/12 – I knew I was forgetting some things in this list:

  • nutritional ketosis is just one influence on your appetite/satiety system.  If you have enough pro-appetite forces in your life, the effect of these may be stronger than the appetite-lessening effect of the keto-adaptation. The Rest of Reality always applies.
  • when you start into nutritional ketosis, you may be still in a restrict/rebound cycle.  The restrict/rebound cycle can take place within a day (low food first part of day, over-eating in later day), within a week (skimping food in week and rebound on weekend) or over months (“dieting”, then rebound after the diet) or over any other time period.  If you have just spent time deliberately eating less than your body is telling you to, even though you might then switch to a healthier approach that would be successful long-term, you still might have to go through the rebound phase set in motion by your previous restriction. This doesn’t mean you have to re-gain the weight, but you might re-gain some (e.g. rebuild muscle) or stall for a while until your body figures it has repaired and recovered from the forced weight loss.  To help this process, be kind to yourself in other ways, to promote recovery from the previous dieting stress – especially, don’t heap on more stress.
  • if you have lost weight recently, you may be in a ‘stall” or “plateau” that you just have to wait out. Stalls happen to every-one.
  • sights, smells, thoughts –  your appetite/satiety system is integrated with your entire functioning.  Seeing and smelling food already sets the digestive system in motion.  You may need to be careful how much you are exposed to foods that are of a type you are not intending to eat.  Thoughts matter – find other things to enjoy and be cautious about negative self-talk.  If you are exposed to food that is in keeping with your intended eating plans and you feel hunger – eat it (or, if that’s illegal, find food you own and eat that).

(4) Concerns About Nutritional Ketosis for Weight Control?

There are always concerns …..I have mentioned some of these near the bottom of Part 1 and in Part 2 and I’ll get back to this topic in a later post. (likely 3 more in this series)

……………………………………………………..

The field is starting to move quickly. As I have been preparing this, an important post has appeared on Dr. Richard D. Feinman’s blog (the biochemist, listed in my blogroll). The post is by Dr. Eugene Fine and he explains a research paper just published. The purpose of the research was to examine insulin lowering as a strategy in cancer treatment.  I expect research interest in this topic to expand rapidly.  Now it is in its very earliest stage and there are only baby steps towards a good working knowledge.

The point of interest in Dr. Fine’s post that relates to the topic of this post is the graph of insulin levels versus blood beta-hydroxybutyrate levels (the type of ketone measured when using blood ketone testing – also noted as beta-OHbutyrate) and how variable the ketone (beta-hydroxybutyrate) levels were between the participants when on a ketogenic diet even when strict care was taken to use diet compositions as identical as possible. Also, they clearly noted appetite suppression.

“(We tried to over-feed the patients in order to maintain weight and calorie intake, but it didn’t work: very low CHO diets do indeed cause spontaneous calorie restriction and weight loss, even when you try to prevent that.)”

To hear more about Dr. Eugene Fine’s work, look for Jimmy Moore’s upcoming podcast with him on Monday, October 22, 2012

To hear more about ketogenic diets and cancer, look for Jimmy Moore’s Ask the Low Carb Experts podcast tomorrow, Oct 18/12 with Dr. Colin Champ.

Related articles

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Some Research:

Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum.

Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE.

Am J Clin Nutr. 2008 Jan;87(1):44-55.   PMID: 18175736   FULL TEXT

“In conclusion, the low-carbohydrate component of the high-protein regimen affects subjective motivation to eat, and volunteers feel less hungry and consume less energy, at least in the short term. Whether LC (ketogenic) diets are a suitable tool for weight loss will remain an important issue for some time, as more complex interactions between phenotype and diet composition are identified (23). This regimen appears to reduce calorie intake without increased hunger, and, therefore, it promotes compliance.”

………………………………………………..

The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms.

McClernon FJ, Yancy WS Jr, Eberstein JA, Atkins RC, Westman EC.

Obesity (Silver Spring). 2007 Jan;15(1):182-7.  PMID: 17228046   FULL TEXT

“Hunger was significantly lessened in the LCKD group for as long as 3 months.”

“Furthermore, the present findings represent a replication and extension of previous studies demonstrating significant appetite suppression during an LCKD.”

17 thoughts on “Ketosis in a Nutshell – Part 5, A Hunger Haven

  1. I can not express to you how much knowledge I have gained from this post. Hunger is something I have always battled and l have learned so much I can apply directly to my life as well to those of my clients’. Thank you.

    • Hi Linda, it’s nice to hear from you and thanks for the kind comment. I know you posted about your situation re: job and I hope you’re keeping your chin up. Your insight and skills are so needed by so many.

      • Dr Dea, thank you. I have finally found my passion in life and nothing will stop me from pursuing it. I know first hand what it feels like to suffer from obesity. and if i can help even one person, then I’m doing what I’m supposed to do. Your thoughful comment means a lot to me and your posts teach me so much. Thanks again for your continued inspiration!

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  8. Just wondering what your thoughts are on intermittent fasting? Quite a few “paleo” or “primal” people are playing around with this- not eating at all during 14 hours and having an eating window of several hours, but they are still eating clean; low carb, no sugar, higher fat etc etc.
    There’s a lot of info out there about it, but it seems to be pretty effective for some people 9women in particular seem to enjoy it, although it’s a big change to make) in reducing body fat levels without caloric restriction, and I assume, what with the low carb aspect. that it also induces ketosis.
    Do you think this could be of benefit or does that count as “rebound eating” in your opinion?
    TIA
    Emma

    • Hi Emma, Sorry to be a bit of a while in responding. It would take a couple of hours and a long post to properly respond. As always and with everything about health, it all depends on who you are and your present circumstances.
      It would produce some amount of ketosis as in “ketones measurable in the blood” – which is not what we mean by the term keto-adaptation (when your body has become adapted to buring fats and ketones as the major fuel supply). I do think that there is probably something important about intermittent day-by-day periods of ketone production – such as not eating in the later evening/overnight and prolonged periods of activity from time to time. I haven’t seen this being discussed, but I speculate that it likely isn’t a good thing that in our modern society people may go years or even decades and virtually never have a time when they go into ketosis (and thus “wake up” the ketogenic machinery and ketone transportation and burning infrastructure). Given how different people are, including the existence of those mysterious people called “slim” despite our modern ways, perhaps for some people this maintanence of more metabolic flexibility may be all the metabolic “tune-up” they need to have a reasonable time controlling their weight.
      In the context of ketogenic diets (here, as always, I use the term “diet” for its meaning of “pattern of food intake”), intermittent fasting will deepen ketosis – at least briefly (although there may be considerable cycling of ketone levels depending on the meals consumed). I suspect that this is part of what is going on regarding Jimmy Moore’s quite high ketone levels. However, there can be too much of a good thing and too rapid a transition to a good thing. We need to pay more attention to learning fromm the experiences of the keto kids and adults in the epilepsy community – where they have learned to treat ketone levels with great respect and have been forced to learn a certain caution and wariness about rapid increases in ketone levels and individual tolerances of different ketone levels. (Book review coming soon of “Dietary Treatment of Epilepsy: Practical Implementation of Ketogenic Therapy”.)
      Intentional intermittent fasting can be done 3 ways (1) deliberately not eating for a period of time, despite hunger, (2) truly spontaneous lack of food intake and (3) deliberately not eating for a period of time and telling yourself that you are not hungry. Note that “intentional” means not counting when due to such things as drugs or illness – such as cocaine or flu. Situation “1”, if practiced routinely, is a version of the ever popular “hunger therapy” that disguises itself in countless ways. Some hunger in the 30 – 60 mintues (or so, not to be taken literally as a specific number) before meals is fine and likely healthy (if it doesn’t make your over-all eating goals more tenuous due to emergence of cravings or unplanned eating). Sometimes some hunger is diifcult to avoid for a brief period of time while making certain transitions in your eating pattern or lifestyle – meaning occasionally, not as an intentional recurrent pattern. (I use “difficult to avoid” rather than “desirable”.) All versions of hunger therapy carry risk of setting off disordered patterns of eating – although it must be acknowledged that some people have done well over time with calorie restriction and value that choice.
      How different is the new darling “intermittent fasting” from the old nemesis “breakfast skipping” that has been infamous as the bane of weight control. It always comes down to “how is that working for you”, which sounds fine, but often it can be surprisingly difficult to know the true answer to that. Depending on how young and how healthy and how much other stress and genetics and past stress exposure (including programming in utero and in infancy) and on and on, a person might do well (or appear to do well) with this over even quite a period of time. There isn’t any kind of testing that can tell you how much stress you are putting on your body and your body control systems with this. If over-done, it can sneak up behind you and bite. Your appetite control system is designed to put a stop to this and doesn’t mind some excessiveness in the rebound. Many an over-weight body has been built by the systematic application of breakfast skimping/skipping. Caffeine and stress both count as “stimulants” that fool people into thinking they aren’t hungry. I think hunger therapy, in all its versions, runs a close second behind high carbs as a major causative factor in the development of the obesity “epidemic”.
      What about truly spontaneous periods of not eating for, say 12 – 24 hours? Ketosis does have some appetite suppressing effects and some people may be having a fair amount of ketones if they are generally low carb, or a very high level of ketones is they are generally keto-adapted. Some might also be using stimulants such as coffee or high intensity exercise to suppress appetite. We will have to see over time how people do with this. The body might not send “rebound, please” signals if the flow of fat from fat stores is ample and metabolised well. Trouble is, the fat may not readily come out of the fat stores in all people all the time – or at least not at the high rate required with fasting. When eating to appetite, you will intuitively respond to this by eating, thus preventing over-stressing your body, raiding your muscles for energy, developing cravings or having your metabolism slow. Besides that, some people may not feel well at the suddenly higher level of ketosis.
      Finally, I think that calorie restriction is so insidiously woven into our thinking and our culture that it can be at play even when a person isn’t aware of it. For example, one manifestation of this is people telling you that what you’re feeling “can’t be hunger” – because it doesn’t match with their idea of when you should be hungry. Most of this re-labelling of various hunger sensations (not all) is still hunger therapy, under another guise. When people say they are fasting and not hungry – I’m sure some people really aren’t, but I also have my concerns that some may not mean the same thing when they say this. For anyone who has struggled with weight over time, it could be difficult not to hear at least some small inner whisper of “you did good” when some form of calorie restriction is done.
      You might be aware of this already, but Stefani at Paleo for Women is quite interested in this topic. http://www.paleoforwomen.com/category/fasting/
      See also post Overnight Fasting a Key? at http://itsthesatiety.com/2012/05/27/overnight-fasting-a-key/
      Time will bring more insight and knowledge on these topics. Hope this has been of some help. Dr Dea

      • Thank you so much for your thoughtful response- and, as with everything, I guess it’s another case of what works for some won’t work for others.
        I also agree that there is so much body shaming and so much focus on caloric restriction as the be all and end all (you have will power! you’re so strong to resist temptation! if you just ate less you wouldn’t be so fat!) that I doubt intermittent fasting is free of those pressures. For example, I am not overweight at all. I’m just a woman who wants to drop my body fat levels because… well, probably because I hold unrealistic ideals about what my 41 year old body should look like and in our society happiness and weight are so intrinsically linked that even intelligent, self aware people get suckered in ;)
        I do worry that this whole “give up all grain based carbs! they’re so bad!” is another way of turning inanimate objects into “good” and “bad” all over again (I’m a recovered anorexic). No bread, no rice, no pasta, no legumes, no sugar… I just feel like it borders on disordered eating, even if it is medically sound- orthorexia might not be in the DSM V but it’s definitely something I have seen so called “recovered” anorexics use as a way of controlling their weight and food intake. Then again, plenty of people also use excessive exercise for the same reason. Anyway, I’m going off onto an unrelated tangent.
        Thanks again for your time and I will continue to research the ketogenic diet, but I am not sure whether it is a safe option for people like myself who already have a history with disordered eating (same goes for intermittent fasting- too triggering imho).
        Cheers,
        Emma

      • Emma, the concerns you bring up are very on topic. Orthorexia is something I am concerned about and I think it shows up more than we think. Trouble is, some people really do need to follow tightly defined diets in order to best enjoy and protect their health. I guess one just tries to find out if the dietary practice one adopts results in more enjoyment of life plus better health versus more anxiety, isolation and withdrawal from engagement in other areas of life. The question would be – do you feel more “whole” and more like the true expression of yourself? All of these things are only tools – no more “good” or “bad” than a pair of glasses.
        Whether something seems “disordered” depends on whether it is credited as valid, which depends on what a person’s experience and knowledge tells them. Not many people would think that a person with Type I diabetes who also had celiac disease was displaying disordered eating or behaviour related to their tight diet choices, curtailed daily flexibility of activity and meal pattern and multiple finger-prick tests each day.
        I have been trying to present nutritional ketosis as a tool to be used thoughtfully, not as a desirable goal in itself. I don’t see it as the de facto preferred state for all to to be in. Some people have medical problems that they can suffer from or do something about, and ketosis can be valuable – for example, for those people who have not (yet) been able to find a “better” way to manage their appetite – the twin goals being weight health with food peace. Many of the benefits of nutritional ketosis are actually from the low glycemic load and can be achieved at whatever total glycemic load you are currently able to tolerate without strain – even if that’s not a “low” carb amount.
        There are many reasons behind the fact that people express themselves enthusiastically online about diet and health topics. Some are pitting themselves against a challenge – like climbing a mountain for the challenge, some enjoy flexing their self-discipline as a self-development path, for some it is like a hobby, some want to control, some have a book or web site they are promoting, some want to be the king of something, some want to fit in to a social group, for some it’s a way to feel superior to others, for some it’s almost like being a group of sports fans – – and on and on. And some have orthorexia and are becoming more miserable as they proceed, rather than more happy. Most people have a good heart and mean to be helpful in other’s lives, yet these other nuances sometimes slip in and cloud the picture. (Ain’t we all imperfect and blind to ourselves.)
        Intermittent fasting and ketosis are the new darling topics, but both present concerns and potential for harm. The wise approach is caution – and listening to your own truest inner voice.
        You have acheived a great success with your health. You can put the photo of that “Everest” on your wall and remind yourself that you have had a health accomplishment as great as anyone’s. That would suggest that you have developed a talent for exercising wise caution and for knowing which of your inner voices to listen to.
        Best wishes for your health and happiness, Dr Dea

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