I’ve been following Jimmy Moore’s N=1 experiment with staying in nutritional ketosis on his blog, but it was instructive to actually watch the man eat during his visit last week. His meals are WAY high in fat now and he watches his protein intake. I must admit, despite everything I’ve read about the benefits of ketosis, when I watched Jimmy scooping gobs of butter and sour cream on his cheesy scrambled eggs in the morning, I couldn’t help thinking, “Wait a minute … you’re losing weight eating like this?”

The reason he’s doing this is that he discovered eating low-carb doesn’t necessarily mean being in ketosis, or at least not in the zone that Drs. Jeff Volek and Stephen Phinney call nutritional ketosis: a blood ketone level of between 0.5 and 3.0 mM. As they explain in their terrific book The Art and Science of Low-Carb Living, it’s within this zone that we can easily tap body fat for fuel and keep our brains happily supplied with ketones.

When Dr. Atkins was practicing and writing his books, he urged people to test their ketone levels with ketone urine strips. That was the technology available at the time. Unfortunately, the ketones in urine aren’t necessarily an accurate reflection of the ketones in the bloodstream, which is the level that matters. The reason for the disparity is that as you become keto-adapted, you tend to use more of the ketones for fuel instead of excreting them. The newer and better technology is a device similar to a glucose meter that tests ketone levels in the blood.

As Jimmy Moore explained on his blog, he was surprised when he first used a ketone meter and saw that despite being on a very low-carb diet, his blood ketone level was only 0.1. After adjusting his diet, he’s hanging around the 2.0 level most of the time – and he’s losing weight again.

For the record, I don’t believe everyone has to be in nutritional ketosis to lose weight. People lose weight on all kinds of diets, including paleo diets that aren’t particularly low-carb. I lost weight on The Zone diet, which at 40% carbohydrates is hardly a ketogenic diet. But for people like Jimmy who are hyper-responders to insulin-producing foods, staying in ketosis may be the key.

People who pooh-pooh low-carb diets like to point out that protein foods raise insulin and therefore the “high-protein” Atkins diet can’t possibly work by lowering insulin levels. Hogwash. When we cut carbohydrates, most of us replace the bulk of those calories with fat, not protein. We’re still consuming fewer insulin-producing foods, and we end up with lower overall insulin levels as a result. But the pooh-poohers do have a point, even if it’s not exactly the point they wanted to make: for some people, a low-carb diet may not work in the long term unless they restrict their protein intake as well.

Let’s return to Jimmy Moore’s experience. We all know (because he’s been quite public and honest about it) that Jimmy lost 180 pounds on the Atkins diet, but then slowly regained about half of that. I’m speculating here, since we don’t have records of Jimmy’s insulin levels during the time he was gaining weight, but let’s suppose for the sake of argument that he was eating enough extra protein to raise his fasting insulin level, despite consuming very few carbs. It doesn’t take much extra insulin to significantly inhibit the release of fatty acids from the fat cells. Take a look at this graphic, which was included in a study by Dr. Volek:

As you can see, the ability to release and burn stored fatty acids falls off sharply as fasting insulin levels increase, even within what’s considered the “normal” range. As the text accompanying the graphic explains:

In fact, adipose tissue lipolysis is exquisitely sensitive to changes in insulin within the physiological range of concentrations. Small to moderate decreases in insulin can increase lipolysis several-fold, the response being virtually immediate. Insulin also stimulates lipogenesis [creating new body fat] by increasing glucose uptake and activating lipogenic and glycolytic enzymes. Small reductions in insulin levels, such as that easily achieved with dietary carbohydrate restriction, remove the normal inhibition on fat breakdown.

Dr. Volek was writing about carbohydrates in that paper, but if excess dietary protein also elevates fasting insulin in some people – even to a relatively small degree – that could cause a similar suppression of ability to burn body fat. That might explain (again, I’m speculating here) why Jimmy regained a lot of weight on his low-carb diet and why he’s losing again now. Restricting calories didn’t work, adding “safe starches” to his meals didn’t work, but lowering his protein intake and getting an even higher proportion of his calories from fat is working, at least so far. He’ll report on his experiment in an upcoming post, so I’ll let him announce the specific results.

Naturally, Jimmy’s experiment piqued my curiosity about my own blood ketone levels, so I bought a meter (a Precision Xtra by Abbot Labs) through Amazon. After a week or so, I determined that on my typical diet, I seem to hang right around 0.8 mM, the lower end of nutritional ketosis. I also learned that I can be pushed out of ketosis more easily than I would have previously suspected.

On Saturday night, Chareva and I took the girls to Red Lobster for a belated anniversary dinner. I ate a lobster, some scallops, two skewers of shrimp, a salad with bleu cheese dressing, three tortilla chips with lobster-cheese dip, two mushrooms stuffed with lobster and cheese, and broccoli drenched in butter. Very low-carb with lots of fat, but also lots of protein. Before bed, I had two glasses of red wine. The next morning, my blood ketone level had dropped to 0.2. Could be high protein intake, could be the wine, could be both.

My belly is almost flat these days, so I don’t have a burning need or desire to lose more weight, but what the heck, I think I’ll experiment with my diet, keep track of my blood ketone levels, and see if it makes any difference. I tried eating more protein and less fat awhile back, and nothing changed. If I get into a consistent state of nutritional ketosis and lose that last little bit of softness around the waist, that would be cool. I certainly have no objection to putting extra butter and sour cream on my eggs.

Below I’ve posted an interview Dr. Andreas Eenfield conducted with Dr. Steve Phinney about why a good low-carb diet should also be a high-fat diet, not (as the goofballs in the media always seem to think) a high-protein diet.

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104 Responses to “Low-Carb = Ketosis? Not Necessarily.”
  1. Eric says:

    Lori – Thanks for that info. I’ll have to give that a shot when I give nutritional ketosis a try in the future. I hope it works.

    Marilyn – Thanks for the reply. I too stare at a computer all day and I’m pretty certain it has caused my eyesight to get worse. However, it has never caused my eye’s to dry out like that. I agree the air conditioning and heating probably doesn’t help. However, there was something else to it. It became a big problem. People would ask me if I was okay my eye’s were so bloodshot. When I layed in bed at night I had to keep the ceiling fan off because I could feel the air blowing into my eyes and it was quite irritating. Somthing’s up. 🙂

    For the record, I e-mailed Dr. Phinney directly and he replied with a surprisingly prompt and thorough email. He essentially said that out of the many thousands of patients he’s had he has never heard any of them mention this dry eye problem. He emphasized how he encourages them to tell him any issues/problems as those observations help him understand what is happening better and his patients are his best teachers. Basically, I was probably not following the diet exactly how he has it layed out in his book. I KNOW I wasn’t. My strategy was simply to avoid carbs to the best of my ability.

    I’ll have to be more careful and precise next time I really limit carbs. Currently I have about 1 sweet potato a day…..no dry eye’s since. Of course, my weight loss has stalled.

    Here’s to learning!

    Eric

  2. Phyllis Mueller says:

    Supplemental fish oil, for many people, relieves dry eye. I hadn’t noticed that when I started taking cod liver oil my dry eye condition went away until I overheard two other customers discussing this during a visit to my optician and I thought–oh, yeah–I haven’t bought any eye drops in a long time.

  3. I can’t echo AndreaLynnette’s comments strongly enough.

    This thread is testimony to the importance of n=1 testing to ensure that we apply the LC principles as our individual conditions require.

    As we get more and more granular in our discussions, the LC model will naturally fragment to reflect the subtle differences between us.

    Absolutely. I lost weight during my fast-food diet even though I was consuming around 100 grams of carbohydrate per day. I lost more when I went lower, but I apparently haven’t been in nutritional ketosis for much of that time. So maybe it’s not necessary for me but is for others.

  4. Bex says:

    Love your work Tom!
    And am very keen to see how your ‘experiment’ goes. I too am about 1-1.5kg from ideal weight, am 43 with 3 kids. Have been low-cerb/paleo for a bit over a year, but really havent lost anything!! Zip! Nada! Even though I am lifting heavy things once or twice a week, and with some hill walking inbetween.
    So I am toying with the ‘go all out and really up my fat intake and lower my protein a smidge’ route/experiment.
    So a very timely post. Thank you.
    My only real concern would be, say I do go deep into ketosis, lose that last bit of weight (Oh happy days!), then what would happen? Should I gradually return to a ‘normal’ diet of paleo or am I destined to remain on a ‘ketosis diet’ forever???
    Will the weight come back if I do??
    So many questions…

    It’s a good question, but I’m not sure of the answer. I’m low-carb most of the time, but have occasional high-carb meals and haven’t regained any weight as a result. I hope it’s the same with ketosis.

  5. Ailu says:

    @Eric: I found your post fascinating. Interestingly, since going low-carb 4 years ago, my eyes dry out very quickly – a ceiling fan blowing from above on low is enough to irritate them. Also, I have developed a HUGE senstivity to onions. Used to be able to chop or cook them, and yes, get the occasional tears – but now, their fumes are downright painful!

    My husband has to cook them now, with the exhast fan on, and me out of the kitchen. Any contact with their gases, feel like daggers being stabbed in my eyes! Then they are bloodshot and swollen for the rest of the day. Never used to be like this. And, oh how I love onions! Oddly, eating them doesn’t bother me at all, even the raw ones. But I just have to wait until their gases have dissipated.

    I know, I know… don’t know if anything about this is truly related to going low-carb – but it is interesting, so the say the least. And very weird… lol

  6. johnny says:

    Can you do interval training (sprints) in are in nutritional ketosis?

    Drs. Phinney and Volek have both found that high-intensity athletes do just fine in ketosis, but only if they’re tested after they’ve had time to adapt.

  7. Marilyn says:

    Ailu, have you tried peeling your onions under running water? If the “fumes” get too bad, I just turn on the water and finish under the water.

  8. Marilyn says:

    This is about fat — sorta. As I washed up my cast iron skillet after breakfast just now, I was thinking about an article I recently read in a magazine. In that article, everybody chimed in to say they NEVER washed their cast iron skillets. One person said their skillet was over 80 years old and had never been washed. Fortunately, I never tossed the little beauty that I bought at a rummage sale decades ago, but never used until recently. The secret? I now put a couple of tablespoons of fat in the skillet before I fry anything. When I finish, I wash the skillet with hot water and some detergent, rinse it carefully and turn it upside down in the dish drainer. If the edges sprout a little rust here and there, I put some olive oil on a paper towel and wipe it off. There’s no hokus-pokus about cast iron. You just have to use enough fat when you fry things. 🙂 They also work great for roasting and braising in the oven.

    We wash our cast-iron skillet if it’s a mess, but otherwise give it a rinse and a wipe and leave a thin layer of fat on it.

  9. Rae says:

    Admittedly the idea of restricting protein makes me cringe, because of all the time I spent as a vegetarian (and then vegan) when I didn’t get nearly enough good quality protein. But it’s true, when I pig out on fat my protein consumption naturally goes down and I lose weight easily. But only when I don’t exercise much. Exercise makes me crave protein and it seems counterintuitive not to satisfy that craving. I still have a couple of vanity lbs I wouldn’t mind losing but I want to build muscle too – haven’t figured out how to do both at once. Though I’m sure it must be possible but it’ll take some experimentation. N=1 and all.

    If you crave protein after exercise, I’d listen to your body.

  10. BawdyWench says:

    I am SO confused over the amount of protein to eat. I’ve been LC since 1998, but have fluctuated up and down (gained 50+ pounds in the first 18 months of menopause without changing diet or exercise at all). Finally, 7 years later at age 57 I’m starting to come back down; still have about 20 pounds to go.

    ANYWAY, I keep seeing recommendations to keep protein down around 60 grams of protein a day.

    BUT, I just read this again this morning from Dr. Eades in his “6-Week Cure” book:

    “…recent research has shown that women, particularly those over 50, utilize the protein in their diets less successfully in muscle building than men do. What that means is that women approaching 50 need more protein for their size than men to preserve and build lean bodies, and most of them get far less than they need.”

    Nor does he limit the amount of protein you eat, at least in that book. In his Protein Power books, he recommends that a woman of my height (5’7″ and weight) should be consuming 102 grams per day.

    Likewise, on page 210 of “The Art and Science of LC Living” paperback edition, they recommend between 1.5 and 2.5 grams per day per kg of reference weight. For me at 170 pounds (ugh!), that works out to be between 115 and 192 grams of protein per day. In an example they cite of a 5’6″ woman who wants to lose 30 pounds, they give her 100 grams of protein per day. That amount of protein is steady through all four diet phases (induction, weight loss, pre-maintenance, and maintenance).

    ***How are you supposed to know what to do? Do I eat 62 grams of protein a day, or up to 192 grams a day? BIG difference!***

    I also wanted to add that I had blood and urine tests done recently, and they tested for ketones among other things. The printout from the lab showed that I had 40 mg/dl of ketones in my urine, which they said was abnormal. They consider 0 to be normal!

    I share your confusion. Depending on whose book I’m reading, the advice for a guy my size ranges from 75 grams to 200 grams of protein per day. So I’ll experiment and see what happens.

  11. Lobstah says:

    I find your site very interesting and insightful. Great to read about facts and real science as opposed to grant-grabbing studies.
    I began my latest “serious” approach to HPLC a few months ago. I’ve eliminated whites from my diet. My wife and I are both quite heavy, and weight is something we’ve struggled with for years now.
    I’m 5’7″, and when I started 2-3mos ago, I weighed in at 260lbs. I am now down to 231, with 31 to go for my Phase I. I haven’t weight 200lbs in quite a few years, so this is all pretty exciting for me at this point. I do splurge from time to time, sort of along the lines of the 17 day diet, where I usually limit splurges to every other weekend. My biggest vice at this point is beer. And no, I’m not the “30-pack of Bud” kind of guy. I enjoy a nice red ale or nut brown ale, hand crafted, by any one of the many micro-brews that are in abundance once again in New England. So for roughly 11 days, I stick to red wine or an Ultra, and then on the following weekend enjoy my treats.
    We just completed a 12 day vacation in Maine. When we left I was at 236, when we returned Sunday, I was at 239. I was very happy with that, as I know that once you increase your carb intake, the first thing that happens is you hold some water weight. Wed morning, 234, this morning, 231.
    Very satisfying, to say the least. My wife and I have been walking at least every other day, and I sometimes play golf if I get up early enough. Played 18 holes this morning, iMapMyWalk said I walked 6.3miles. Sorta tells you something about the quality of my golf game, eh? 🙂

    Very interesting point about protein. Had never thought much about it until reading this thread, so will definitely keep an eye out as to how much I’m consuming. This morning I switched from 2 eggs to 1 egg and 2 slices of ham, fried in butter.

    Lob

    Congrats on the weight loss and I hope it keeps working for you.

  12. Dan says:

    I’m concerned. Yes, he’s losing weight, but that doesn’t mean he’s losing fat. There’s a point where ketosis can become catabolic, and a diet that’s only 10-15% protein would certainly fit that bill.

    I’m a supporter of low-carb diets in general, but Jimmy’s taking this to an extreme. I’m genuinely worried about the guy.

    He’s been getting his advice directly from Drs. Phinney and Volek, and his “extreme” diet fits the macronutrient ratio Dr. Volek (a former powerlifting champion and still a very muscular guy) sticks to himself.

  13. Macy, I just tried your “keto pudding”. Oh, my! I used 60g of sour cream, 30g of mascapone, 5 drops of Stevia extract, 1/8 tsp. vanilla extract and 1 tsp. cocoa powder. In a (made up) word – fantabulous! 238 cals, 22.6g fat (85.5%), 3.3g protein (5.5%) and 5.4g total carbs (9.1%), in case anyone is interested. It definitely fits the bill for a yummy, high fat snack!

  14. Peggy Holloway says:

    I am interested in this issue of dry eye syndrome. I have been VLC for nearly 13 years, so when my eyes started getting blood-shot and irritated over the last two years, I made no connection to low-carb. I had to give up contacts a year ago and often have broken capillaries in the corners of my eyes. I’ve tried every kind of eyedrop and nothing seems to work. My eyes are constantly irritated and slightly burning. At first, I thought I had an infection, but this is chronic. I’d come to the conclusion that it is an age thing. I’m going to try to be more regular about taking fish oil and see if that helps.

  15. Firebird7478 says:

    Sorry, Rebecca. Fantabulous appears in the Van Morrison song, “Moondance”. But that dessert looks awesome. Would probably try something less expensive than mascapone.

  16. Underground says:

    When you wash cast iron, roughly wipe it dry, then put it back on a hot eye for a minute immediately after washing just until it’s warmed and thoroughly dried out. This will help ensure that water doesn’t sit on it and keep the rust away.

    If you’re eating LC and are having issues with dry eyes I would suggest one, hydration, and two try eating more and different fats similar to what Dr. Phinney suggested above. I was having some issues with LC until I realized that I needed to up my fat intake. I like my protein, so I’m still searching for the right balance for myself.

    Of course there are other factors besides diet that can cause that. Something for the optomotrist to look at.

  17. jclivenz says:

    Dry eye syndrome could indicate Vitamin A deficiency. Phyllis mentions Cod liver oil. CLO is high in Vitamin A (just make sure it is not synthetic added back in). Refer to Weston Price Foundation for CLO recommendations.
    Sweet potato (like carrot) presumably high in beta carotene the precursor to Vitamin A (the body may make the conversion in the presence of saturated fat).
    “True Vit A only occurs in foods of animal origin and requires fat for absorption. The best sources are liver and other meats, clo,egg yolks, butter and cheese from grass fed cows…” Mary G Enig PhD “Know Your Fats”

  18. LaurieLM says:

    Dear Good Tom, I am anticipating and looking forward to hearing about the future results of your experiment. And please, I would love to know what your ketone levels are around your weekly (still doing it?) 24-hour fast. I am all about LCHFLP and intermittent fasting. I read on Good Jimmy’s blog that when he tried IF, it was a disaster. However, by your description in one comment above of him eating breakfast but then not eating anything again until supper- well that is the very definition of daily IF! And I totally understand how giving it a try, having a prescription for doing it and focusing on it might have made him NUTS and why he thinks he ‘failed’ at it when he reported it didn’t work out for him before. But he seems to me to be clearly naturally practicing IF anyway.
    But even more interestingly, all humans who sleep through the night (and don’t ‘sleep-eat’), IF each and every 24 hours throughout their entire lives. Some people have extended the benefits of it by fasting either daily, weekly or monthly for longer than the usual 8 hour daily fast we all participate in. I find doing so, extending my native fast, has been a miracle in my life.
    I am fascinated by the concept of some of us having damaged our metabolisms and if that happens and if repairs can be made once the damage has been wrought. I think on purpose daily IF might be helpful. And I am keen on learning more about the mechanism of IF, whether or not we are doing it consciously or don’t know we are engaging in it. I IF daily, with a 18 hour fast (encompasses my normal night fast), and 6 hour eating window.

    Once I kicked myself out of nutritional ketosis with a Red Lobster dinner heavy on protein followed by two glasses of wine, I’ve stayed kicked out so far. My fasting level has been in the 0.3 – 0.4 range so far.

  19. Ailu says:

    Thanks jclivenz. I don’t think it could be possible I am deficient in Vit A, as I eat 2-3 eggs every day, along with near daily meat, butter & a little cheese, and even sweet potatoes once a week or so. Also thought it might be B6, to no avail. But I’m always experimenting with supplements, so I appreciate the suggestions. 🙂

  20. Ailu says:

    @Underground: Interesting. Already eat a lot of fat – but maybe it just needs to be more balanced. I will try upping my fish oil, and see if that makes a difference.

  21. greg says:

    AWESOME! This is exactly what I need. I used to eat around 75% of calories from fat and easily dropped to low 180 / high 170 lbs. After some blood work, I foolishly listened to my doctor and reduced my fat. He was worried about my total cholesterol, and I crept back up to 189.2 (yes, that 0.2 lbs was pretty consistent) despite eating around 20g carbs a day. The fat is going back in.

  22. Susan says:

    Eric

    I have been LCing for about 3 1/2 years. I am usually at or below 50 carbs a day. I had lasik surgery about 11 years ago, so I use drops everyday. When I find my eyes feeling much drier (even when I have used extra drops and have taken in extra water) than normal, I found that if I increase my fish oil supplementation for a couple of days that it takes care of the problem for me.

    Chronic dry eye is the pits. Good luck finding your solution.

    Susan M.

  23. Hitssquad says:

    Bill,

    Have you read Susanne Holt’s 1997 insulin-index paper?:
    http://www.marksdailyapple.com/insulin-index/#axzz20Ztp0G8X

    Mark writes, about the index: “High protein, virtually no-carb foods like meat and eggs, while low on the glycemic index, measured high on the insulin index. In other words, while the meat and eggs didn’t cause a spike in blood sugar the way most carbohydrates do, they did result in an unexpectedly significant rise in insulin.”

    Your statement “Gram-for-gram, carbs are far more insulinogenic than protein” might not be true in general.

    I think the real reasons we worry about carbs more are:

    1. We can’t live on zero protein, whereas we *can* live on zero carbs; and
    2. Unlike protein (on a calorically unrestricted diet), carbs *can* make up the majority of calories.

    So, the reason we pay more attention to carbs is there’s more potential to cut carbs — not because of any major gram-for-gram difference in insulin response.

    Well, there are a few other points I’ll toss into the mix:

    1. I don’t recall saying “Gram-for-gram, carbs are far more insulinogenic than protein.” If I did, point it out so I can remember not to do it again.

    2. Protein raises insulin but also raises glucagon, which acts as insulin’s counter-regulatory twin to a degree.

    3. I don’t believe we become insulin resistant simply because insulin goes up frequently. I believe we become insulin resistant when our cells need to protect themselves against what insulin is trying to accomplish. If insulin goes up frequently because we’ve eaten protein, I don’t see why our cells would try to protect themselves against an influx of amino acids. But if insulin goes up frequently because we’ve eaten foods that spike blood sugar, cells that already have all the glucose they need would try to protect themselves against an infusion of still more glucose, which would be toxic.

  24. Sue says:

    it seems kind of silly. is Jimmy going to eat ths way for life?

    If it works, yes. People in some hunting cultures lived that way for life.

  25. Hitssquad says:

    Tom,

    1. I had addressed my entire comment to Bill. Here’s Bill’s comment:
    http://www.fathead-movie.com/index.php/2012/07/09/low-carb-ketosis-not-necessarily/comment-page-1/#comment-820779

    2. Doesn’t glucagon stimulate the liver to release glucose?

    3. Good points. Thanks.

    My bad, I thought you were addressing me. Correct, insulin lowers blood sugar while storing fat, while glucagon encourages gluconeogenesis and the release of fatty acids, both intended to raise/preserve blood sugar. That’s I meant by glucagon being insulin’s counter-regulatory twin to an effect.

  26. Hitssquad says:

    Sue,

    I, for one, plan on eating this way (nutritional ketosis) for life — not because I have any fat to lose or any need to maintain (I’ve always been rail thin, even inhaling pizza, bagels, baguettes, and rolled oats all day long) — but because I, as Gary Taubes put it, don’t want to get cancer (and heart disease, and Alzheimer’s, and diabetes, and hypertension, and Advanced Glycation End-products (AGE’s), and mitochondrial burnout, etc.):
    http://www.youtube.com/watch?v=XDtiYahxr5I&t=287s

    “10 of 10 – Gary Taubes at the Walnut Creek Library on 4/2/11 – Rivendell Bicycle Works”

    Also, I don’t want the rebound-hypoglycemia I suffered from most of my life to ever return.

    • Blu3Fedora says:

      Amen! I, like most people, started on the original Atkin’s Diet using the paperback 70’s version. Then, all of the “revamping” he and then the new owners of Atkin’s INC, really messed it up.

      I have no doubt based on my amazing results, 398lbs to 170lbs today and maintained for over 10 years, that Nutritional Ketosis is the proper way that human being were meant to eat.

  27. Hitssquad says:

    Hi, Tom. You wrote: “in the zone that Drs. Jeff Volek and Stephen Phinney call nutritional ketosis: a blood ketone level of between 0.5 and 3.0 mM. As they explain in their terrific book The Art and Science of Low-Carb Living”

    I have the companion book, The Art and Science of Low Carbohydrate Performance, and it seems to imply nutritional-ketosis starts at 1.0 mM:

    “many doctors and lay people alike confuse nutritional ketosis (blood ketones at 1-3 millimolar) with keto-acidosis (blood ketones greater than 20 millimolar).”

    “Previous work has shown that BOHB levels in the blood within the range of nutritional ketosis (1-3 millimolar) decreases mitochondrial ROS production”

    “A low carbohydrate diet that increases ketone levels above 1 millimolar (typical of someone eating less than 50 g/day of total carbs) increases expression of monocarboxylic acid transporters levels eightfold in rat brain cells[18] and also increases brain uptake of ketones by a similar magnitude[19] accounting for over half the brain’s fuel use.”

    In the first book, they used 0.5 as the starting point. Perhaps they changed their definition a bit later.

  28. Hi, Tom!

    I got my ketone testing strips last night and tested ketones and glucose this morning. For the past 10 days, I have been eating 187g fat (85%), 54g protein and 20g total carbs (not net carbs). I hate tracking, but there it is…

    My ketone reading this morning was 3.1, and fasting glucose was 81. I guess it is working! I will test my glucose 1.5 hours after breakfast this morning, and I expect to see a good number.

    This is fun! And I’m losing weight and inches for the first time in a year. Yay!

    Are you still testing?

    I’ve been testing, but I’m having a difficult time getting above 0.5 lately. I know it’s not excess protein, so I guess I’ll need to try more fat.

  29. Ailu says:

    The whole protein with insulin response intrigues me. Reason being, I get a severe hypoglycemia reaction from any kind of liquid protein. I’ve never been able to have protein shakes – my body reacts the same as if I had eaten pancakes with syrup!

    So I’m finding all this extremely interesting… based on it, I’ve decided to embark on a change of diet – I am going to lower my protein and up my fat even more. I’ve got 20 lbs on me that crept up recently, and I can’t shake them off, even with a low-carb stick. But if I add more fat… hmm… let’s see what happens…

    Always good to experiment and see what works for you.

  30. Colin T. says:

    Your phrasing made it sounds like your blood monitor tested ketone levels, but I clicked the link and was surprised to see a Glucose monitor. Then I saw the different strips: I had no idea! The prices of the strips sure do vary a lot, though, or the products just aren’t set up properly: there’re some at $5 per strip and some at a tenth of that. How often do you test?

    The Precision Xtra tests both. I’ve been testing a few times per week. If you run a search online, you’ll find cheaper sources for the strips.

  31. Jennifer says:

    Just watched Fat Head last night-very interesting! I do have a question, though. I am a ova-lacto-vegetarian who hates the smell/taste/texture of any meat. Are there any resources you could point me to that would show me how I could follow a low carb/high protein diet?

    There are low-carb cookbooks for vegetarians on Amazon:

    http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=low+carb+vegetarian

  32. Hitssquad says:

    Jennifer,

    Jimmy Moore did a podcast show on vegetarian low-carbing on September 15, 2011:
    http://www.thelivinlowcarbshow.com/shownotes/4450/498-l-c-vegetarian-diet-author-john-theobald-and-veterinarian-dr-travis-einertson

    The short answer: investigate coconut oil and pea protein isolate. (John Theobald recommended whey protein on the show, but by the time I emailed him later he was already recommending pea protein instead.) The reason for the pea protein isn’t to consume a lot of protein, but to get adequate protein without the carbs that veggie protein-sources usually come with.

    Of course, eggs are good low-carb protein sources too.

  33. Eric says:

    I read the reviews of the Precision Xtra meter and half of them were very negative. It makes me question at the very least the quality control of the manufacturing process. One problem is that the folks who noticed the accuracy issues had a means of double checking, and I wonder if those who rated it highly did.
    I have considered getting a meter to check myself since I went Primal just to find out, but wonder which one to get. Also, do most brands come with ketone checking strips or just Abbott labs?

    Most glucose meters don’t check ketones. I’m only aware of the Precision Xtra and one more … Nova something, I think.

  34. Dana says:

    One thing about how “people lose weight on different diets”: we don’t hear enough about what kind of weight they’re losing. There are people who lose weight on Twinkies but then it turns out they actually lost 8 or 9 pounds of lean weight and their bodyfat level is still just under obesity–a more accurate measure of obesity than either weight or BMI. Unless someone’s willing to do a before-and-after with a BodPod or a DEXA scan, their number on the scale is just a number.

    There’s also the point that even when weight loss on low-carb and on low-fat are roughly similar, the low-carbers’ labs have improved dramatically in most, if not all of these studies.

    So it’s all a matter of context. Glad for someone that they weigh less now on Weight Watchers; hope they are not sacrificing bone mass in the long run.

    Bingo. I lost weight going low-carb, then gained weight after lifting weights more regularly and still got a bit leaner.

  35. Pran says:

    I don’t know if i would eat this way forever, since its kinda difficult for me to cut out bread and rice. But, as an amateur bodybuilder, following a ketosis diet is perfect for a 2-3 month period to cut some fat without losing too much muscle mass. Then i usually take a week or two off to get my pizza and sandwhich fix taken care of hahaha.

  36. Tim says:

    I am a bit confused by your reasoning as to why Jim Morrison regained his weight. Maybe you are just leaving out info. He lost 180 lbs using Atkins diet which is relatively higher in protein. This was a long process so any adpations had taken place during this time. Yet you are saying the exact same diet put 1/2 the wieght back on. The reason you give for this is protein was causing to much insulin release thus reveresing weight loss?

    The same diet was taking the weight off. No way suddenly that same food, same macro percentages and total calories caused him to gain fat weight. Its not like he suddenly started producing more insulin from a diet that was not causing the issue before. More than likely he had effects on his liver or adrenals that caused the issue. Some people when loosing large amounts of weight can have cotrisol levels go up along with this the liver can start to slow its conversion of T4 to T3. In turn blood lipoproteins go up rather than being used by cells as low T3 causes reductions in the receptors. These changes could also have casues his liver to become less insulin sensitive thus effecting conversion processes. The lowered T3 causing a slowing of metabolic rate. That combined with the effects on lipoproteins could lowered his hormone production specifically testosterone. All leading to fat gain.

    It may do well for people to do a bit more studying of body protein turn over rates, the effects and metoblic effects. your average person has a turnover of 300-400 gram protein per day. This is even on lower 60-90grams of total dietary protein intake. Much of that turn over ends up as glucose.
    Further glucose produced via glucongensis has a significantly lower insulin response than dietary glucose ingestion. After any intense exercise the effects of insulin response to carbs is minimized in its effect on lipolysis. Studies have shown the body continues to use fatty acid oxidation as its primary fuel source even after this. During a workout insulin’s effects are blunted significantly as well. Hence why exercise is so critical to any fat loss plan.

    So I doubt very much that the plan that allowed him to obviously keep his insulin low enough to loss 1280 lbs suddenly started converting protein at a new super high rate enough to spike his slin enough to regain large amount of the weight.

    Something changed. His diet or something effecting his metabolism that caused it.

    I would much rather use careful carb manipulation in a over all low carb high protein moderate fat diet than to eat mounds of lard etc in excess.

    Be careful of focusing to much on one tree when you are in the middle of a forest.

    I have no comment on Jim Morrison’s quest to lose weight. Since he died decades ago, I assumed he had no interest in losing weight.

  37. Sam says:

    I did my own ketogenic diet experiment. Female, 165 lbs, 5″3, 42 yrs old. Already suffer from impaired fasting glucose (levels around 110 pre diet). Ate low carb <100 carbs before my experiment. No weight loss, no change in blood glucose on low carb. Switched to keto for three months, ate a lot of dairy, meat, eggs. Kept protein to about 60g. Fasting blood glucose levels went up slightly to average above 120. Post meal also went up but have always been in normal range. Blood ketones non existent. Could barely register above 0.3. Urine ketones in purple range (no idea how, dehydration ?). Lost weight but suspect it was water/glycogen. Revert to higher carbs that weight comes back on within a day or two.

    So, what's going on ? Do my high fasting/baseline blood glucose levels mean that I have a lot of insulin circulating constantly, meaning I can't get into nutritional ketosis ? Does that mean while my levels are that high I can't burn fat -hence no real fat loss ? I can't seem lower blood glucose levels with diet, either low carb or keto, so am I doomed to being overweight forever? Low carb and keto control my hunger though so I do end up eating less but why eat less if you cant lose weight ? What's the answer for me? Anyone have any ideas ?

    You may need to give it more time. It took me several days of going high-fat/low-carb to get my morning ketone levels above 0.4. Peter Attia said it took him a month.

  38. Sam says:

    Yes perhaps more time might help. I also just read Lyle macdonald who suggests aspartame and caffeine might keep you out of ketosis. I have both but not in huge quantities. I will try cutting them out and see what happens. It’s been suggested I may have a form of diabetes (mody 2) where baseline blood glucose levels are higher than normal. It is a mild form and is treated with…diet and exercise. Yay..the two things that don’t seem to make any difference (for me). The chances of getting a diagnosis of diabetes 2 let alone a liitle known version here in Australia are pretty slim. My fasting levels are crap but my post meals are fine. My fasting levels rise higher the longer i fast.

    What confuses me the most is how could I have urinary ketones but no blood ketones. It seems that would be impossible. Unless my ketone blood meter is not accurate.

    If I do have diabetes does that impact ketosis ? I’ve heard of ketosis resistant diabetes mellitis. It sort of correlates that diabetes sufferers would have trouble dropping insulin levels enough to trigger ketosis, especially if they are insulin resistant. Anyway, I will continue experimenting and see how I go. Thanks for your suggestions.

    I’m not sure about diabetes affecting ketosis. You can excrete ketones in the urine but still not have many in your blood. Part of becoming keto-adapted is training your body to use them for fuel instead of excreting them.

  39. Sam says:

    That makes sense. Maybe I just wasn’t keto-adapted -didnt give it long enough. If you aren’t using your ketones and you are eating very little carbs what exactly are you burning ? Are your muscles being broken down for energy ? I seems to have lost a little muscle mass and maybe 60g dietary wasn’t enough. I was just beginning to lose my appetite/hunger so maybe I was just on the verge…anyway I’m just thinking out loud. Thanks for your responses.

    If your body is conditioned to relying on glucose and you’re not eating carbohydrates, it will make glucose from protein — from protein in food or in your muscles. I’d give it more time.

  40. Francesco says:

    Today, I went to the beach front with my children. I found a sea shell and gave it to my 4 year old daughter
    and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear.

    She never wants to go back! LoL I know this is completely off topic but I had to tell someone!

    Holy crap. A nice hermit crab would have at least made some oceans sounds before pinching her ear.

  41. kris says:

    A high protein, low fat diet results in ketosis, because the end result of converting protein into glucose results in ketosis, and also results in the ketones produced being adopted by the body with glucose being saved for necessary organs.

    Gluconeogensis is often a stable rate, unless you are diabetic, or have other issues that results in hepatic gluconeogensis, Dietary Proteins Contribute Little to Glucose Production, Even Under Optimal Gluconeogenic Conditions in Healthy Humans © 2013 by the American Diabetes Association. http://diabetes.diabetesjournals.org/content/62/5/1435.abstract

    Although I’m not completely certain, other doctors and dietitians say a high protein,low carb diet means you are already in ketosis.

  42. kris says:

    I meant low carb diet, although I’m not sure what a low carb diet, moderate fat diet, or low fat diet could achieve this.

  43. Jessica says:

    Hi,

    I’ve been trying to follow a keto diet for weeks and trying to get myself into Ketosis and simply can not. I’m VERY insulin resistant and seem to have an insulin response to just about everything. This morning I ate a hard boiled egg with olive oil and a few strips of bacon and my blood sugar has been up and down ever since. I need advice as to WHAT to eat. I’m at a loss. I JUST figured out I need to cut out the whey – today was my second day of no whey protein. I’m using heavy cream though. I’m just at a loss about what to eat and when. I feel like my food options are so limited. Like I can’t just drink heavy cream. I need something else but I react to everything. Can anyone help me with this?

    Whey does produce an insulin response, so good move there. You can try limiting your protein if you haven’t already and adding some MCT oil to your diet.

  44. Jessica says:

    I guess my question is then, if you limit your protein what exactly do you eat? As Carbs are not an option for me. You can’t go around drinking olive oil. Thanks for the input. BTW I’m better today. I think I was withdrawing off what little carb I was getting or the whey. I pretty much was having a whey protein bar and a shake every day. I’m thinking that’s a no go for me from now on.

    Lots of fat. The books “The Art and Science of Low-Carbohydrate Living” and “The Art and Science of Low-Carbohydrate Performance” offer good advice on how to eat a nutritious high-fat diet. There’s also this book for recipes:

    http://www.fathead-movie.com/index.php/2013/03/21/book-review-fat-fast-cookbook/

  45. Babs says:

    Let me say i have read this blog post about 40 times since september. At first this worked for me but now im not in ketosis and cant figure out why.

    Jessica: Ive been trying to stay in ketosis since about the last week of Sept 2013. Was testing in ketosis purple on the sticks (eating all the normal stuff like eggs bacon HWC) but suddenly for no apparent reason i test in beige now. I was 147#, have got down to 139# soketimes as low as 137# but my weight will. not. budge for a month now. So im not in ketosis an dnot losing weight. What ur saying sound slike my case except i was in ketosis for a while there an dlosing weight. Im going to try to start adding back in carbs and see if that helps. Been reading about Insulin Index and theres many fatty/protein foods that raise Insulin (not blood sugar) more than carbs. And if lower insulin levels=weight loss, well, now that really complicates this situation cuz my experience is not fitting with what low carb people say. I dont know what to do, but i think adding back carbs slowly may help…afterall, Atkins had u add back carbs. Theres an article on Kicking Carb Clutter that talks about this.

    Tom, u know anything about Insulin Index? I havent found an insulin meter to test ur insulin levels. U know of one? Im on a month long weight loss stall and adding fat is what Everyone says to do. But that hasnt been working. I tried ur IF for 16 hours a day this week and still nothing. Know anything about adding back carbs?

    I’m not aware of an insulin meter, but you might look into getting a ketone meter. It’s more accurate than the strips. Using a ketone meter is how Jimmy Moore figured out he was eating too much protein.

    Not everyone needs to stay in ketosis or go zero-carb to lose weight. It’s a useful tool, but not the only tool. I’m not on a zero-carb diet and I’m usually in mild ketosis at best when I check. I have at least one high-carb meal on weekends, usually a Mexican dinner complete with rice and beans. The rest of week, it’s mostly meat, eggs and vegetables for me, but I’ll have half a sweet potato now and then.

  46. I had the same question when balancing fat protein and carbs. I finally used a calculator to determine my ketogenic ratio. I eventually lost 100 pounds. What I found worked best was to set a fixed amount of protein (in my case 90 grams) and carbohydrate at the highest at 20 grams, and adjusted my fat with the calculator to get the lowest amount of fat while still remaining at a ratio of 2 or above. This kept my calories in a deficit. If my protein goes up then I need to increase fat to stay in the keto ratio, although my calories may be over the amount to lose weight. Same with protein. But I can see ahead of time what my meal will do. A simple ketogenic ratio calculator is on this website.

    http://www.flexibleketogenic.com/

    Thanks for the link.

  47. Ross Korbell says:

    Hi all, I have read extensively on the lchf diet and I have one important question which I can find no answers. That is,
    What happens to the high fat that I eat if I am not in ketosis?

    Any insight on this will be greatly appreciated from the bottom of my heart. Thanks everyone for sharing so much info and experiences, it really helped tremendously. I already lost 14 pounds in lchf one month although I am probably not in ketosis because I eat bananas for the potassium and it prevents the “weird” feeling. I also eat things like fried chicken where there is carbs and sugars in the batter. However I am hesitant to purposely ingest fats although that is suppose to give better results. Perhaps I will feel more reassured if I know what happens to fats if I am not in ketosis..? Help!

    It’s not necessary to be in ketosis all the time to burn fat. If you’re losing weight, all is well. You’re using the fat you ingest for fuel.

  48. Linda says:

    I loved the LCHF program when I was on it. The problem? My blood sugar kept dropping terribly. Yes, I drank the salted broth, but it was really inconvenient to keep carrying around the broth. And, I was doing the program for over 3 weeks. I was so disgusted with my blood sugar dropping that I stopped the program. Change of diet shouldn’t be that inconvenient. I can understand for the first week or so drinking the broth, but over 3 weeks?? That “feeling” is way too scary for me. I even took the potassium and magnesium. VERY frustrating 🙁 If I didn’t have so many symptoms, I would have stayed on the program. Any one else experience this?

  49. Linda says:

    And how long is the broth supposed to be consumed for? A month? 2 months?

  50. Lucas says:

    Hi, I’ve been on a strict Atkins for 7 days and my ketones (measured with blood devices) are always below 0.6 mg/dl. I’ve read that too much protein could ruin it, so now I’m consuming 150g of protein, I’ve also read that carrots and other vegetables could take you out so I don’t eat much of them. Besides this I each a good portion of cheese. No sweetener, nothing besides protein (meat and eggs), vegetables and fat cheese (with 0 carbs on the label).
    So why am I still, after 7 days, below the sweet spot (1.5-3 mg/dl)?
    I’ve done Atkins before and in 3 days entered in Ketosis. Now it’s the second time I’m trying that impaired my Ketosis.
    I’ve measured my blood glicose just for the sake of not a pre-diabetic problem and it was in the morning 91 mg/dl (below 110) which is normal.
    Any light in the matter?
    Thanks

    • Tom Naughton says:

      Some people — I’m one of them — have to restrict protein quite a bit to get a higher reading on the ketone meter. That’s why I don’t aim for constant ketosis. Experience tells me I’m better off with a higher protein diet.

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