Reactions To Arguments About Ketosis

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So far I’ve only read about 2/3 of Keto Clarity, Jimmy Moore’s recent book.  (As usual, I’m behind on my reading.  The book was released three weeks ago.)  Since the book is about nutritional ketosis, naturally I’ve been replaying the debates about ketosis in my mind as I read.  I don’t want to clutter up my soon-to-appear review of the book with those debates (the book, after all, is mostly a how-to guide for people who have already decided to try a ketogenic diet) so I thought I’d chime in with some thoughts on ketosis now and review the book on its own merits.

I’m not a fan of caustic debates among bloggers and authors who all advocate a more-or-less paleo, whole-foods diet but disagree on safe starches or ketosis.  I explained why in my post about Differences, Commonalities and the Judean People’s Front.  We agree far more than we disagree, but when the topic of ketosis comes up, you can almost sense some people wanting to yell “Splitters!” across the coliseum.

Depending on which splitter has the floor, nutritional ketosis is either the natural human metabolic condition and should be sought by everyone who wants to be lean and healthy, or it’s an emergency-only condition that will ruin your metabolism and possibly kill you.  I don’t buy either argument, at least not as a blanket statement for everyone.  I believe achieving ketosis could be beneficial or not, depending on the individual.  So I’ll just toss out some of the arguments I’ve come across recently in books, blogs and podcasts and respond with what went through my head when I heard them – and that’s all these are: my personal reactions to those arguments.

Ketosis was the natural metabolic state of our Paleolithic ancestors.

I used to believe that, but I don’t anymore.  I think paleo people probably drifted in and out of ketosis, depending on the season and what foods were obtainable.  Fossilized bones and fecal samples tell us that many if not most early humans consumed a wide variety of plants, including starchy plants, and a whole lot of fiber.  We call them hunter-gatherers for a reason.  If all they ate was meat, they’d just be hunters.

As Jimmy’s book and others point out, to achieve and maintain nutritional ketosis, you not only have to restrict carbohydrates, you will probably have to restrict protein as well.  I don’t think paleo people would have restricted either.  As the Jaminets discussed in their Perfect Health Diet book, the hunter-gatherer tribes whose diets were documented typically consumed somewhere in the neighborhood of 15 to 30 percent of their calories as carbohydrates.  That alone would prevent nutritional ketosis for most of us.  Meanwhile, the Inuit – our poster-boys for a carb-free diet – apparently consumed rather a lot of freshly killed seafood that contained perhaps 20 percent of its calories in the form of glycogen, otherwise known as muscle starch.

But let’s suppose for the sake of argument (since the point has indeed been hotly debated) their seafood didn’t contain that much glycogen.  It’s been documented that adult male Inuits consumed an average of 240 grams of protein per day.  That’s not exactly what I’d call protein restriction, and I find hard to believe anyone would stay in nutritional ketosis while eating that much protein.

Paleo humans only ate plants as a fallback food if there wasn’t enough meat available.

I know that one isn’t true.  At least it wasn’t true for many Native American tribes.  I just recently read that in areas where hunting tribes and farming/gathering tribes lived near each other, they got together for food swaps.  The hunters traded meat for maize, beans, squash, etc.  I don’t think they’d voluntary trade away precious meat for what they considered a desperation-only food.  They must have liked those starchy plant foods.  As someone who enjoyed fresh squash from Chareva’s garden with dinner a couple of nights ago, I can tell you I’d happily swap some excess meat for it.

If you’re not in nutritional ketosis, it means you’re still a sugar-burner.

Simple math says otherwise.  I believe (as do the Jaminets, by the way) that we should get most of our energy from fat.  But you can get most of your energy from fat without being in nutritional ketosis, which is defined as a reading of 1.0 or higher on a blood ketone meter.  Let’s look at some numbers.

Suppose I consume 2,000 calories in a day, including 100 grams of protein and 100 grams of carbohydrate – in other words, roughly what I consumed during my Fat Head fast-food diet.  That would be 800 calories from protein and carbohydrates combined, plus 1200 calories from fat.  My brain would have used up much of the carbohydrate, and since my muscles didn’t shrink, I certainly wasn’t converting all that protein to glucose and using it for fuel.  But what the heck, for the sake of argument, I’ll say all 800 protein and carbohydrate calories were used for energy.

With me so far?  Good.

Given the weight I lost during that month, I was burning at least 3,000 calories per day, possibly more.  That means I was burning 2200 calories or more in the form of fat … which means even if every gram of carbohydrate and protein was used for fuel (which it wasn’t), 73% of my energy needs came from fat.  So I obviously wasn’t a sugar-burner.  But I can tell you from my own n=1 attempt at maintaining nutritional ketosis that I can’t do it while consuming 100 grams of protein and 100 grams of carbohydrate in a day.

Here’s another recent example:  as I recounted on the blog, I spent five hours last Saturday clearing the brush from our fields.  It was hard, physical work that no doubt burned rather a lot of calories.  For breakfast (my only meal before all that work), I had four eggs fried in butter and two pieces of gluten-free toast slathered in butter.  The toast provided 22 grams of carbohydrate, or a whopping 88 calories.  If I wasn’t burning mostly fat during the day’s labors, I would have keeled over.  And yet I wasn’t in nutritional ketosis.  I checked out of curiosity and registered 0.4 on the meter.

If you don’t feel good or experience health problems while in a constant state of ketosis, there’s something wrong with you and you need to fix it.

I disagree completely, and when I hear that one, it sounds eerily like vegan-think.  Tell a vegan you felt lousy while trying to give up animal foods, and she (because most vegans are she) will reply that meat is evil, we know it’s bad for you, so if you don’t feel good without meat in your diet it means you’re addicted to meat, or you’re not doing your vegan diet correctly, or there’s an underlying health problem you need to identify and fix so you can give up meat.

Nonsense.  If you feel lousy on a vegan diet but then feel better after eating a steak, it means you should eat the steak.  That’s how any proponent of a paleo diet would reply.

But if you tell some people in the everyone should be in ketosis crowd that you felt better and saw some health problems disappear after eating two or three potatoes per week, suddenly the potato becomes like meat to a vegan.  No, no, no, the potato is bad!  If you feel better after eating the potato, it means you’re not doing your ketogenic diet correctly.  You need more fat.  You need to eat nose-to-tail.  Something is still broken in your metabolism, so you need to dig deeper and find the underlying issue and fix it.

No, it means you should eat the potato.

The whole premise of paleo diets is that the ideal human diet was shaped by evolution.  The diet that kept our paleo ancestors healthy is the diet that will keep us healthy too.  For reasons I explained above, I don’t believe our paleo ancestors lived in a state of chronic ketosis.  There’s no reason we should all be genetically geared to thrive on a diet that none of our ancestors actually consumed.  In fact, adopting that diet might be a bad idea for some people.

But once again for the sake of argument, let’s suppose that with enough diligence and determination, you could identify that deep, underlying problem that’s causing you to feel lousy when you stay in ketosis for weeks on end.   Here are your options:

  • Spend months of your life and hundreds if not thousands of dollars undergoing tests, waiting for results, undergoing more tests, digging and researching and visiting specialists and perhaps finally identifying that deep, underlying metabolic problem that caused you to feel good after eating a potato … but feeling like crap until you do identify the deep, underlying metabolic problem.
  • Eat the potato, feel good, and go on your merry way.

Pretty easy choice, if you ask me.

Ketosis will ruin your metabolism.

Like I said, I believe staying in chronic ketosis could be a bad idea for some people.  That doesn’t mean it’s bad for everyone.  Dr. Jeff Volek has lived on a ketogenic diet for decades.  So has Nora Gedgaudas.  Dr. Andreas Eenfeldt has been measuring ketones and maintaining ketosis for (if memory serves) at least two years now. If their metabolisms are broken and their health is going down the tubes, you sure as hell can’t tell by looking at them.

Back during the raging safe-starch debate on this blog, I mentioned that I’ve heard from people who lost weight and felt better after adding some starch back into their diets, and that I believe them.  I have no reason not to believe them.  I’ve also seen posts and read comments from people who were able to lose weight and keep it off for the first time in their lives after going ketogenic.  I believe them too.

A ketogenic diet has clearly been a godsend for Jimmy Moore.  Yes, you could argue (as so many internet cowboys have) that if Jimmy can’t keep his weight down on anything other than a strictly ketogenic diet, it means his metabolism is broken.  Fine.  Drinking a 12-pack of Coca-Cola per day and ballooning up to over 400 pounds by age 30 probably will break your metabolism.

But if going ketogenic allows you to feel great and lose nearly 80 pounds and keep it off, then go ketogenic … unless, of course, you believe it’s better to remain obese while spending years of your life and hundreds if not thousands of dollars undergoing tests, waiting for results, undergoing more tests, digging and researching and visiting specialists and perhaps finally identifying that deep, underlying metabolic problem that prevents you from losing weight while eating potatoes.

Ketogenic diets are stupid because everyone apart from diabetics should be able to consume at least 150 grams of carbohydrate per day.

I don’t think the everyone should eat starch argument makes any more sense than the no one should eat starch argument.  All humans have the AMY1 gene, which makes it possible to digest starch.  That’s one of the many reasons I believe our paleo ancestors ate starchy plants.  But some clearly ate a lot more than others.  Let’s review a quote from Denise Minger’s book Death By Food Pyramid:

It turns out the number of AMY1 copies contained in our genes is not the same for everyone. And the amount of salivary amylase we produce is tightly correlated to the number of AMY1 copies we inherited. AMY1 copy number can range from one to fifteen, and amylase levels in saliva can range from barely detectable to 50 percent of the saliva’s total production. That’s a lot of variation.

It sure is.  And that means some people can handle a whole lot more starch than others.  Research shows that people with fewer copies of the AMY1 gene are more likely to be obese.  To quote a study I mentioned in a previous post:

The chance of being obese for people with less than four copies of the AMY1 gene was approximately eight times higher than in those with more than nine copies of this gene. The researchers estimated that with every additional copy of the salivary amylase gene there was approximately a 20 per cent decrease in the odds of becoming obese.

That’s why when people have pointed to the Kitavans as examples of people who are lean and healthy despite a diet very high in starch, I’ve replied, “Good for them.  But I’m not a Kitavan.”  I haven’t had a genetic test to determine how many AMY1 copies are floating around in my DNA, but given the difference in my weight and health on high-starch vs. low-starch diets, I suspect I’m in that under-four-copies group.

I usually eat two meals per day.  To get 150 grams of carbohydrate into my diet, I’d have to consume 75 per meal.  Not a chance.  After supplementing with resistant starch, I’ve found I can have that potato or squash with dinner and end up with a post-meal glucose peak in the 125-135 range.  I’m fine with that.  So now I have a potato with dinner a few times per week.

But when I consumed two potatoes (i.e., about 70 grams of starch) awhile back as an experiment, my glucose ended up at 195 and stayed high for two hours.  I’m not fine with that.  And no, I don’t think it’s because I need to eat more starch to raise my tolerance.  That’s just another version of the if you can’t be healthy on this diet, it means you’re not doing it right argument.  If I’m in the low-amylase group, there is no way for me to do it right.  Yes, I can eat some starch – but only some.  Based on my experiences and n=1 experiments, I’d say 100 grams is the upper limit for me.  Your upper limit may be higher or lower.  We’re all different.

A ketogenic diet will starve your gut bacteria and ruin your gut health.

If there’s one warning ketogenic dieters should pay attention to, I’d say that’s the one … although I think the possible danger lies in a lack of fiber, not ketosis per se.  I recently watched a two-part series on the gut biome produced by ABC Catalyst in Australia.  The bottom line is that our gut bacteria need fiber, period.  It’s their food.  I no longer buy the notion tossed around by some low-carbers that fiber is useless.  It’s not only useful, it’s probably crucial for long-term gut health.

In part one of the series, researchers did some blood work on a young, very fit gymnast after feeding him a meal of French fries and other junk food.  He was surprised to learn that his body was pumping out a higher-than-average level of insulin to normalize his blood sugar – in other words, he was at risk for developing diabetes.  (The doctor/journalist who hosted the episode only pumped out half as much insulin after the same meal.)  In part two, after a month on a high-fiber diet, the same gymnast ate the same junk-food meal.  This time his body required only half as much insulin to do the job.  Fiber has been shown in research to improve insulin sensitivity – and since most of us who adopt low-carb diets want to lower our insulin levels, fiber should be part of the diet.

That doesn’t necessarily mean the fiber has to come from starchy plants, but if were on a ketogenic diet, I’d sure as shootin’ be loading up on as many high-fiber vegetables as I could.  I’d also try supplementing with resistant starch as soon as possible.

Okay, those are my thoughts about the ketosis pro and con arguments.  You may now proceed to the comments and yell “Splitter!”

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207 thoughts on “Reactions To Arguments About Ketosis

  1. Ulfric Douglas

    “As Jimmy’s book and others point out, to achieve and maintain nutritional ketosis, you not only have to restrict carbohydrates, you will probably have to restrict protein as well. ”
    Sensible.
    What is bizarre is talking about food from two points of view as if they’re the same : a starving early human has very very different nutritional aims to an old fat American with way too much food and leisure. (I mean no insult : I count myself close to the latter)
    Let’s be clear on what we’re aiming for.

    Reply
  2. Ulfric Douglas

    “As Jimmy’s book and others point out, to achieve and maintain nutritional ketosis, you not only have to restrict carbohydrates, you will probably have to restrict protein as well. ”
    Sensible.
    What is bizarre is talking about food from two points of view as if they’re the same : a starving early human has very very different nutritional aims to an old fat American with way too much food and leisure. (I mean no insult : I count myself close to the latter)
    Let’s be clear on what we’re aiming for.

    Reply
  3. David

    Tom,
    If you’re at an ideal weight and your health markers are good, is there any reason to think being in ketosis all the time is desirable? I tend to fall into the Jaminet’s range for macro-nutrients. I do plan to read Keto Clarity in the near future.

    It seems like to get in the fat range for ketosis, I would need to jack up the fat calories (chug olive oil, eat coconut oil by the ice cream scoop or eat eggs and bacon fried in butter and cheese with a side of avocado). Or eliminate fruit and most veggies.

    Reply
    1. Tom Naughton

      I believe ketosis is effective for obesity, epilepsy, diabetes, possibly some cancers, possibly Alzheimer’s, and probably other conditions where it hasn’t yet been tested. I am not at all against people going on ketogenic diets if they have a specific goal in mind for which ketosis may be beneficial.

      I do not, however, believe staying in chronic ketosis is necessary for ideal health. For some people, chronic ketosis will clearly produce less-than-ideal health. I suspect that for most of us, the safest strategy for acquiring the benefits of ketosis is to make it a cyclical condition.

      Reply
  4. David

    Tom,
    If you’re at an ideal weight and your health markers are good, is there any reason to think being in ketosis all the time is desirable? I tend to fall into the Jaminet’s range for macro-nutrients. I do plan to read Keto Clarity in the near future.

    It seems like to get in the fat range for ketosis, I would need to jack up the fat calories (chug olive oil, eat coconut oil by the ice cream scoop or eat eggs and bacon fried in butter and cheese with a side of avocado). Or eliminate fruit and most veggies.

    Reply
    1. Tom Naughton Post author

      I believe ketosis is effective for obesity, epilepsy, diabetes, possibly some cancers, possibly Alzheimer’s, and probably other conditions where it hasn’t yet been tested. I am not at all against people going on ketogenic diets if they have a specific goal in mind for which ketosis may be beneficial.

      I do not, however, believe staying in chronic ketosis is necessary for ideal health. For some people, chronic ketosis will clearly produce less-than-ideal health. I suspect that for most of us, the safest strategy for acquiring the benefits of ketosis is to make it a cyclical condition.

      Reply
      1. David

        Tom,
        Thanks for the feedback, it makes sense to me. I was listening to Jimmy’s podcasts with experts from Keto Clarity, and somebody mentioned if your: insulin is low, leptin is low, blood glucose is low, triglycerides are low and you are eating quality fats then chances are you are in good health, even if you are not in a constant state of ketone.

        Reply
  5. Clover

    So, having skimmed the comments, I have a question: Does nutritional ketosis become easier to maintain over time? Since mid-puberty I’ve been eating low carb, at >50g carbohydrate per day. I’ve never restricted protein (since I wasn’t aiming for ketosis specifically), and having quickly estimated my consumption today it looks like I eat a good 100-150g of the stuff.
    From what I hear, protein should be restricted more than that to maintain ketosis, yet whenever I check my urine levels, I come up ketotic.
    Just wondering if the Inuit and other folk eating a meat heavy diet tend to adapt to ketosis even with higher protein intake. I’m nowhere near the 240g mark today, of course, but there have been times when I’ve just pigged out on jerky and bacon and still been in ketosis afterwards…so maybe it’s not actually a metabolically extreme state if the body is adapted to it?

    Reply
    1. Tom Naughton

      If you’re in ketosis, then you can handle more protein than a lot of other people. The Inuits weren’t in ketosis when tested. No surprise, with all that protein and the glycogen in freshly-killed seafood.

      Reply
      1. LCC

        This is so true. I know there are days when I’m at 50% protein and I stay in a mild state. If I eat 70-80% I’m high.

        Over the holidays, ate pie and other sugary foods (at a minimum of course) and maintained mild ketosis.

        Reply
  6. Clover

    So, having skimmed the comments, I have a question: Does nutritional ketosis become easier to maintain over time? Since mid-puberty I’ve been eating low carb, at >50g carbohydrate per day. I’ve never restricted protein (since I wasn’t aiming for ketosis specifically), and having quickly estimated my consumption today it looks like I eat a good 100-150g of the stuff.
    From what I hear, protein should be restricted more than that to maintain ketosis, yet whenever I check my urine levels, I come up ketotic.
    Just wondering if the Inuit and other folk eating a meat heavy diet tend to adapt to ketosis even with higher protein intake. I’m nowhere near the 240g mark today, of course, but there have been times when I’ve just pigged out on jerky and bacon and still been in ketosis afterwards…so maybe it’s not actually a metabolically extreme state if the body is adapted to it?

    Reply
    1. Tom Naughton Post author

      If you’re in ketosis, then you can handle more protein than a lot of other people. The Inuits weren’t in ketosis when tested. No surprise, with all that protein and the glycogen in freshly-killed seafood.

      Reply
      1. LCC

        This is so true. I know there are days when I’m at 50% protein and I stay in a mild state. If I eat 70-80% I’m high.

        Over the holidays, ate pie and other sugary foods (at a minimum of course) and maintained mild ketosis.

        Reply
  7. Michael

    “That’s why when people have pointed to the Kitavans as examples of people who are lean and healthy despite a diet very high in starch…”

    And these people seem to forget that the Kitavans eat at most 1.5 meals per day and that the main source of their energy is the big end of the work day meal.

    They don’t eat a high starch breakfast followed by a high starch lunch followed by a high starch dinner because most of the time they just don’t eat period until dinner time comes.

    1. they don’t eat processed crap sold in boxes, they eat clean food and have been doing so for who knows how many thousands of years

    2. they do intermittent fasting and have been doing it for who knows how many thousands of years

    We obviously can’t compare their diet to other diets especially modern western diets simply by looking at the starch content or the macronutrient ratios. Duh.

    Reply
  8. Michael

    “That’s why when people have pointed to the Kitavans as examples of people who are lean and healthy despite a diet very high in starch…”

    And these people seem to forget that the Kitavans eat at most 1.5 meals per day and that the main source of their energy is the big end of the work day meal.

    They don’t eat a high starch breakfast followed by a high starch lunch followed by a high starch dinner because most of the time they just don’t eat period until dinner time comes.

    1. they don’t eat processed crap sold in boxes, they eat clean food and have been doing so for who knows how many thousands of years

    2. they do intermittent fasting and have been doing it for who knows how many thousands of years

    We obviously can’t compare their diet to other diets especially modern western diets simply by looking at the starch content or the macronutrient ratios. Duh.

    Reply
  9. LCC

    You should definitely read Stefansson’s actual accounts of the Inuit. Many populations of Inuit never saw a fish. And those that did or had an abundance of lean meats made sure to have plenty of whale blubber on hand to dip their lean in. This was a critical takeaway from his books.

    LCC

    Reply
  10. LCC

    You should definitely read Stefansson’s actual accounts of the Inuit. Many populations of Inuit never saw a fish. And those that did or had an abundance of lean meats made sure to have plenty of whale blubber on hand to dip their lean in. This was a critical takeaway from his books.

    LCC

    Reply

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