Reactions To Arguments About Ketosis

      207 Comments on Reactions To Arguments About Ketosis

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. Bret

    Reasonable as always, Tom. I’ll just share my thoughts piece by piece:

    I think paleo people probably drifted in and out of ketosis, depending on the season and what foods were obtainable.

    And likely even within the same day. Many people likely experience ketosis almost nightly, due to the overnight fast–especially if you reach/approach that 16-hr fasting window the Jaminets recommend.

    [240 g/day are] 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.

    I have seen bloggers outright ignore this fact, or dismiss it with the most unsatisfying explanation ever (one person said, “It’s really hard to eat raw meat, so I doubt they really ate that much”). I totally agree with your point–I would be shocked if this much protein allowed for nutritional ketosis. The notion seems simply absurd, given what we know about the need to limit protein strictly to stay in ketosis.

    That means I was burning 2200 calories or more in the form of fat …

    Of which, given your example diet, 1000 or so came from your body’s internal fat storage. This example really illustrates the apparent sensibility of the Jaminets’ recommendation for folks trying to lose weight to actually cut the fat a bit…just not cut it way down and replace the missing fat calories with a truckload of carbohydrates. Just the minimum amount of whole-food carbs to meet your body’s glucose needs (maybe even a bit less), plus an adequate amount of whole-food protein to maintain body mass, plus enough whole-food fat to reach satiety and prevent nutrient deficiency, but no more (or at least not much more). Seems to make perfect sense to me.

    In fact, adopting [a diet of chronic ketosis] might be a bad idea for some people.

    Not the least notable of which are the Inuit, who, as Richard Nikoley has pointed out time and again, miserably failed a glucose tolerance test after a fast-induced state of ketosis. Maybe pure glucose shouldn’t be the measuring stick for this kind of stuff, but… Being that they had fantastic readings before their fast, I am thinking this constitutes a pretty strong argument for folks to think long, hard, and twice before committing to chronic ketosis.

    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.

    Agreed. Given the relationships that have been uncovered between the gut flora and the rest of the body, it seems like a dumb idea to keep viewing our bodies as machines with a fuel tank that only takes one type of gas. Rather, we and our gut bacteria appear to be codependent organisms living in symbiotic homeostasis. Keeping those bacteria healthy, which includes feeding them, seems like a really smart idea.

    Me personally: At the end of the day, I don’t care whether I am technically in ketosis or not. I am not going to eat gobs of fat, watch my protein like a hawk, and actively avoid carbohydrates. That seems unnatural, tedious, and unrealistic, and excessively so on all three counts–but that is me. Rather, I aim to get enough animal protein each day (and by a variety of sources, including offal), not sparing the fat that comes with it, and eat plenty of fibrous starchy plants, without overdoing it so that I risk an inappropriately large glucose spike. Neither highly processed vegetable oils nor refined carbs, such as sugar and white flour, need be a part of the equation. Might not satisfy the extremists on either side, but it sure beats the hell out of the S.A.D.

    1. Tom Naughton

      All good points, Bret. I’m not at all opposed to people going through the counting and measuring required to achieve nutritional ketosis if they’re after a specific benefit of being in ketosis. But for most of us, it’s a relatively simple matter of just eating real food.

  2. Garry Lee

    I find your stuff very interesting, Tom. You have an open mind about things, which is something very important in my view. I’m on 50g carbs a day for 8 months, occasionally straying up to 70 but not beyond. This is not a matter of belief for me, but it’s been so successful in losing and then maintaining weight, for me, that’s I’ve not considered changing it for the moment.
    I read all the science. I’m a retired doctor. Coming from a fat family (all my father’s family were fat and his mother and one brother had DM2) I’ve had to go low carb to get my weight down. Despite exercising like a madman all my adult life (I’m 64) I was starving until I cut the carbs.
    Looking forward to you review!!

    1. Tom Naughton

      Better to find the key at age 64 than never, but isn’t it a shame we didn’t all learn about this stuff when we were young whippersnappers?

      1. Randal L. Schwartz

        I’m still happy I got informed (thanks to Andy) at 50, before my first cardiac event. And at the same time, angry that I spent my entire adult life being “chubby” (or worse) for no darn reason, except that the entire medical community had been hoodwinked. Geez. Someone owes me my life.

  3. Garry Lee

    A comment on a comment above. The Inuit failing a glucose tolerance test is a normal finding for someone who’s been in dietary ketosis. This is the cause of the carb-induced brain fog. It’s physiological (i.e. a harmless adaptation). If you’re going to have a GTT and are on a ketogenic diet, you should up your carbs to 150g per day for three days. Otherwise, you are going to appear diabetic when you’re not.
    That’s a piece of info I picked up on my reading.
    Another thing is that someone on a ketogenic diet may have a slightly higher fasting glucose than he did have. Again, a physiological adaptation.
    So, instead of jumping to conclusions, as many of the “anointed” do, look this stuff up.

    1. Tom Naughton

      The Inuit passed a glucose tolerance test with flying colors while on their normal diets, then failed after ketosis was induced via fasting. So if being in ketosis causes a person to fail a GTT — which it does — it’s very unlikely their normal diet was ketogenic. That was the point.

  4. Bret

    Reasonable as always, Tom. I’ll just share my thoughts piece by piece:

    I think paleo people probably drifted in and out of ketosis, depending on the season and what foods were obtainable.

    And likely even within the same day. Many people likely experience ketosis almost nightly, due to the overnight fast–especially if you reach/approach that 16-hr fasting window the Jaminets recommend.

    [240 g/day are] 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.

    I have seen bloggers outright ignore this fact, or dismiss it with the most unsatisfying explanation ever (one person said, “It’s really hard to eat raw meat, so I doubt they really ate that much”). I totally agree with your point–I would be shocked if this much protein allowed for nutritional ketosis. The notion seems simply absurd, given what we know about the need to limit protein strictly to stay in ketosis.

    That means I was burning 2200 calories or more in the form of fat …

    Of which, given your example diet, 1000 or so came from your body’s internal fat storage. This example really illustrates the apparent sensibility of the Jaminets’ recommendation for folks trying to lose weight to actually cut the fat a bit…just not cut it way down and replace the missing fat calories with a truckload of carbohydrates. Just the minimum amount of whole-food carbs to meet your body’s glucose needs (maybe even a bit less), plus an adequate amount of whole-food protein to maintain body mass, plus enough whole-food fat to reach satiety and prevent nutrient deficiency, but no more (or at least not much more). Seems to make perfect sense to me.

    In fact, adopting [a diet of chronic ketosis] might be a bad idea for some people.

    Not the least notable of which are the Inuit, who, as Richard Nikoley has pointed out time and again, miserably failed a glucose tolerance test after a fast-induced state of ketosis. Maybe pure glucose shouldn’t be the measuring stick for this kind of stuff, but… Being that they had fantastic readings before their fast, I am thinking this constitutes a pretty strong argument for folks to think long, hard, and twice before committing to chronic ketosis.

    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.

    Agreed. Given the relationships that have been uncovered between the gut flora and the rest of the body, it seems like a dumb idea to keep viewing our bodies as machines with a fuel tank that only takes one type of gas. Rather, we and our gut bacteria appear to be codependent organisms living in symbiotic homeostasis. Keeping those bacteria healthy, which includes feeding them, seems like a really smart idea.

    Me personally: At the end of the day, I don’t care whether I am technically in ketosis or not. I am not going to eat gobs of fat, watch my protein like a hawk, and actively avoid carbohydrates. That seems unnatural, tedious, and unrealistic, and excessively so on all three counts–but that is me. Rather, I aim to get enough animal protein each day (and by a variety of sources, including offal), not sparing the fat that comes with it, and eat plenty of fibrous starchy plants, without overdoing it so that I risk an inappropriately large glucose spike. Neither highly processed vegetable oils nor refined carbs, such as sugar and white flour, need be a part of the equation. Might not satisfy the extremists on either side, but it sure beats the hell out of the S.A.D.

    1. Tom Naughton Post author

      All good points, Bret. I’m not at all opposed to people going through the counting and measuring required to achieve nutritional ketosis if they’re after a specific benefit of being in ketosis. But for most of us, it’s a relatively simple matter of just eating real food.

  5. Garry Lee

    I find your stuff very interesting, Tom. You have an open mind about things, which is something very important in my view. I’m on 50g carbs a day for 8 months, occasionally straying up to 70 but not beyond. This is not a matter of belief for me, but it’s been so successful in losing and then maintaining weight, for me, that’s I’ve not considered changing it for the moment.
    I read all the science. I’m a retired doctor. Coming from a fat family (all my father’s family were fat and his mother and one brother had DM2) I’ve had to go low carb to get my weight down. Despite exercising like a madman all my adult life (I’m 64) I was starving until I cut the carbs.
    Looking forward to you review!!

    1. Tom Naughton Post author

      Better to find the key at age 64 than never, but isn’t it a shame we didn’t all learn about this stuff when we were young whippersnappers?

      1. Randal L. Schwartz

        I’m still happy I got informed (thanks to Andy) at 50, before my first cardiac event. And at the same time, angry that I spent my entire adult life being “chubby” (or worse) for no darn reason, except that the entire medical community had been hoodwinked. Geez. Someone owes me my life.

        1. Tom Naughton Post author

          Easy solution. Live to be 105 and enjoy every minute of it. You’ll have that life you’re owed.

  6. Garry Lee

    A comment on a comment above. The Inuit failing a glucose tolerance test is a normal finding for someone who’s been in dietary ketosis. This is the cause of the carb-induced brain fog. It’s physiological (i.e. a harmless adaptation). If you’re going to have a GTT and are on a ketogenic diet, you should up your carbs to 150g per day for three days. Otherwise, you are going to appear diabetic when you’re not.
    That’s a piece of info I picked up on my reading.
    Another thing is that someone on a ketogenic diet may have a slightly higher fasting glucose than he did have. Again, a physiological adaptation.
    So, instead of jumping to conclusions, as many of the “anointed” do, look this stuff up.

    1. Tom Naughton Post author

      The Inuit passed a glucose tolerance test with flying colors while on their normal diets, then failed after ketosis was induced via fasting. So if being in ketosis causes a person to fail a GTT — which it does — it’s very unlikely their normal diet was ketogenic. That was the point.

    2. Bret

      To supplement Tom’s reply, it was really Richard’s point that the Inuit were not in ketosis regularly. My point here is that ketosis does not necessarily result in universally excellent biomarkers, the way many unconditional ketosis trumpeters imply. People considering going into chronic ketosis deserve to know the full facts, not just the one-sided view many people give.

      On to your retort: So your answer to a post-ketosis BG in the 300s is that the literature says you should up your carbs to 150 g/day for three days? First, I don’t care what any literature says I “should” do. That’s a silly appeal to authority to begin with. Secondly, What is the purpose of a GTT if you are going to modify your normal diet beforehand, other than to pass an insurance physical? Sounds like you’re defending ketosis for the sake of defending ketosis. By the way, what do you think is happening to your BG over those three days, as you prepare for your GTT? If your reaction is like the Inuit’s, then it is hitting the 300s. All to get a good GTT result… Doesn’t sound too smart to me.

      Care to elaborate on your point about a higher fasting BG being a physiological adaptation? Much like your previous point, that tells us absolutely nothing useful. Tom’s BG in the 190s was a physiological adaptation of his eating those potatoes. Getting fat from overconsuming refined carbs is a physiological adaptation. Red, inflamed skin from scrubbing yourself with a steel brush is a physiological adaptation. Calling a phenomenon whose cause nobody disputes a physiological adaptation tells us nothing in a debate about the pros and cons of conflicting dietary philosophies. A higher BG is a higher BG in my book, and is not a flattering point in favor of ketosis.

      I do not appreciate one bit your suggestion that I have jumped to conclusions, displayed the same attitude as ‘the anointed’, and failed to look this stuff up. Those are all three assumptions, and quite wrong ones, at that.

    3. Damocles

      From an evolutionary perspective, it makes perfect sense for the body to increase insulin resistance during ketosis.
      Its a signal for the body that carbs are very scarce at the moment. So by increasing insulin resistance, cells wich can well burn lipits and ketons refuse to snatch the glucose from the blood, – leaving more for the most important organ: the brain.
      As the brain needs (even in ketosis) a certain amount of glucose to funtion.

      The insulin resistance in ketosis is a smart allocation of glucose (to the brain), when carbs are coming available,
      and to not have to rely on gluconeogenesis from proteins.

      When carbs come available again regularily, the insulin resistance can be reduced,
      so all the other cells can uptake this fuel.

      1. Richard Nikoley

        Damocles:

        “From an evolutionary perspective, it makes perfect sense for the body to increase insulin resistance during ketosis.”

        Yes, this is all very well known and understood, including the fact that some textbooks (I used to have a handy reference) indicate that after a time of adaptation, the brain’s absolute glucose requirement goes down (like from 120-130g per day to ~60).

        Here’s your blind spot, though, in my view. This is not an adaptation to ketosis. It’s an adaptation to STARVATION. Ketosis itself is a physiological adaptation to starvation. So-called nutritional ketosis is really a hack designed to get a person into ketosis by means other than fasting or chronic starvation, and in a very odd way: restriction of not just carbohydrate to near nil, but restriction of protein as well. Stop and think about it. How does that even pass anyone’s smell test as a desirable daily state?

        I concede that long-term ketosis likely has some therapeutic value, as do a number of pharmaceuticals and other therapies when properly prescribed by a clinician with LOTS OF EXPERIENCE. I also concede, in fact strongly support, the notion that episodic ketosis is likely very beneficial. Autophagy. It’s called fasting and just about every religious tradition includes it in some way for good reasons having nothing to do with pleasing doG.

        But, chronic starvation in a bad idea, a priori. I suspect chronic ketosis to model a starvation state through restriction of both carbohydrate and protein at the same time, requiring upwards of 80% fat—that’s pretty vapid in terms of micronutrients—to be an equally bad idea for the vast majority of people the vast majority of the time.

        This really falls under the “extraordinary claims” clause. As ought anything so unnatural on its face.

        1. Bret

          I would add to Richard’s remarks that multiple pieces of evolutionary evidence support the idea that humans function optimally on some amount of whole-food carbs. Our teeth are somewhat of a compromise between the long, sharp fangs of a giant feral cat and the short, flattened molars of sheep and cows. Same could be said of our digestive tracts (carnivores’ are shorter and simpler than ours; herbivores’ are longer and more complex–multiple stomachs and whatnot).

          I have a hard time reconciling the notion that chronic ketosis is biologically optimal with the evidence of ketosis-induced glucose intolerance/insulin resistance, as well as the anecdotes rolling in by the hundreds saying that people are experiencing the symptoms Tom and Richard have mentioned (cold hands/feet, brain fog, creeping weight gain, etc).

          [i]Can[/i] we function in chronic ketosis? Absolutely. And it is certainly plausible that for [i]some[/i] people with various and severe metabolic derangements, chronic ketosis might be their best bet for the longest and happiest possible life. But as a baseline for otherwise healthy people (this is the real essence of the debate, in my mind), it makes little sense (to put it gently), in light of all the contradictory evidence.

          It disappoints me immensely to see that many respected experts/gurus in the low-carb community have fallen victim to a groupthink-reinforced confirmation bias of VLC/ZC’s supposed biological superiority with a dependence on one-liners to get them out of every argument. One such one-liner is (paraphrased), “There is absolutely no necessity for dietary glucose or its more complex cousins.” That’s a cute thought, but it only rebuffs the assertion that humans cannot function [i]at all[/i] on chronic ketosis. I cannot speak for anyone else, but I myself do not dispute that vegan propaganda-reeking statement one bit. The question of [i]optimal[/i] functionality, on the other hand, is a much more complex and multi-faceted question. It certainly cannot be answered with such a simple and narrow-minded quip.

          1. Tom Naughton Post author

            I should clarify in case anyone misunderstands: I never personally had the cold hands and feet or brain fog, didn’t start creeping up in weight, and my thyroid was normal when I had a battery of lab tests last year in honor of turning 55. I’ve heard from plenty of people who did have those problems on VLC, and I believe them.

            I decided to move more towards a Perfect Health diet because I wanted to make sure I’m feeding my gut bacteria adequately. I was at 100 grams of carb when I shot Fat Head, and those were lousy carbs, so I was pretty sure I could return to that level with potatoes and squash without any issues. My weight is still the same as when I was closer to VLC, so obviously some extra starch hasn’t been a problem.

            1. Bret

              Sorry for the potential confusion. I didn’t mean to suggest that either you or Richard had experienced those symptoms, only mentioned that others had reported them.

              Since I’m already burning another comment, I’ll mention my own experience. I actually did get into some of that brain fog eating VLC. Nothing horrible or extreme, but still noticeable.

              Now, I have added back in a decent dose of starch (regularly eating potatoes, sweet potatoes, and beans, among a few other things), and I have not noticed the fog in months, or had any other perceptible problems, with weight or otherwise.

      2. Richard Nikoley

        Duck emailed a paper earlier and guess what I happened upon (emphasis mine)?

        http://apjcn.nhri.org.tw/server/APJCN/12/4/396.pdf (pg 398)

        Studies examining the long-term safety of ketogenic diets are few in number with most of the available data coming from the application of ketogenic diets in the treatment of paediatric epilepsy.18 The diet used in this patient group is a high-fat, adequate protein, low- carbohydrate diet designed to mimic the biochemical changes that occur during starvation. Studies of children who have followed a ketogenic diet for management of epilepsy found that about 50% of children will continue on the diet for at least a year.18 Reasons for discontinuing the ketogenic diet were due to either a lack of efficacy or due to the restrictive nature of food choices. Common adverse events attributed to the diet included dehydration, gastrointestinal symptoms, hypoglycaemia, as well as carnitine and vitamin deficiencies. Cognitive effects, hyperlipidaemia, impaired neutrophil function, uroli- thiasis, optic neuropathy, and osteoporosis have also been reported to occur in some patients following ketogenic diets.19 In addition, elevation of blood uric acid levels is a well-recognised side effect of prolonged ketosis.7

        Extraordinary claims demand extraordinary evidence. Can everyone agree that remaining in perpetual ketosis by means of restricting BOTH carbohydrate AND protein in other to “mimic the biochemical changes that occur during starvation” is:

        1. A-priori unnatural, since the biochemistry in a state of starvation is not a NORMAL physiological state.

        2. An extraordinary claim, when asserted as some sort of optimal diet for long term health or weight maintenance.

        …Thus, requiring very extraordinary evidence, up to a standard that ought to be absolute proof. Otherwise, everyone out there doing this “nutritional” ketosis nonsense in perpetuity is conducting a massive experiment with zero basis in natural reality.

        Just the word itself is a complete scam. “Nutritional.” Let’s see, restrict both macronutrients with the most vitamins, minerals, phytonutrients, and replace it with the macronutrient with the very least by far of all those things. Call it “nutritional.”

        …Alright, now I’m getting angry.

  7. Tammy

    Tom – This is a great post – and exactly what I’ve been thinking or been believing for a long time. I believe our ancestors were in and out of ketosis as became necessary by environmental factors so they were quite adaptable.

    It’s funny I’ve been self experimenting since 2002, so quite a while now, and I’ve come up with a pretty definitive list of what works and what doesn’t for me. Recently my husband and I have been comparing results and though we both fall into the 2/3’s that can’t sustain the SAD without packing on the pounds, we both react quite differently to different foods via the handy glucose meter. For instance, I have no problem with eating starch as long as it doesn’t morph back into other grain based or junk items which I have to be careful of. I don’t lose weight eating starch, but I don’t gain weight either. And yes starch does actually make my gut happy, which until all the more recent info I hadn’t paid much attention to.

    My post meal readings with starch are always up in the 120’s which I’m ok with but my husband barely gets to 100 even though we both start out about the same. It’s funny because I’m of northern European decent and he’s southern Italian. He can definitely handle more of a carb load than I can but I’m way better with dairy. Like I don’t have any problem drinking milk or anything (even though I haven’t had it for quite some time now) but I eat all other full fat dairy.

    I just think its fascinating being able to look at heritage and food consumption and things like that.

  8. Damocles

    I belive in the human nature of optimizing lazyness.

    In paleo nutritional terms that would mean:

    get the most amount of satisfacting nutrients with the least amount of work possible.
    These paleo groups of people would not have ignored the bush of ripe berries, or tubers that they saw.
    Nor would they have let the rabbit or antilope staggering around the camp walk by for ehtical reasons.

    If you have the tech of hunting (spears, clubs) you use it. Im sure the ancient arrows found where not used
    for shooting down apples.
    Also if you have the tech of fire, you can conveniently rost your tuber plants, wich might otherwise not be eadable.
    Same goes for rosting meat..

    I see ketosis as a nessecity when food was scarce, (no luck hunting, gathering, or the group travelling – having to move the camp elsewhere)
    The body fat is a wonderful battery, that works as it should, when the metabolism is not messed up.
    But when in season (fruits), or snatching that tasty honey from the bee hive, there is no need to rely on ketosis (draining the batteries).

    1. Tom Naughton

      Agreed. In fact, Jimmy has had people on his podcast who say ketosis is most beneficial when it’s cyclical.

  9. Justin

    I’m really loving this new “everybody’s different/lets all get along” mindsets that seem to be trickling out of this community. Nowadays, if anyone asks me if I think the food pyramid should be flipped upside down in the next update, my response is something like “it would probably be better than the current one for most people, but having a single nutritional diagram for everybody is a bad idea”. I think that in a perfect world, there should be allowed to be multiple ideas to try, all on a level playing field, with no single method being forced on anybody. The main problem I’ve seen with the “level” part is that scientists say things like “this is likely to be true, but we should keep testing and looking into it, and its possible that things could change in the future”, and governments say things like “We know this is true, doesn’t everybody?”.

  10. Alex

    Glucomannan (the stuff that shirataki noodles are made of) may be a good fiber for ketogenic dieters, as it’s also one of the butyrate promoting fibers. My experience is that it doesn’t have the gas, bloating, and cramping that raw potato starch has. There have been problems with glucomannan supplements in pill form causing intestinal blockages, so the best way to take it is powder mixed into a full glass of water, so that it is completely hydrated and won’t form hard clumps.

    As for the raw potato starch, it is an awesome thickener for cooked gravy and sauces.

    1. Bonnie

      Unless you’re like me. I’ve found that even a small amount of glucomannan causes very loose stools. It’s working well for my husband, tho. He adds a bit of SF fruit-flavored syrup to make it palatable.

      But I wonder if it would have the same effect on me made into shirataki noodles. I do like alfredo sauce!

      1. cavenewt

        I use konjac (glucomannan) noodles instead of regular pasta. Even my teenager will eat spaghetti on these noodles. You can get ’em at konjacfoods.com. They have a new style that uses a little bit of soluble oat fiber to improve the texture.

  11. PhilT

    I suspect you only really know if you’re a sugar burner by measuring your respiratory gases. As well as the carbs you ate before clearing the field you had muscle and liver glycogen reserves to pull on which are also carb based, and the added complication of the liver producing glucose while consuming fats.

    If my heart rate is over 120 I’m primarily burning carbohydrates (from respiratory analysis), even though I didn’t eat them. Does that make me a sugar burner ? probably. Perhaps there’s a terminology or definition problem here.

    I too struggle to get ketone levels into the single figures, although I have done so while consuming quite a lot of carbohydrate in an overall calorie deficit while working my nuts off physically.

    1. Tom Naughton Post author

      I suppose that would be the precise measurement, but even on the days I have a potato with dinner, I’m still usually under 100 grams of carbohydrate, plus I still go entire days on an almost-carb-free diet as a matter of taste preference. There just isn’t enough glucose in my diet for it to be anything other than a minor contributor to my fuel supply.

  12. tony

    Tom, you stated “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.”

    Can you please define what’s a broken metabolism? In addition to Jimmy’s cokes, what other things will break the metabolism? How can a broken metabolism be repaired?

    Thanks!

    1. Tom Naughton

      A person’s metabolism could be broken in many ways. He may produce inordinate insulin spikes when consuming any sugar or starch at all. He may be severely leptin resistant. He may have a low rate of resting energy expenditure. Dr. Richard Johnson has even mentioned research showing that some people convert glucose to fructose, which then causes the damage we associate with high fructose consumption. And I suspect there are other aspects to it that no one has identified yet.

      1. Cindy M

        After having taken Biochemistry this summer, I learned that glycolysis turns ALL glucose into a derivative of fructose (fructose-6-phosphate). The problem may not be the turning the glucose into fructose, rather a problem turning that fructose into pyruvate as the end product of sugar break down. Perhaps by a lack of ATP or phosphate to add the phosphate groups needed to the fructose to completely degrade it. Fructose needs two phosphate groups added to it before it can be turned into pyruvate, which then travels through the TCA cycle in the mitochondria to make energy (after it is further broken down into acetyl-CoA). This is how fats are actually metabolized… they are broken down 2 carbons at a time into acetyl-CoA, which travels through the TCA cycle. Some people need the added carbs in their diet to maintain the organic transition steps of the TCA cycle, as those molecules are siphoned off to form other important molecules in the body.

        Sorry for nerding out on the biochemistry! Great post!

        1. Bret

          I would add that calorie for calorie, sucrose (the half-glucose/half-fructose table sugar) overwhelms the body with a bigger insulin response than pure glucose. Gary Taubes discusses this process at length in Good Calories, Bad Calories.

          He concluded in the epilogue that table sugar and HFCS appeared to be likely the most damaging refined carbs of all, due to the double barrel action of simultaneous glucose and fructose metabolism. Take this stuff in huge quantities, and your problems compound all the more.

      2. Boundless

        > Dr. Richard Johnson has even mentioned research
        > showing that some people convert glucose to fructose …

        He’s also mentioned (in his book The Fat Switch), that obese people commonly have a bacterium that converts fructans to fructose. There are several dietary sources of fructans, but #1 is wheat (which is yet another reason why it’s also the #1 thing to ditch in diet).

  13. Dr Jay Wortman

    One of the benefits of ketosis is the anti-inflammatory effect of BHOB. According to Jeff Volek, there is a half-life to this effect meaning that you can still get that benefit if you are in and out of ketosis. Another data point to support your position.

    1. Tom Naughton

      Thanks, Jay. That’s excellent news for people who don’t do well on long-term ketogenic diets. They could at least give a cyclical ketogenic diet a try.

      1. Boundless

        Coming late to the great keto debate is exogenous ketones, such as the KetoForce product already on the market.

        It can raise blood ketone levels even in glycemic metabolism. So for someone seeking specific benefits that high ketone levels bring (as therapy for certain medical conditions, for example), it may not be necessary to struggle with fine-tuning a high fat, VLC, protein-restricted diet (R-KD).

        Another KD blogger with an admittedly broken metabolism is about to give KF try, just to see if there’s any obvious benefit.

  14. Bryan Harris

    Splitter!!!

    Oops uh I mean good article. The keys are like right next to each other on the keyboard. 🙂

  15. Tammy

    Tom – This is a great post – and exactly what I’ve been thinking or been believing for a long time. I believe our ancestors were in and out of ketosis as became necessary by environmental factors so they were quite adaptable.

    It’s funny I’ve been self experimenting since 2002, so quite a while now, and I’ve come up with a pretty definitive list of what works and what doesn’t for me. Recently my husband and I have been comparing results and though we both fall into the 2/3’s that can’t sustain the SAD without packing on the pounds, we both react quite differently to different foods via the handy glucose meter. For instance, I have no problem with eating starch as long as it doesn’t morph back into other grain based or junk items which I have to be careful of. I don’t lose weight eating starch, but I don’t gain weight either. And yes starch does actually make my gut happy, which until all the more recent info I hadn’t paid much attention to.

    My post meal readings with starch are always up in the 120’s which I’m ok with but my husband barely gets to 100 even though we both start out about the same. It’s funny because I’m of northern European decent and he’s southern Italian. He can definitely handle more of a carb load than I can but I’m way better with dairy. Like I don’t have any problem drinking milk or anything (even though I haven’t had it for quite some time now) but I eat all other full fat dairy.

    I just think its fascinating being able to look at heritage and food consumption and things like that.

    1. Tom Naughton Post author

      Your husband is like Chareva. She can eat a big serving of starches and her glucose will barely crack the 100 mark, then slide back down pretty quickly. I suppose that’s part of the reason she’s naturally lean.

    2. Toni

      Wow, you just described my husband and myself! He’s Sicilian – he can eat loads of pasta and bread with no consequences (and is naturally pretty lean), but he can’t touch dairy with a 30 foot pole (maybe small amounts of cheese or yogurt, but no actual milk). I’m Irish, English, and Swedish – I can drink milk til the cows come home, but if I walk past a loaf of bread I gain 5 lbs. So I still cook pasta for him, but I think he has benefited from the dropping of the industrial oils (using less processed fats these days) and the overall reduction of sugar and heavily processed foods in our diet. He keeps dropping inches without losing pounds, I’ve been dropping both.

  16. Damocles

    I belive in the human nature of optimizing lazyness.

    In paleo nutritional terms that would mean:

    get the most amount of satisfacting nutrients with the least amount of work possible.
    These paleo groups of people would not have ignored the bush of ripe berries, or tubers that they saw.
    Nor would they have let the rabbit or antilope staggering around the camp walk by for ehtical reasons.

    If you have the tech of hunting (spears, clubs) you use it. Im sure the ancient arrows found where not used
    for shooting down apples.
    Also if you have the tech of fire, you can conveniently rost your tuber plants, wich might otherwise not be eadable.
    Same goes for rosting meat..

    I see ketosis as a nessecity when food was scarce, (no luck hunting, gathering, or the group travelling – having to move the camp elsewhere)
    The body fat is a wonderful battery, that works as it should, when the metabolism is not messed up.
    But when in season (fruits), or snatching that tasty honey from the bee hive, there is no need to rely on ketosis (draining the batteries).

    1. Tom Naughton Post author

      Agreed. In fact, Jimmy has had people on his podcast who say ketosis is most beneficial when it’s cyclical.

    2. Bret

      I see ketosis as a nessecity when food was scarce, (no luck hunting, gathering, or the group travelling – having to move the camp elsewhere)
      The body fat is a wonderful battery, that works as it should, when the metabolism is not messed up.
      But when in season (fruits), or snatching that tasty honey from the bee hive, there is no need to rely on ketosis (draining the batteries).

      Damocles, that was extremely well put. I don’t have hostility toward ketosis as a metabolic process, certainly not like many mainstream, low-fat ‘experts’ do (whether they are confusing it with diabetic ketoacidosis or not). But I see it as one tool in the bag. We wouldn’t use a hammer to fix a broken window or a sore thumb, and most of us probably shouldn’t use ketosis as an end-all/be-all response for every metabolic issue we run into.

      If you consider the nasty blood sugar spikes that people undergoing chronic ketosis get when they eat carbs or undergo a GTT, then it seems reasonable to surmise that chronic ketosis underexercises the components of one’s glucose metabolism (or rather, renders them completely dormant). Much like failing to exercise a muscle for a long period of time. It is going to get weak and then do a poor job when you need it.

      Of course, the S.A.D. of 300+ g of carbs, many being refined, is like chronically overexercising that muscle to extreme exhaustion. Something has to give eventually, and that is when we get fat and diabetic.

      To me, the most reasonable course for most people is probably to eat a moderate amount of whole-food carbs. Ketosis may come and go overnight, or during occasional fasts, and that is just fine. And on the other hand, one may occasionally eat 200 or 250 g of whole-food carbs in a day, like Mark Sisson has said he does every so often (sorry, don’t have a link handy), and that shouldn’t be a big deal, either, because we are keeping our metabolisms healthy with a good balance between the two, rather than biasing them in an extremely one-sided way.

    3. Duck Dodgers

      “I see ketosis as a nessecity when food was scarce, (no luck hunting, gathering, or the group travelling – having to move the camp elsewhere)”

      Unfortunately, fat was very hard to come by when food was scarce, as this study demonstrates (well worth reading in its entirety):

      From: Energy Source, Protein Metabolism, and Hunter-Gatherer Subsistence Strategies

      Our concern is with periods of high lean meat (i.e., high protein) consumption, when carbohydrates and animal fat would have been scarce or unavailable to hunters and gatherers as sources of calories…

      …It should be pointed out, however, that the few minimum values that do exist for wild ungulate meat may nevertheless tend to underestimate somewhat the actual amount of fat available to hunter-gatherers in a carcass, because the values do not include subcutaneous and visceral fat deposits, fat in the bone marrow, and so forth. On the other hand, as will be discussed more fully below, many of these fat reserves may become largely or totally depleted during the winter and spring, bringing the available fat levels more in line with the values for meat alone.

      Game meat is notoriously lean. The paper is excellent as it walks through the measurements and challenges of finding adequate fat when food was scarce. And let’s not forget that fat was also used for other things (lamp oil, for instance).

      All of the research on actual ketogenic diets (Bellevue Experiment, for instance) was done with fatty domesticated animals. Wild game meat is far, far leaner and it would be virtually impossible to stay ketogenic consuming large quantities of such lean animals. There just isn’t enough fat in the carcasses to keep everyone ketogenic unless you discard most of the meat (which would never be done when food is scarce).

      And please reference actual scientific data, if you care to refute.

  17. Justin

    I’m really loving this new “everybody’s different/lets all get along” mindsets that seem to be trickling out of this community. Nowadays, if anyone asks me if I think the food pyramid should be flipped upside down in the next update, my response is something like “it would probably be better than the current one for most people, but having a single nutritional diagram for everybody is a bad idea”. I think that in a perfect world, there should be allowed to be multiple ideas to try, all on a level playing field, with no single method being forced on anybody. The main problem I’ve seen with the “level” part is that scientists say things like “this is likely to be true, but we should keep testing and looking into it, and its possible that things could change in the future”, and governments say things like “We know this is true, doesn’t everybody?”.

    1. Tom Naughton Post author

      Well, that’s the inherent problem with top-down solutions. They’re one-size-fits-all by nature.

    2. Stephen

      I also like this realization that paleo, low-carb, and vegan diets can all be successful. We definitely share more in common than we think, even between the high-carb and low-carb approaches. Personally, I think the common denominator is low inflammation (which improves leptin and insulin sensitivity). I think it’s the veggies and fiber that gives us this protection. I think the differences are minor, and are preference-based. I eat tons of starch and veggies, because I like it that way. I’m pretty sure animal products and veggies would work just as well, but I’d rather get my calories from starch (they’re easier to cook, and I like the taste).

      Please, some one agree with me … )

  18. Alex

    Glucomannan (the stuff that shirataki noodles are made of) may be a good fiber for ketogenic dieters, as it’s also one of the butyrate promoting fibers. My experience is that it doesn’t have the gas, bloating, and cramping that raw potato starch has. There have been problems with glucomannan supplements in pill form causing intestinal blockages, so the best way to take it is powder mixed into a full glass of water, so that it is completely hydrated and won’t form hard clumps.

    As for the raw potato starch, it is an awesome thickener for cooked gravy and sauces.

    1. Bonnie

      Unless you’re like me. I’ve found that even a small amount of glucomannan causes very loose stools. It’s working well for my husband, tho. He adds a bit of SF fruit-flavored syrup to make it palatable.

      But I wonder if it would have the same effect on me made into shirataki noodles. I do like alfredo sauce!

      1. cavenewt

        I use konjac (glucomannan) noodles instead of regular pasta. Even my teenager will eat spaghetti on these noodles. You can get ’em at konjacfoods.com. They have a new style that uses a little bit of soluble oat fiber to improve the texture.

  19. Duck Dodgers

    Well said, Tom. Great post.

    It should be more than obvious that paleo ancestors sought out carbs when gathering. After all, the key to survival in the wilderness (as any survivalist knows) is to eat energy positive plants. It would be completely moronic for any hominid to avoid such easy calories when searching for food.

    1. Tom Naughton

      Yup, if I were living in the wild, I wouldn’t turn down any source of edible food unless I couldn’t stand the taste — and even then, I’d eat it if I were hungry enough.

  20. tony

    Tom, you stated “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.”

    Can you please define what’s a broken metabolism? In addition to Jimmy’s cokes, what other things will break the metabolism? How can a broken metabolism be repaired?

    Thanks!

    1. Tom Naughton Post author

      A person’s metabolism could be broken in many ways. He may produce inordinate insulin spikes when consuming any sugar or starch at all. He may be severely leptin resistant. He may have a low rate of resting energy expenditure. Dr. Richard Johnson has even mentioned research showing that some people convert glucose to fructose, which then causes the damage we associate with high fructose consumption. And I suspect there are other aspects to it that no one has identified yet.

      1. Cindy M

        After having taken Biochemistry this summer, I learned that glycolysis turns ALL glucose into a derivative of fructose (fructose-6-phosphate). The problem may not be the turning the glucose into fructose, rather a problem turning that fructose into pyruvate as the end product of sugar break down. Perhaps by a lack of ATP or phosphate to add the phosphate groups needed to the fructose to completely degrade it. Fructose needs two phosphate groups added to it before it can be turned into pyruvate, which then travels through the TCA cycle in the mitochondria to make energy (after it is further broken down into acetyl-CoA). This is how fats are actually metabolized… they are broken down 2 carbons at a time into acetyl-CoA, which travels through the TCA cycle. Some people need the added carbs in their diet to maintain the organic transition steps of the TCA cycle, as those molecules are siphoned off to form other important molecules in the body.

        Sorry for nerding out on the biochemistry! Great post!

        1. Bret

          I would add that calorie for calorie, sucrose (the half-glucose/half-fructose table sugar) overwhelms the body with a bigger insulin response than pure glucose. Gary Taubes discusses this process at length in Good Calories, Bad Calories.

          He concluded in the epilogue that table sugar and HFCS appeared to be likely the most damaging refined carbs of all, due to the double barrel action of simultaneous glucose and fructose metabolism. Take this stuff in huge quantities, and your problems compound all the more.

      2. Boundless

        > Dr. Richard Johnson has even mentioned research
        > showing that some people convert glucose to fructose …

        He’s also mentioned (in his book The Fat Switch), that obese people commonly have a bacterium that converts fructans to fructose. There are several dietary sources of fructans, but #1 is wheat (which is yet another reason why it’s also the #1 thing to ditch in diet).

          1. whatever

            And to answer the second part of Tony’s question: tragically, once broken, your metabolism cannot always be repaired. If caught it in time, you might have hope. After several decades, sorry. It’s gone. Life’s unfair like that sometimes. 🙁

  21. Dominik

    I’m pretty sure I don’t have lots of AMY1 copies either, AND I’ve been supplementing with RS and fiber since January and am doing really well with it. I’m fairly low carb, trying to not be in ketosis anymore (some safe starches), but falling back from time to time. I know lots of people who wouldn’t feel good on my diet, but I do. Basically, everything you said is reasonable from my POV.

  22. Dr Jay Wortman

    One of the benefits of ketosis is the anti-inflammatory effect of BHOB. According to Jeff Volek, there is a half-life to this effect meaning that you can still get that benefit if you are in and out of ketosis. Another data point to support your position.

    1. Tom Naughton Post author

      Thanks, Jay. That’s excellent news for people who don’t do well on long-term ketogenic diets. They could at least give a cyclical ketogenic diet a try.

      1. Boundless

        Coming late to the great keto debate is exogenous ketones, such as the KetoForce product already on the market.

        It can raise blood ketone levels even in glycemic metabolism. So for someone seeking specific benefits that high ketone levels bring (as therapy for certain medical conditions, for example), it may not be necessary to struggle with fine-tuning a high fat, VLC, protein-restricted diet (R-KD).

        Another KD blogger with an admittedly broken metabolism is about to give KF try, just to see if there’s any obvious benefit.

        1. Tom Naughton Post author

          I wonder if exogenous ketones provide the same benefits. Kind of like drugs that raise HDL — they don’t really do much for heart health, perhaps because it’s not just HDL per se that’s beneficial, but also the biological processes that raise HDL.

          1. Gemma

            Peter Attia may have no broken metabolism because he supplemented with UCAN SuperStarch (67% resistant starch) ad libitum during his ketogenic diet experiment.

            Exogenous ketones. Sounds so yummy.

            1. Boundless

              > Peter Attia may have no broken metabolism because
              > he supplemented with UCAN SuperStarch (67% resistant
              > starch) ad libitum during his ketogenic diet experiment.

              And Quest bars, which are VLC but not keto. But with both, as I recall, he was feeding into a certain depletion of glycogen stores.

              And he’s no longer full-time keto, which I took to be a signal that chronic keto might not be an ideal state for people who didn’t need to be ketogenic for some specific reason.

              > Exogenous ketones. Sounds so yummy.

              And it’s not just the taste: KetoForce has a ph of 11. Someone with epilepsy or cancer might not care, if it helps avoid the seizures or arrests the tumor with less detailed care than straight R-KD requires. What EK might do for ALS, Alzheimers, Parkinsons, T1D, and a host of other ailments that sometimes respond to keto is anyone’s guess.

              The benefits and hazards (if any) of EKs are yet to be fully learned. I am expecting the IOC to ban ’em at any moment, which might be tough, as there may be no way to distinguish ketone bodies produced by the liver from those produced by Patrick Arnold.

            2. whatever

              Attia makes a very important point: if you supplement the ketones, you don’t burn your own fat. Great – so youcan fake your score on the ketone meter without the supposed *hassle* of actually changing your diet, but you’re still stuck with all the downsides of having visceral fat – the cytokines, the negative hormonal activity etc. So you may look great on the ketone meter but that won’t solve your need for a man-bra to keep those moobs from bouncing. 😉 To be frank.

            3. twitchyfirefly

              True, but this is where individual situations come in to play. As someone who is not overweight but who has a neurodegenerative condition thought to be autoimmune, I do supplement with exogenous ketones to attempt to keep my ketone level up. This in addition to attempting to stay in nutritional ketosis.

  23. Zooko Wilcox-O'Hearn

    Hey there, Tom. Thanks for the thoughtful article. On the last point, that you said was the one warning that keto dieters should pay attention to, I’d love it if you’d read our article proposing a contrary hypothesis. What if the complete opposite is true?

    http://www.ketotic.org/2013/11/similarities-between-germ-free-mice-and.html

    What if the advantages of a ketogenic diet come in part from *starving gut bacteria*? 🙂 I don’t expect that you’ll read that one article and change your mind, but I do hope that you’ll read the whole thing and find it to be interesting.

    Regards,

    Zooko

    1. Tom Naughton

      Well, it’s certainly an interesting hypothesis. Thanks for passing it along.

    2. Gemma

      @Zooko

      Are you a lab mouse with a 1-2 year life-span, or a human hoping to lead a healthy life for several decades?

      Sure all that fat in the ketogenic diets reduces the diversity and washes much of the gut flora away. No dispute about that.

      But do you really consider such a state as beneficial LONG-TERM?

      If so, you must be joking.

      1. Martin

        @Gemma

        the thing is that we don’t know really which state is beneficial in the long term: eating a higher-carb diet and maintaining a higher volume of gut flora or eating a lower-carb diet and maintaining a lower volue of gut flore.

        You cannot be sure that the former is better just as I cannot be sure that the latter is better, no studies on this exist, to the best of my knowledge.

        Just because some individuals eating higher carb diet supposedly improved their health by adding RS to the diet does not mean they would not have been better off if they had switched to a low carb diet earlier without worrying to much about the gut bacteria

        1. Richard Nikoley

          Martin:

          “the thing is that we don’t know really which state is beneficial in the long term: eating a higher-carb diet and maintaining a higher volume of gut flora or eating a lower-carb diet and maintaining a lower volue of gut flore.”

          Well, so far, about 107 billion people have lived on earth and they all had gut bacteria. Moreover, the historical and modern records document now billions upon billions of of cases of profound longevity of 80 years and greater.

          It’s also not an issue of “volume” as you suggest, but one of a balance of species. There are upwards of 500-1,000 species in a gut, most of them at chemical warfare with one-another or competing for food. Most bacteria can be beneficial or pathogenic. Most people have e. coli, salmonella and even c. dificile in them, but they are kept at bay by other species.

          Perhaps you’re unaware that the gut microbiota constitutes 70% of the human immune system.

          Here’s a partial list of autoimmune conditions that have been associated with disruptions in the balance of the human gut.

          Addison’s Disease
          Alopecia
          Ankylosing Spondylitis
          Antiphospholipid Syndrome (APS)
          Autoimmune Hepatitis
          Behcet’s Disease
          Bullous Pemphigoid
          Castleman’s Disease
          Celiac Disease
          Chronic Fatigue Syndrome
          Chronic Inflammatory Demyelinating Neuropathy (CIDP)
          Churg Strauss Syndrome
          Crohn’s Disease
          Endometriosis
          Fibromyalgia
          Infertility
          Giant Cell Arteritis
          Glomerulonephritis (Autoimmune Kidney Disease)
          Graves’ Disease
          Guillain-Barre Syndrome
          Hashimoto’s Thyroiditis
          Idiopathic Pulmonary Fibrosis
          IgA Nephropathy
          Interstitial Cystitis
          Kawasaki Disease
          Lichen Planus
          Lupus
          Meniere’s Disease
          Mixed Connective Tissue Disease (MCTD)
          Multiple Sclerosis
          Myasthenia Gravis
          Narcolepsy
          Pemphigus
          Pernicious Anemia
          Polyarteritis Nodosa
          Polymyositis
          Primary Biliary Cirrhosis
          Psoriasis
          Raynaud’s Disease
          Reiter’s Syndrome
          Rheumatoid Arthritis
          Sarcoidosis
          Scleroderma or CREST Syndrome
          Silicone Immune Toxicity Syndrome
          Sjogren’s Syndrome
          Stiff-Man Syndrome
          Type 1 Diabetes
          Ulcerative Colitis
          Vascular Dementia
          Vasculitis
          Vitiligo
          Wegener’s Granulomatosis

    3. Harold

      Interesting article. When I was on a low dose of Metformin I lost weight effortlessly. Once my HbA1c got down to 5.4 the doctor wouldn’t prescribe it to me any more. Maybe a keto diet would give me the same effect. I have tried adding a carb night every week or two, have added resistant starch and a dirt based probiotics for the last year, the result, while my A1c is still at 5.4 I have put on 40 lbs, my blood pressure is up and my doctor wanted to tie my down and force statins down my throat. I think it’s time for a change. Thanks Zooko for giving me some reason for not wearying about starving my gut.

      1. Galina L.

        I believe the supplement Berberine works similarly to Metformine, there are also countries where you can buy Metformine without a prescription. I would pay $1000 to go to Moscow or Mexico, for example, to get a necessary for me medicine (after I explore other options).
        Yes, the opinion of the people who absolutely believe that we should consume some starches is very pressing at the moment, but creeping weight gain from cold “safe starches” or mega farting from raw starches without any promised positive changes are often enough for the realization that not all what is claimed by somebody would be true in your own case.

        1. Gemma

          Many drugs including Berberine and Metformin actually works via impacting gut flora.

          In the end, aren’t we non-stop talking the same points?

          What gut flora are you harbouring, what food are you feeding to your microbes, how these microbes effect your health and what are the ways to change your gut flora compositions?

          There is a recent interesting article by Dr. Ayers on the antibiotic properties of Metformine:

          “Metformin is the treatment of choice for type 2 diabetes and yet, like many other common drugs, the full extent of its impact on the body (and the body’s essential microbiome of bacteria and fungi) has not been studied. This article should not be seen as a criticism of the pharmacological efficacy of Metformin in lowering blood sugar. The point here is that Metformin alters gut flora and its major pharmacological impact may result from alteration of the gut flora and not direct action on cells of body organs. ”

          http://coolinginflammation.blogspot.cz/2014/05/metformin-antibiotic-with-autoimmune.html

  24. Martin

    Re: A ketogenic diet will starve your gut bacteria…

    Two possibilities:
    1. A ketogenic diet will indeed starve your gut bacteria, you will lose a good deal of the little guys and it’s bad.
    2. A ketogenic diet will simply decrease your need for the amount of gut bacteria that people eating higher-carb have. So you will lose a good deal of the little guys that you don’t need any more and it’s OK.

      1. whatever

        Another possibility is that the vast majority of people suffer from too much BAD bacteria, and starving them to establish a normal proportion will benefit health. It’s not that we should have as much bacteria as possible, it’s that we should have a certain proportion of good vs. bad bacteria, and each have to stay in their correct places in the body. So killing off overgrowths of bad bacteria or misplaced good bacteria could be helpful too.

  25. Duck Dodgers

    Well said, Tom. Great post.

    It should be more than obvious that paleo ancestors sought out carbs when gathering. After all, the key to survival in the wilderness (as any survivalist knows) is to eat energy positive plants. It would be completely moronic for any hominid to avoid such easy calories when searching for food.

    1. Tom Naughton Post author

      Yup, if I were living in the wild, I wouldn’t turn down any source of edible food unless I couldn’t stand the taste — and even then, I’d eat it if I were hungry enough.

        1. Tom Naughton Post author

          No need. We harvested squash and sweet potatoes from Chareva’s garden last autumn, and they were edible for months.

        2. Duck Dodgers

          Interestingly, you won’t much, if any, fat on wild game during the Winter. Wild game meat in the Winter is virtually entirely protein — as Winter fat stores are diminished on animals that are already very lean during times of plenty. Good luck getting most of your calories from fat in that case.

          Once you do a caloric breakdown on wild game meat, it becomes fairly obvious that there just isn’t enough fat in wild animals to support ketosis — particularly when such large quantities of protein were consumed by carnivorous cultures.

          1. Damocles

            Thats true if you eat (like most westeners) only the muscle meat,
            and avoid the offal (especially brain).

            There is still a large amount of fats in those tissues.

          2. Pat

            Wild animals store a lot of fat in their bone marrow. Most herbivores in cold climates are not going to eat enough during winter to maintain themselves, especially when they are pregnant (i.e. deer). Also, many do store fat (mostly abdominal) in fall for winter – look at bears and raccoons in late fall, they are more than chubby. Most cold-climate human cultures saved their main hunting for late fall and early winter, when animals were fat, winter coats had come in so furs were warmer, and the cold weather meant meat could be safely stored for long periods of time. Late winter and early to mid spring would be the least productive times for hunting, since animals would have used up their fat reserves, so humans would need to still be using their stored meat.

            1. Duck Dodgers

              “Thats true if you eat (like most westeners) only the muscle meat,
              and avoid the offal (especially brain).”

              A Caribou brain weighs about 2 or 3 pounds and it’s not entirely fat. A fresh human liver contains more than 100g of glycogen. It is tradition for carnivorous hunters to consume their prey’s liver immediately/soon after a kill. Keep in mind that a single cupcake has only about 30g of carbs.

              “Wild animals store a lot of fat in their bone marrow.”

              That’s wishful thinking. A perusal of the scientific literature says otherwise:

              From: Energy Source, Protein Metabolism, and
              Hunter-Gatherer Subsistence Strategies

              It should be pointed out, however, that the few minimum values that do exist for wild ungulate meat may nevertheless tend to underestimate somewhat the actual amount of fat available to hunter-gatherers in a carcass, because the values do not include subcutaneous and visceral fat deposits, fat in the bone marrow, and so forth. On the other hand, as will be discussed more fully below, many of these fat reserves may become largely or totally depleted during the winter and spring, bringing the available fat levels more in line with the values for meat alone…

              …Second, hunter-gatherers may augment their supplies of storable fat through labor-intensive activities such as rendering bone grease. Preparation of bone grease involves smashing the bone, heavy limb elements as well as lighter vertebrae and ribs, and then boiling the small pieces of bone in water until the grease is extracted. Grease is skimmed off the water and placed in skin containers to harden. Among nomadic groups lacking pottery, the laborious boiling process is accomplished by heating rocks in a fire and transferring them to a perishable container such as a skin bag that contains the broken-up bones (see Binford 1978 for a description of grease rendering). Commonly, the rendered fat is mixed with an equal proportion of pulverized, jerked lean meat to make pemmican, an energy-rich food that can be stored for several years if kept dry (Stefansson 1956:179, 188).

              And so, if you want to consume the marrow “grease” you have to go through an unusually intensive process and it’s usually consumed as part of pemmican.

              However, Per Wikholm recently pointed out that even Stefansson admitted that pemmican derived from Caribou is too lean — and roughly 60% fat, which is not enough to fat to sustain ketosis.

              I highly recommend reading the Energy Source, Protein Metabolism, and
              Hunter-Gatherer Subsistence Strategies
              paper. It clearly shows how difficult it was for hunter-gathers to obtain fat from wild game.

              Finally, here’s a paper that examines the extractable fat content of reindeer…

              Body growth and carcass composition of lean reindeer (Rangifer tarandus tarandus L.) from birth to sexual maturity

              Body growth and carcass composition were measured in lean reindeer during the juvenile growth period between birth and 3 years of age. Mean carcass weight in these lean reindeer was 56 ± 4% of body weight and the deposition of body muscle and bone mass was linearly correlated with body weight after the 1st month of age. The weight of the brain relative to body weight and carcass weight declined, while the relative changes in heart, liver, kidneys, parotid glands, and tissues of the gastrointestinal tract were small after the neonatal period. The extractable fat content in carcasses increased from 4.4 to 11.4% of wet weight or approximately 100 g fat at birth and 3.5 kg fat in adult reindeer. Fat-free dry matter represented a constant percentage (18–20%) of wet carcass weight independent of body weight after the neonatal period, while a significant inverse relationship between carcass fat and body water was found.

              If we’re going to make statements about how “fat” wild game supposedly is, it needs to be backed up with hard data. Otherwise, it’s just an exaggeration.

            2. Pat

              My main point was that wild animals have more fat at certain times of the year than other times, which means those times are more useful in terms of harvesting for long-term storage. Of course they are low on fat in late winter and spring, they have been using it all winter. I have seen the bone marrow of a yearling dear that died of starvation in March – its bone marrow was bright red, no fat left.

              I suppose I should have mentioned age – your last article is on lean reindeer during their growth period, it says nothing about mature females in fall, who need fat to keep themselves and their pregnancies going during the winter (see article below). It says nothing about mature males before the rutting season, who need good fat stores to get through the rut (because they don’t eat much during it, and many die afterwards of exhaustion). Similarly, there is a huge difference in fat content of spawning salmon as they hit the estuaries and when they reach the spawning grounds. Many West Coast societies lived most of the year on fat salmon they harvested over a few weeks.

              Other points – some species have more fat than others (bear versus deer versus reindeer, there is a gradient there). Some parts of the body have more fat than others (bone marrow, visceral fat versus skeletal muscle). Pemmican has whatever fat content the makers of the pemmican choose to make it have. It was basically dried pounded meat, dried berries, and fat, in whatever ratios the cooks chose.

              And of course there were other foods – around here (Eastern Canada) there are lots of wild berries over the season (labour intensive and you have bears as competitors, but they are there), and maple sugar for carbs (also labour intensive). Plus the Three Sisters.

              We can find all sorts of data, here is one:

              Seasonal patterns in body mass, body composition, and water transfer rates of free-ranging and captive black-tailed deer (Odocoileus hemionus sitkensis) in Alaska

              Katherine L. Parker, Michael P. Gillingham, Thomas A. Hanley, Charles T. Robbins
              Canadian Journal of Zoology, 1993, 71(7): 1397-1404, 10.1139/z93-193

              Abstract

              Body mass, body composition, and water transfer rates were determined over a continuous 2-year period in nine free-ranging Sitka black-tailed deer (Odocoileus hemionus sitkensis). Body masses showed a cyclical pattern, declined 14 – 31% between October and March, and were best described by a five-parameter, biologically based regression model. The amount of mass lost by black-tailed deer over winter depended on the peak body mass attained during fall. During winter, animals used 70 – 82% of their body fat and 10 – 15% of their protein reserves. Body fat was preferentially mobilized at rates 2.3 – 11.6 times higher than protein. Because of the higher energy content of fat, fat accounted for 83 – 92% of the catabolized energy. Water transfer rates varied seasonally with average summer values approximately four times those of winter; lactating deer had significantly higher rates of water transfer than nonlactating animals. Seasonal changes in all of the above parameters for wild deer were greater than those for eight deer of the same age in captivity.

            3. Duck Dodgers

              Well, all that study seems to show is that deer catabolized their fat well — which isn’t very surprising. That’s what fat is for, after all. You didn’t find anything explaining that deer are “fatty”. It should be obvious that deer are quite lean.

              If we actually look at studies that measure the amount of fat in the marrow, we see that there really isn’t very much.

              Gazelle bone marrow yields and Epipalaeolithic carcass exploitation strategies in the southern Levant (Free Download)

              Nice try though.

            4. Duck Dodgers

              “your last article is on lean reindeer during their growth period, it says nothing about mature females in fall, who need fat to keep themselves and their pregnancies going during the winter (see article below).”

              The article clearly pointed out the adult lean reindeer fat yields, which were paltry. If your argument is that cultures only ate a long term diet of pregnant female reindeer, that’s not a very convincing argument.

              “It says nothing about mature males before the rutting season, who need good fat stores to get through the rut (because they don’t eat much during it, and many die afterwards of exhaustion).”

              Can you show evidence of the fat yields of well-nourished reindeer, in the scientific literature? Even if the fat content of these lean animals were doubled, they would still be unimpressive.

              Fat that was captured in rutting season was rationed throughout the winter — it wasn’t used for some great keto bender, all at once. And a good portion of the fat was used to fuel oil lamps.

              “Similarly, there is a huge difference in fat content of spawning salmon as they hit the estuaries and when they reach the spawning grounds. Many West Coast societies lived most of the year on fat salmon they harvested over a few weeks.”

              Those salmon-eating cultures ate roots, bulbs and rhizomes such as wapato (duck potato), camass (which similar to a sweet potato) and bracken (a rhizome).

              “some species have more fat than others (bear versus deer versus reindeer, there is a gradient there).”

              Not aware of any cultures that subsisted mainly on bear. The Indians who ate bear also ate starches and they used a lot of the fat for other things — like fueling oil lamps.

              “And of course there were other foods – around here (Eastern Canada) there are lots of wild berries over the season (labour intensive and you have bears as competitors, but they are there), and maple sugar for carbs (also labour intensive).”

              You’re conveniently forgetting the starchy roots and bulbs eaten by those cultures. You can even find Yup’ik potatoes in Alaska. If you can find plants, you can usually find starchy roots/tubers.

            5. Duck Dodgers

              “Wild animals store a lot of fat in their bone marrow”

              False.

              From: Gazelle bone marrow yields and Epipalaeolithic carcass exploitation strategies in the southern Levant (Free Download)

              We found extensive variation in marrow fat content among individual gazelles. Animals with the highest marrow yields were killed in the spring while animals killed in the early autumn had lower fat contents. Nevertheless, our results suggest that gazelle marrow provided a reliable, albeit small fat resource for prehistoric foragers in all seasons

              ..Despite the relatively low marrow yield from a single gazelle carcass, the fragmentation of the Epipalaeolithic assemblages indicates that humans routinely opened gazelle long bones for marrow.

              Be sure to take a peek at the charts and figures in the PDF showing the caloric tallies of marrow fat. There’s no doubt that every part of the animal was relished, but it’s not difficult to see that wild game is too lean to get the majority of one’s calories from fat.

            6. Duck Dodgers

              Ok, Pat… I’m going to throw you a bone, literally. As I prefer to look directly at the scientific research to determine the truth when we can. I’ll retract my “false” statement as their are a few minor exceptions for “unstressed” African ungulates.

              I found the study that is most relevant to what prehistoric hominids did with scavenged marrow. I think you’ll like what it has to say in terms of marrow providing some measurable energy. But, I think it still falls short for sustaining ketosis over the long term.

              I’m sure we are all familiar with the notion that early humans/hominds scavenged carcasses left from obligate carnivores, rather than being skilled hunters early on. Skilled hunting came much later.

              From: Variability in long bone marrow yields of East African ungulates and its zooarchaeological implications by T. Cregg Madrigal

              Larger mammal long bones and the marrow they contain may be critical forunderstanding the subsistence strategies of prehistoric hominids. Long bone fragmentsdominate most zooarchaeological assemblages. Because these long bones once contained a calorie·dense resource, their fragmentation reflects, at least in part, the acquisition of energy by hominids wielding pounding tools. Hominids might be expected to have focused consumption on marrow from the bones providing the highest caloric yields. This proposition can be explored fully only if the magnitude and basis of variability in long bone marrow yields is understood. In this paper, we report gross yields of long bone marrow for East African ungulate individuals…

              …Our results indicate that Bed I Olduvai hominids were preferentially breaking those larger mammal long bones that provided the greatest gross energy gain. In neglecting many lower-yielding bones, hominids were not maximizing energy gain from marrow exploitation, nor were they operating in an extremely energy-limited mode (D. Metcalfe,pers. comm; contra Blumenschine, 1991). Rather, the amount of food energy available to the hominids who broke marrow bones at the sites seems to have been adequate, whether the energy was derived from animal or plant foods.

              The high femur fat levels of individuals that provided the best models of long bone abundances at the two sites suggest that hominids had access to animals that had suffered little nutritional stress. Hominids do not seem to have been exploiting marrow bones from animals that died of malnutrition, such as is most likely to occur at the height of the long dry season (see also Speth, 1989).

              Our evidence that hominids were able to select high-yielding bones is inconsistent with their characterization as marginal scavengers who had access only to the low-yielding parts abandoned by bone crunching carnivores (see. e.g.Binford, 1981). Rather, the selectivity is consistent with passive scavenging opportunities from abandoned lion, leopard, and machairodont kills (Blumenschine, 1987;Cavallo & Blumenschine, 1989; Marean,
              1989), with confrontational scavenging (e.g. Bunn, 1986), and with hunting. However, access to fully-fleshed carcasses is not required to explain the relative abundance of long bones at the sites. Long bone abundances correlate negatively but insignificantly to flesh yields (Blumenschine, 1991). Exploitation of passive scavenging opportunities that targeted high yielding marrow bones is all that is required to explain longbone abundances at the sites.

              Even carcass acquisition strategies that are limited to marrow are far from marginal in
              terms of daily energy needs and predictability. Assuming the caloric requirement of an adult Homo habilis was approximately 2000 Kcal/day,* the 12 major marrowbones from a nutritionally unstressed wildebeest (ca. 3080 Kcal, Table 5) would provide over 1.5 person-days of total caloric requirements. A size 2 bovid would provide approximately 85%
              of daily caloric requirements, and a size I bovid about 25%. These yields may not be sufficient to sustain an active system of food sharing of the sort envisioned by Isaac (1978), but on an individual level, they could have provided a critical energy supplement. Further, this supplement may have been predictably located, as indicated by the availability of abandoned felid kills in modern savanna-woodlands (Blumenschine, 1987; Cavallo & Blumenschine, 1989). While our results cannot be used to infer the contribution of marrow to hominid energy budgets, the high gross yields we have documented in combination with thelow processing times of marrow bones (Blumenschine & Madrigal, in prep.) suggest that marrow may have been a preferred energy source. As such, marrow may have been a prime target of carcass processing by hominids despite its low contribution to total carcass yield.

              Whew!

              So, if you take the time to read through the study, we see that the only real “high fat” marrow yields came from an unstressed wildebeest. These wildebeest were an exception (see Figure 4). Grant’s Gazelle’s and Impala’s had almost half the Kcals of a wildebeest (the long bones of each single carcass able to provide 85% of daily caloric needs for an adult).

              The key point seems to be that in order for an adult hominid to stay ketogenic chronically, he would have to scavenge the bones of an unstressed wildebeest every 1.5 days of his life (or a single unstressed Grant’s Gazelle or Impala per day) and never share the bones with anyone in his family.

              That seems rather far fetched over the long term, especially when we consider that the animals were only “unstressed” when plants were abundant. And virtually every other animal besides those few exceptions were far leaner (see Figure 4, again).

              So, that’s the most relevant study I could find to what Paleolithic ancestors did with their marrow. Given the prevalence of human AMY1 starch genes as well as the C4 isotopes found in most hominid fossils, it would appear that marrow fat was a highly preferential supplement that was shared amongst entire families/tribes.

              Would you concur? Happy to hear your thoughts.

            7. Tom Naughton Post author

              As it so happens, I’m currently listening to a 20-hour book about the Navajos and the white western expansion that ended their reign in the southwest. In one section, we hear from a young pioneer woman (via her journal) about the awesome taste of the marrow extracted in copious amounts from buffalo thigh bones. Better than butter, she declared. So I guess at least a big ol’ buffalo could keep you in marrow for awhile.

            8. Duck Dodgers

              Good point, Tom. Marrow extraction is fairly well studied, though the analysis from the bison data is still evolving. Apparently the level of extraction varied tremendously from site to site and season to season.

              For instance…

              Paleo-Indian Bison Remains From The 12 Mile Creek Site In Western Kansas

              The site represents a winter/spring kill of a predominantly male herd. Human processing of the bison carcasses was apparently limited to removal of meat and perhaps hides. There is no evidence for extensive carcass dismemberment or marrow extraction. The absolute size of the kill (MNI=12) is very similar to a number of other Folsom-age sites on the Plains. However, the high degree of carcass articulation and lack of systematic marrow extraction at 12 Mile Creek differ from sites such as Lubbock Lake, Agate Basin, and Cattle Guard. This pattern of limited or gourmet butchery is more commonly observed at large-scale kills, such as Lipscomb. One possible explanation for this is that the 12 Mile Creek bison were in relatively good condition at the time of the kill and provided the hunters with an adequate supply of meat, fat, and hides without the need for extensive butchery of the carcasses. It is also possible that a very small number of hunters made the kill and therefore did not have the ability of need to extensively process all of the carcasses at the site.

              A common theme for bones collected for marrow extraction is that bison were often killed away from the villages, so the hunters needed to determine which bones they were going to transport back to the villages. They were very selective, and typically just carried back the bones that would yield the most fat. So, they usually weren’t bringing back entire carcasses to their families.

              There is “bone marrow”, which is easy to extract, but is typically found in the large bones and has a short shelf-life. And there is “bone grease” which is far more difficult to extract, and required more skill, but has a longer shelf-life. Since bone grease is difficult to access and produce, it’s not considered to be a major source of calories.

              One of the best studied sites for Bison bone marrow extraction is at the Mitchell Prehistoric Indian Village in South Dakota. The lodges from the village date back 1,000 years ago and the site was only inhabited for about 100 years. But, the site is interesting because the earliest settlers of the site didn’t seem to prioritize marrow extraction and bone grease was largely ignored until later in the site’s timeline. By the end of the site’s use, they were extracting everything they could possibly get from the bones.

              A Chronology of Bone Marrow and Bone Grease Exploitation at the Mitchell Prehistoric Indian Village

              Bone marrow and bone grease exploitation has been demonstrated as an activity of considerable importance to the inhabitants of the Mitchell site (Karr et al. 2008). Large quantities of heavily fragmented bone have been excavated from midden areas, the majority of which represents bison…

              EARLY CONTEXT
              One of the most striking aspects of the bone material from the early occupation of the site is the vast quantity of whole and partial bones, and bone fragments that measure 100mm or greater in maximum dimension. More than half (55 percent) of all bone material in this sample remains wholly or partially intact, and nearly an additional quarter (23 percent) of the material measures greater than 100 mm in maximum dimension (Figures 1 and 5). The presence of such a large amount of bone material in these classes indicates that while significant amounts of bone fat were available, the early inhabitants of the Mitchell site disregarded that resource. As a result of the very large quantity of whole and partial bones, a relatively small number (n=63) of diaphyseal fragments was available for analysis in spite of the large size of the sample as a whole. These diaphyseal fragments produce an average FFI score of 1.59, a value indicating fresh bone fracture for the purpose of marrow extraction (Figure 2). Three fragments display dynamic impact scars, while none exhibit evidence of gnawing. The amount of cancellous material relative to other elements remains quite high in all size classes, further indicating that these significant sources of bone grease were being ignored (Figure 3). Sixty-five percent of all fractures on high-quality, marrow-containing diaphyseal fragments are fresh, while nearly 25 percent are dry and 10 percent are mineralized (Figure 4).

              I won’t quote the entire paper, but towards the end of the site’s timeline, the Indians became exceptionally good at extracting the bone grease and marrow from the bones — nothing was wasted. But, why the increased demand for fat? Did they just become more skilled? Or was it something else?

              The researchers postulate…

              The production of pemmican is known as an important foodstuff from the ethnographic record though other factors may have contributed to the development of bone grease processing at the Mitchell site. These include simple consumption as a dietary product, use in material cultural applications, or as a trade good. A declining resource base at the end of the cultural occupation of the Mitchell site may have led to an increased need to exploit lower-yielding bone elements. This may have included the exploitation of lower-quality fat bearing elements such as ribs, jaws, and vertebral spines. Production of bone grease and pemmican as trade goods may have also led to the rapid development of bone grease processing activities at the site, a theme that requires further investigation.

              It’s a mystery. But, the common theme seems to be that the marrow appears to not have been the #1 priority for the hunters. Sometimes it was extracted, and sometimes it wasn’t. It appears that the marrow was only prioritized when demand was high and resources allowed for its extraction. And it’s reasonable to consider that the fat was used for other things (fueling lamps, trade, etc).

              Anyway, we know those Bison-eating cultures ate the “Three Sisters” (squash, maize corn, and beans) so they were never believed to be ketogenic. Interesting nevertheless!

            9. Tom Naughton Post author

              Interesting stuff, Duck. Even without the Three Sisters, it seems unlikely the buffalo-hunters would have been in chronic ketosis with all that protein in the diet.

            10. gary

              “The key point seems to be that in order for an adult hominid to stay ketogenic chronically, he would have to scavenge the bones of an unstressed wildebeest every 1.5 days of his life (or a single unstressed Grant’s Gazelle or Impala per day) and never share the bones with anyone in his family.”

              You seem to be forgetting about the skull and associated edible brain material, although wildebeest don’t have massive brains this is significant source of high fat nutrition.

            11. Duck Dodgers

              The reason why I “forgot” about the brains is that skulls weren’t always brought back to the base camps.

              From: Hadza Hunting, Butchering, and Bone Transportand Their Archaeological
              Implications

              Meat consumption at butchering stations is generally limited to the relatively small bits adhering to bones which have been stripped of meat for transport
              (mainly ribs, skulls, mandibles, and long bones)…Ribs are sometimes cracked in half, and the broken ends are gnawed and sucked. If skulls are stripped of meat, that meat is always eaten on the spot, the skull and mandible are thoroughly shattered, and all edible contents are consumed…Once the animal has been disarticulated and the consumption of meat and marrow form skeletal elements to be discarded is complete, the remaining meat and bones are packed for transport, and the party leaves for camp…

              And if you look at Figure 1 (SK) in that study, you can see that only antelope skulls were always transported. It sounds like the brains were usually consumed at the kill site, but were generally awkward to carry back to base camp.

              At any rate, let’s take a look at calories, shall we?

              According to Table 6 of a study on the “Experimentally Derived Extraction Rates for Marrow” we see that the exceptional “unstressed” adult female wildebeest offers about 1,900 Kcal from fat from its 6 major marrow bones. A stressed wildebeest offers about 730 Kcal from marrow fat, and an extremely stressed wildebeest offers only 231 Kcal of marrow fat. Usually another 300 Kcal of fat can be be found from the front and hind foot, which were often selectively transported. Keep in mind that the wildebeest has about twice the marrow fat of any other ungulate on the African savannah!

              Now for the brains. Brains are about 60% fat. A Wildebeest brain yields about 290 Kcal, so that works out to about 200 Kcal from fat. Another 159 Kcal of fat could be found in the mandible.

              Interestingly the zebra offers a bit larger brain (yielding roughly another 180 Kcal of fat) but it offers much less marrow fat than a wildebeest does.

              No matter how you slice it, the only way a early hunter could stay in ketosis is if he individually hoarded virtually all or most the fat from his kills. This kind of chronic hoarding hypothesis is fairly ridiculous when you consider that humans tend to have families and villages to feed — which is why there is so much evidence of bone transport in the first place.

              There doesn’t seem to be any realistic evidence in the scientific literature to support chronic ketosis in early humans. It’s really a myth. In fact, when you look at all the research on Underground Storage Organs (USOs) and the prevalence of multiple AMY1 starch genes, it should be fairly obvious that starch consumption makes us human.

            12. Duck Dodgers

              Actually…I should have been more clear. The only way a early hunter could stay in ketosis is if he only hunted the fattiest animals (wildebeest/bison) and individually hoarded virtually all or most the fat from his kills. I honestly don’t know how anyone actually buys into it.

            13. Pat

              And to get us even more off topic – the brains may often have been used to tan leather. Isn’t that convenient? The bearer of the skin also provides the means to tan it.

              You guys posted a lot on this while I was away! My only point in the first post was that the amount of fat available from prey animals will vary with age, sex, season and species. I never said anything about % fat in the diet of those people, or % animal versus plant. However, it did produce an interesting discussion.

            14. gary

              What doesn’t seem realistic to me is the conclusions you draw from the evidence in these studies. Who is to say an individual doesn’t eat 2 or 5 brains? and carry back one set( or indeed 3 or none?) of bones from killing sites. There isn’t enough evidence in these studies to calculate what may have been eaten from scavenging, your logic in predicting what seems ‘likely’ is flawed, we cannot infer from this evidence the complete diet of early hominids with any certainty, we can only say butchering occurred and speculate on how they may of eaten.

            15. Duck Dodgers

              Gotcha, Pat. Interesting for sure!

              Gary said: “Who is to say an individual doesn’t eat 2 or 5 brains? and carry back one set( or indeed 3 or none?) of bones from killing sites.”

              Well, Gary, that would imply a huge amount of discarded meat from unstressed animals.

              And secondly, that’s not what the scientific literature says about quantified bone/skull extractions. Researchers ran calculations on the quantity, species, and types of bones that were cracked open and the quantity and types of bones that were transported back to the base camps — and repeated this exercise across sites all over the world — and the evidence doesn’t support that theory. What do you want me to tell you?

              As Stephan Guyenet put it…

              From: Fat and Carbohydrate: Clarifications and Details

              It is worth noting that the ancestral African hunter-gatherer diet was probably not high in fat on most days, at least not animal fat. African game is characteristically extremely lean, and the only African hunter-gatherer group I’m aware of that gets a fair amount of fat is the !Kung, and most of that fat comes from mongongo nuts (although the mongongo fruit/nut is mostly carbohydrate by calories, a fact that Staffan Lindeberg recently pointed out to me). Most African game just doesn’t contain much fat, even if you include the brain and marrow, and the primary exceptions, like hippos, are extremely dangerous to hunt with stone-age weapons (9). I have yet to see a single credible account of an African hunter-gatherer group that regularly eats a diet high in animal fat. If you know of one, please cite it in the comments.

              I’ve come across a lot of arguments that the ancestral human diet was typically high in fat, but these invariably strike me as wishful thinking.

  26. Dominik

    I’m pretty sure I don’t have lots of AMY1 copies either, AND I’ve been supplementing with RS and fiber since January and am doing really well with it. I’m fairly low carb, trying to not be in ketosis anymore (some safe starches), but falling back from time to time. I know lots of people who wouldn’t feel good on my diet, but I do. Basically, everything you said is reasonable from my POV.

  27. B35

    It honestly depends on the person, such as some can eat vegan, but most can’t without serious health consequences. The same goes for ketosis. I can digest small to medium amounts of carbs fine, but if I drink or eat a load of them supplemented with sugar, I start shaking. Mostly I find that if you eliminate processed sugar, processed oils, and a few carbohydrates from your diet, you will lose weight and feel better.

    And that is my two cents on this.

  28. Zooko Wilcox-O'Hearn

    Hey there, Tom. Thanks for the thoughtful article. On the last point, that you said was the one warning that keto dieters should pay attention to, I’d love it if you’d read our article proposing a contrary hypothesis. What if the complete opposite is true?

    http://www.ketotic.org/2013/11/similarities-between-germ-free-mice-and.html

    What if the advantages of a ketogenic diet come in part from *starving gut bacteria*? 🙂 I don’t expect that you’ll read that one article and change your mind, but I do hope that you’ll read the whole thing and find it to be interesting.

    Regards,

    Zooko

    1. Tom Naughton Post author

      Well, it’s certainly an interesting hypothesis. Thanks for passing it along.

    2. Gemma

      @Zooko

      Are you a lab mouse with a 1-2 year life-span, or a human hoping to lead a healthy life for several decades?

      Sure all that fat in the ketogenic diets reduces the diversity and washes much of the gut flora away. No dispute about that.

      But do you really consider such a state as beneficial LONG-TERM?

      If so, you must be joking.

      1. Martin

        @Gemma

        the thing is that we don’t know really which state is beneficial in the long term: eating a higher-carb diet and maintaining a higher volume of gut flora or eating a lower-carb diet and maintaining a lower volue of gut flore.

        You cannot be sure that the former is better just as I cannot be sure that the latter is better, no studies on this exist, to the best of my knowledge.

        Just because some individuals eating higher carb diet supposedly improved their health by adding RS to the diet does not mean they would not have been better off if they had switched to a low carb diet earlier without worrying to much about the gut bacteria

        1. Richard Nikoley

          Martin:

          “the thing is that we don’t know really which state is beneficial in the long term: eating a higher-carb diet and maintaining a higher volume of gut flora or eating a lower-carb diet and maintaining a lower volue of gut flore.”

          Well, so far, about 107 billion people have lived on earth and they all had gut bacteria. Moreover, the historical and modern records document now billions upon billions of of cases of profound longevity of 80 years and greater.

          It’s also not an issue of “volume” as you suggest, but one of a balance of species. There are upwards of 500-1,000 species in a gut, most of them at chemical warfare with one-another or competing for food. Most bacteria can be beneficial or pathogenic. Most people have e. coli, salmonella and even c. dificile in them, but they are kept at bay by other species.

          Perhaps you’re unaware that the gut microbiota constitutes 70% of the human immune system.

          Here’s a partial list of autoimmune conditions that have been associated with disruptions in the balance of the human gut.

          Addison’s Disease
          Alopecia
          Ankylosing Spondylitis
          Antiphospholipid Syndrome (APS)
          Autoimmune Hepatitis
          Behcet’s Disease
          Bullous Pemphigoid
          Castleman’s Disease
          Celiac Disease
          Chronic Fatigue Syndrome
          Chronic Inflammatory Demyelinating Neuropathy (CIDP)
          Churg Strauss Syndrome
          Crohn’s Disease
          Endometriosis
          Fibromyalgia
          Infertility
          Giant Cell Arteritis
          Glomerulonephritis (Autoimmune Kidney Disease)
          Graves’ Disease
          Guillain-Barre Syndrome
          Hashimoto’s Thyroiditis
          Idiopathic Pulmonary Fibrosis
          IgA Nephropathy
          Interstitial Cystitis
          Kawasaki Disease
          Lichen Planus
          Lupus
          Meniere’s Disease
          Mixed Connective Tissue Disease (MCTD)
          Multiple Sclerosis
          Myasthenia Gravis
          Narcolepsy
          Pemphigus
          Pernicious Anemia
          Polyarteritis Nodosa
          Polymyositis
          Primary Biliary Cirrhosis
          Psoriasis
          Raynaud’s Disease
          Reiter’s Syndrome
          Rheumatoid Arthritis
          Sarcoidosis
          Scleroderma or CREST Syndrome
          Silicone Immune Toxicity Syndrome
          Sjogren’s Syndrome
          Stiff-Man Syndrome
          Type 1 Diabetes
          Ulcerative Colitis
          Vascular Dementia
          Vasculitis
          Vitiligo
          Wegener’s Granulomatosis

    3. Harold

      Interesting article. When I was on a low dose of Metformin I lost weight effortlessly. Once my HbA1c got down to 5.4 the doctor wouldn’t prescribe it to me any more. Maybe a keto diet would give me the same effect. I have tried adding a carb night every week or two, have added resistant starch and a dirt based probiotics for the last year, the result, while my A1c is still at 5.4 I have put on 40 lbs, my blood pressure is up and my doctor wanted to tie my down and force statins down my throat. I think it’s time for a change. Thanks Zooko for giving me some reason for not wearying about starving my gut.

      1. Galina L.

        I believe the supplement Berberine works similarly to Metformine, there are also countries where you can buy Metformine without a prescription. I would pay $1000 to go to Moscow or Mexico, for example, to get a necessary for me medicine (after I explore other options).
        Yes, the opinion of the people who absolutely believe that we should consume some starches is very pressing at the moment, but creeping weight gain from cold “safe starches” or mega farting from raw starches without any promised positive changes are often enough for the realization that not all what is claimed by somebody would be true in your own case.

        1. Gemma

          Many drugs including Berberine and Metformin actually works via impacting gut flora.

          In the end, aren’t we non-stop talking the same points?

          What gut flora are you harbouring, what food are you feeding to your microbes, how these microbes effect your health and what are the ways to change your gut flora compositions?

          There is a recent interesting article by Dr. Ayers on the antibiotic properties of Metformine:

          “Metformin is the treatment of choice for type 2 diabetes and yet, like many other common drugs, the full extent of its impact on the body (and the body’s essential microbiome of bacteria and fungi) has not been studied. This article should not be seen as a criticism of the pharmacological efficacy of Metformin in lowering blood sugar. The point here is that Metformin alters gut flora and its major pharmacological impact may result from alteration of the gut flora and not direct action on cells of body organs. ”

          http://coolinginflammation.blogspot.cz/2014/05/metformin-antibiotic-with-autoimmune.html

          1. Galina L.

            In my case I feel better without any starches. I have several health issues – allergies, migraines, a mild mood problem probably at least partially related to me being at a menopausal age (1960 is my year of birth). Ketosis makes every of my health issues better, especially migraines, not a consumption of starches which I tried to re-introduce one or two years ago due to a peer pressure on several blogs I normally read or used to read.
            I have been off my asthma meds since 2007, the year when I started a LC diet. If some people have got a positive result consuming raw starch or eating cold potatoes, it is fine with me, there are others who have a different experience. My point is – many things sound convincing in a theory, it is better to try what works for you without just trusting somebody or follow a current trend. Regardless of how wide-spread ketosis was among paleo people, the facts behind neurological benefits of ketosis are pretty solid, and many modern people could improve the quality of their life with it.
            With my comment I did an attempt to support a person who had a different experience than Tom. I don’t take a Metformine, I was just trying to tell a person how to get the substance he obviously needed.

            1. Gemma

              Galina,

              the question is if your health could have been improved EVEN MORE more via another dietary approach.

              You might be harming yourself with restricted diet and long term keto. Time will tell.

  29. Martin

    Re: A ketogenic diet will starve your gut bacteria…

    Two possibilities:
    1. A ketogenic diet will indeed starve your gut bacteria, you will lose a good deal of the little guys and it’s bad.
    2. A ketogenic diet will simply decrease your need for the amount of gut bacteria that people eating higher-carb have. So you will lose a good deal of the little guys that you don’t need any more and it’s OK.

      1. whatever

        Another possibility is that the vast majority of people suffer from too much BAD bacteria, and starving them to establish a normal proportion will benefit health. It’s not that we should have as much bacteria as possible, it’s that we should have a certain proportion of good vs. bad bacteria, and each have to stay in their correct places in the body. So killing off overgrowths of bad bacteria or misplaced good bacteria could be helpful too.

        1. Tom Naughton Post author

          I can see that, which is perhaps why some people see improvements soon after entering ketosis. But after killing off the bad gut bugs, I think the goal should be to repopulate with good ones.

  30. Pam

    The gymnast ate the whole hamburgers but the host looked like he was not eating the bun. Made me question his insulin result if indeed he didn’t eat the bun.

    1. Tom Naughton

      The host claimed they ate the same meal. I hope so. Either way, it was interesting that the gymnast only required half the insulin to process the same meal a month later.

  31. B35

    It honestly depends on the person, such as some can eat vegan, but most can’t without serious health consequences. The same goes for ketosis. I can digest small to medium amounts of carbs fine, but if I drink or eat a load of them supplemented with sugar, I start shaking. Mostly I find that if you eliminate processed sugar, processed oils, and a few carbohydrates from your diet, you will lose weight and feel better.

    And that is my two cents on this.

  32. Pam

    The gymnast ate the whole hamburgers but the host looked like he was not eating the bun. Made me question his insulin result if indeed he didn’t eat the bun.

    1. Tom Naughton Post author

      The host claimed they ate the same meal. I hope so. Either way, it was interesting that the gymnast only required half the insulin to process the same meal a month later.

  33. Paleophil

    Thanks for the reasonable and open-minded article, Tom. Unfortunately, splitters tend to be the targets of the harshest personal attacks from true believers. Here’s hoping your reasonableness and sense of humor will discourage some of that.

    Tom wrote: “you sure as hell can’t tell by looking at them.”

    I’ll just add a caveat. Given that adult chronic nutritional ketosis is a novel approach in human history and microbiology is a relatively new field, it probably makes sense for those trying it to get their GI microbiome checked and do some other simple and inexpensive tests (such as body temperature, resting heart rate and blood pressure) before and during, to be aware of the signs of problems that some VLCers have reported (such as dry eyes, cold extremities, lethargy, muscle cramps, new food sensitivities, poor sleep quality, lack of dream recall, and short term memory problems) and poor metrics (such as one or more of basal oral temperature well below 98.6F, RHR well below 70, very low blood pressure, high and rising or erratic fasting and postprandial blood glucose, triglycerides below 50, WBC below 4, low FT3, and high and rising TSH), and to keep abreast of microbiome news.

    There’s a tendency to think “I look and feel great and I know VLC is safe and healthy, so any sign or symptom must be either a good thing or not related to VLC.” It’s difficult to step outside the paradigm and look at things objectively when one is immersed in it.

    Of course, some will disagree that these signs, symptoms and metrics are negative indicators. Each individual will have to decide for themselves whether they are concerning within the context of their overall health.

    1. Paleophil

      …and check with your healthcare practitioner and do some research if you’re not sure if something is a bad sign.

    2. Annlee

      Personally, I can tell when I’ve overshot my max carbs — I get very dry eyes the next day. For me, somewhere around 30g CHO/day is the sustainable max. But then, I broke my metabolism with too much “healthy whole grains” for too long. I think Peter D nailed it – it depends on how broken you are. I would add, and where you’re broken.

      1. Paleophil

        I love having free access to Peter D’s alternative view. I like seeing all sides of the story. Yes, I was broken and wasn’t able to tolerate much carbs, and I found that I didn’t have to settle for my broken state and instead could work to improve it some, just as Tom N. appears to have managed to do. I used to have to stay below 30g CHO/day. No longer.

  34. Galina L.

    Lets not forget that ketosis have many healthy benefits not limited to the management of epilepsy or a bipolar disorder. Many find mood stabilization and mental benefits to be very important, ketosis also is helpful for the people who face their body reaction on a weight loss due to the leptine drop caused by the weight loss. Very often complains on “broken metabolism” are the complains on the normal way of a human body to function – it perceives a fat loss as a starvation episode which needs to be corrected, so the coldness, low energy, increased hunger are often the part of a successful weight loss, especially for females. Ketogenic diets are notorious for an appetite suppression and energy stabilization.

    Many of us are not ready to take what nature has in stock for us , it may be especially true for middle aged females. In a Paleo world we would be old crones with misshaped from a hard work bodies after 45 years old or probably even earlier, for a male a Paleo dream looks more appealing.

  35. Paleophil

    Thanks for the reasonable and open-minded article, Tom. Unfortunately, splitters tend to be the targets of the harshest personal attacks from true believers. Here’s hoping your reasonableness and sense of humor will discourage some of that.

    Tom wrote: “you sure as hell can’t tell by looking at them.”

    I’ll just add a caveat. Given that adult chronic nutritional ketosis is a novel approach in human history and microbiology is a relatively new field, it probably makes sense for those trying it to get their GI microbiome checked and do some other simple and inexpensive tests (such as body temperature, resting heart rate and blood pressure) before and during, to be aware of the signs of problems that some VLCers have reported (such as dry eyes, cold extremities, lethargy, muscle cramps, new food sensitivities, poor sleep quality, lack of dream recall, and short term memory problems) and poor metrics (such as one or more of basal oral temperature well below 98.6F, RHR well below 70, very low blood pressure, high and rising or erratic fasting and postprandial blood glucose, triglycerides below 50, WBC below 4, low FT3, and high and rising TSH), and to keep abreast of microbiome news.

    There’s a tendency to think “I look and feel great and I know VLC is safe and healthy, so any sign or symptom must be either a good thing or not related to VLC.” It’s difficult to step outside the paradigm and look at things objectively when one is immersed in it.

    Of course, some will disagree that these signs, symptoms and metrics are negative indicators. Each individual will have to decide for themselves whether they are concerning within the context of their overall health.

    1. Paleophil

      …and check with your healthcare practitioner and do some research if you’re not sure if something is a bad sign.

    2. Annlee

      Personally, I can tell when I’ve overshot my max carbs — I get very dry eyes the next day. For me, somewhere around 30g CHO/day is the sustainable max. But then, I broke my metabolism with too much “healthy whole grains” for too long. I think Peter D nailed it – it depends on how broken you are. I would add, and where you’re broken.

      1. Paleophil

        I love having free access to Peter D’s alternative view. I like seeing all sides of the story. Yes, I was broken and wasn’t able to tolerate much carbs, and I found that I didn’t have to settle for my broken state and instead could work to improve it some, just as Tom N. appears to have managed to do. I used to have to stay below 30g CHO/day. No longer.

  36. Galina L.

    Lets not forget that ketosis have many healthy benefits not limited to the management of epilepsy or a bipolar disorder. Many find mood stabilization and mental benefits to be very important, ketosis also is helpful for the people who face their body reaction on a weight loss due to the leptine drop caused by the weight loss. Very often complains on “broken metabolism” are the complains on the normal way of a human body to function – it perceives a fat loss as a starvation episode which needs to be corrected, so the coldness, low energy, increased hunger are often the part of a successful weight loss, especially for females. Ketogenic diets are notorious for an appetite suppression and energy stabilization.

    Many of us are not ready to take what nature has in stock for us , it may be especially true for middle aged females. In a Paleo world we would be old crones with misshaped from a hard work bodies after 45 years old or probably even earlier, for a male a Paleo dream looks more appealing.

  37. Onlooker

    Entirely too reasonable and rational, Tom. You’re never gonna kick up a good controversy with this kind of thinking. 🙂

    1. Tom Naughton Post author

      Yeah, I should probably consider the marketing aspects before writing these things.

  38. Donna M

    Great post Tom, and I think that my son had his metabolism damage from eating poorly in his 20’s. He was overweight and suffered from cluster headaches. Ketosis has been a godsend to him. He’s lost 50 pounds and the headaches have subsided (which is good because they are known to cause suicide due to their immense pain). He’s been in ketosis (much like Jimmy) for the past year, and sees no reason to slow down. He even takes part in his local roller derby league for exercise(a sport where you put skates on and skate in a circle with your team). It’s exhausting for him but I’m so proud of him to be able to do such a physical activity like that.

    Keep up the good work. God Bless.

    1. Tom Naughton Post author

      That sounds like a lifesaving turnaround, Donna. Congrats to your son.

      My son Zack is on a roller derby team. Perhaps they’ll bump into each other (literally) someday.

    2. Galina L.

      I manage migraines with a ketogenic diet, it is also a great tool for many conditions associated with a menopause.

  39. Paul the rat

    Hi Tom,
    We do not need dietary fiber to ‘feed’ our good gut microbes. Our intestinal mucosa produces mucus of which mucins are the main component. Mucus protects our gut from chemical and physical damage and is replaced rapidly. Bacteria play a key role in mucus recycle by degrading mucins and using such derived energy for growth, in a process this degradation leads to production of butyric acid. The synthesis of mucins is energetically demanding – thus our intestinal cells get some of this energy back in a form of butyric acid – main fuel for colonocytes. It is a perfect symbiosis. I would argue that butyric acid obtained from degradation of dietary fiber was a secondary adaptation in humans – we produce our own butyric acid factory, so to speak, i a form of colonocytes – mucins – bacteria loop.

    Curr Gastroenterol Rep. 2010 Oct;12(5):319-30. doi: 10.1007/s11894-010-0131-2.
    Intestinal goblet cells and mucins in health and disease: recent insights and progress.
    Kim YS1, Ho SB.
    Author information

    Abstract
    The mucus layer coating the gastrointestinal tract is the front line of innate host defense, largely because of the secretory products of intestinal goblet cells. Goblet cells synthesize secretory mucin glycoproteins (MUC2) and bioactive molecules such as epithelial membrane-bound mucins (MUC1, MUC3, MUC17), trefoil factor peptides (TFF), resistin-like molecule beta (RELMbeta), and Fc-gamma binding protein (Fcgbp). The MUC2 mucin protein forms trimers by disulfide bonding in cysteine-rich amino terminal von Willebrand factor (vWF) domains, coupled with crosslinking provided by TFF and Fcgbp proteins with MUC2 vWF domains, resulting in a highly viscous extracellular layer. Colonization by commensal intestinal microbiota is limited to an outer “loose” mucus layer, and interacts with the diverse oligosaccharides of mucin glycoproteins, whereas an “inner” adherent mucus layer is largely devoid of bacteria. Defective mucus layers resulting from lack of MUC2 mucin, mutated Muc2 mucin vWF domains, or from deletion of core mucin glycosyltransferase enzymes in mice result in increased bacterial adhesion to the surface epithelium, increased intestinal permeability, and enhanced susceptibility to colitis caused by dextran sodium sulfate. Changes in mucin gene expression and mucin glycan structures occur in cancers of the intestine, contributing to diverse biologic properties involved in the development and progression of cancer. Further research is needed on identification and functional significance of various components of mucus layers and the complex interactions among mucus layers, microbiota, epithelial cells, and the underlying innate and adaptive immunity. Further elucidation of the regulatory mechanisms involved in mucin changes in cancer and inflammation may lead to the development of novel therapeutic approaches.

  40. Gemma

    “We do not need dietary fiber to ‘feed’ our good gut microbes. Our intestinal mucosa produces mucus of which mucins are the main component.”

    So called Paul the rat′s perpetuum mobile.

    1. Paul the rat

      obviously Gemma you are unable to see the difference between human gut physiology and principles of perpetuum mobile – that is fine with me.

  41. Richard Nikoley

    “perpetuum mobile”

    Laf, Gemma. Good one.

    Hey, Tom, really good on you, this post. I’m so glad to see this more reasonable approach to carbohydrate—originally begun by Paul—gain the traction it deserves and to have it dovetail so nicely with the exploding science of the gut biome, resistant starch, dirt as probiotics, etc.

    Honesty is the best policy.

    1. Tom Naughton Post author

      Good on you for pounding away on the topics of resistant starch and the gut biome, Richard. The information was too compelling to ignore.

      Happy trails, wherever you and your RV happen to be.

  42. Kris

    Tom, I didn’t read all the comments so I apologize if what I say was already covered. I had the same exact high blood glucose reactions as you after adding a little too much starch to my diet. Since I was suffering a few side effects of low-carbing, I figured I was destined for diabetes and possibly even insulin injections because I felt I couldn’t stick to it any longer. At first I started experimenting with eating starches such as potatoes or oatmeal for breakfast, but with minimal fat if any at all, and no protein. I found that I was getting lower and more controlled BG readings… in fact lower than when I was on the LC diet. When the negative side effects of low carb began to disappear, I became more and more relaxed about the carb issue. I must admit, I do feel best when keeping wheat to a minimum and getting most of my carbs from fruits and vegetables, although I will eat some sugar on occasion if I feel like it. Now, whenever I test my BG it is consistently normal. When low-carbing my fasting readings were anywhere from 118-125. Now they are 90ish. I am not meaning to encourage you to make any changes if you feel that what you are doing works for you. I just want to let you know the BG readings may be temporary and perfectly normal for a body that is just not used to eating starches and sugar any longer.

    1. Tom Naughton Post author

      It used to be that even one small potato would jack me up to 165 or higher, but that’s when I was pretty strict low-carb. I’ve been doing a high-carb Saturday night for a couple of years, and I added potatoes back into my diet months ago. So at this point, I don’t think it’s an adjustment issue. I suspect I’m just in that low amylase group and there’s a limit to how much starch I can tolerate.

      1. Kris

        If one potato once jacked you up to 165 and now it doesn’t, but now 2 does… doesn’t that imply that perhaps after a while 2 won’t either? A most likely high fat Mexican carb Saturday probably isn’t helping you adjust to carbs either.

        Fat interferes with the body being able to move glucose through the blood quickly. Diabetics know it’s not just the carbs that cause high BG readings. Perhaps this was by design to help us store fat once upon a time. I am not saying fat is unhealthy but some fat and protein with your meal could have interfered with the added starch of a 2nd potato being metabolized efficiently.

        I wonder if you ate the 2 potatoes for breakfast without the protein and fat, if you would still have the same reaction. Or try oatmeal with very little brown sugar and cinnamon. These are the two breakfasts I ate for several weeks when first experimenting with added carbs. Not that you would choose to eat these foods but I found this enabled the kick-start my body needed to normalize my blood sugar. I later was able to eat what I wanted while maintaining normal readings.

        I realize it all sounds counterintuitive given what we low carbers were taught, but this was my experience. Then again, it’s quite simple… when vegetarians stop eating meat, they lose the enzymes to digest it. I’ve done this too and had a horrible time introducing animal protein again. I don’t think the carb scenario is much different. As humans, we are quite adaptable; our bodies adjust as long as we are eating real food… quality food. I am a believer now though, that being too restrictive can cause heath issues just as likely as being too careless and glutinous.

        1. Tom Naughton Post author

          Could be, but frankly, I don’t see the point in conditioning my body to be able to handle two potatoes at one sitting, even if that were possible. I still consider a low-carb/high fat diet to be the best diet for the greatest share of the population. But low-carb doesn’t necessarily mean VLC or ketogenic. The Jaminets consider the Perfect Health Diet to be low-carb and high-fat, and I think that’s an accurate label. If you follow their diet, you’d be at less than half the carb intake of the USDA’s Dietary Guidelines near or even above double the fat intake. PHD isn’t designed to make glucose your primary fuel — the Jaminets are adamant about that. It’s designed to provide enough glucose for glucose-dependent tissues, with fat serving as the primary fuel source.

          For me, it’s come down to eat that potato or squash with dinner if I want it, or have the gluten-free toast with breakfast. Even doing that, I’m usually below 100 grams per day, and I don’t feel any need to go higher.

          1. Kris

            I agree with you Tom. I do try to implement much of what the Jaminet’s preach. I love their philosophy of eating for optimum nutrient while being satiated. One issue I still question is the high fat component. First of all, I never realized they promoted their diet as high fat. It appears to me their diet is largely plant foods, half of which is starch, some protein and some fat.

            Regardless, I still believe eating a high fat diet does something metabolically to store fat or gets metabolized slower. I keep thinking of all those squirrels eating nuts to fatten up and make it through the whole winter without food. Or the crazy Naked and Afraid folks, literally starving on vegetation and berries, and then will eat the eyes out of a decaying dead bird, and somehow know that eating a boar (if they are lucky enough), is what will sustain them for weeks. How does that speak to most of us surrounded by such an abundance of food? If you are eating all day every day, chill out on the protein and fat… you are what you eat???

            I notice most people who promote or do well with high fat diets are men who are very active and/or never had a weight problem. My experience is that I seem to lose weight easier when I cut down on fat. Although, when I was younger I did the stair-stepper an hour a day, ran and also did weight training. I ate all the nachos and ice cream I wanted without gaining weight. Could be just a calorie issue, but I suspect not.

            Btw, thanks for your time Tom and entertaining my thoughts.

            1. Kris

              I think high fat may trigger some sort of hibernation response, something that tells the body to slow metabolism, so if one is consuming a lot of fat and not very active, they may be likely to gain weight. Just a gut feeling… no pun intended.

            2. Tom Naughton Post author

              Their diet is largely plant food by weight, but mostly fat by calories, upwards of 50%. Fat is calorically dense, which is why the Naked and Afraid folks feel so much better after eating some, but also it’s satiating — another reason the Naked and Afraid people feel so much better after eating some. Several controlled studies have shown that people on high-fat, reduced-carb diets spontaneously eat less.

  43. Nads

    Sounds like there could be something to Carb Nite. Although I don’t like the junk food it promotes. Personally, I feel best cycling in and out of ketosis.

    1. Tom Naughton Post author

      My carb night (usually Saturday) consists of a Mexican dinner I wouldn’t consider junk.

  44. Richard Nikoley

    Kris:

    “Now, whenever I test my BG it is consistently normal. When low-carbing my fasting readings were anywhere from 118-125. Now they are 90ish.”

    This was my experience, my wife’s…other family members. Essentially everyone I know.

    In fact, there is a confirmation bias going on in the LC community and I believe it’s used a bit nefariously by some to promote LC diets.

    Suppose you’re a couch potato, overweight, completely out of shape, etc. Suppose further that you’re a member of a group that dub themselves VLE – Very Low Exercise. The aim of this group is to consistently keep your heart rate under 100 so as to avoid becoming a “Palpitator.” Any kind of spike is taken very seriously.

    Then one day, the elevator is broken, so you get up off your electric scooter and take the stairs. After several flights you note that your heart is racing, so you get out your meter, insert a testing strip (har har! 🙂 and low & behold THEY WERE RIGHT! 250 bpm. YOU’RE PRE-PALPITATOR IF NOT FULL-BLOWN PALPITATOR TYPE 2!

    YOU CAN NOT TOLERATE EXERCISE AT ALL!

    1. Martin

      Let’s go trail running Richard, or climbing. I would love to see how well you can tolerate exercise 🙂

    1. Tom Naughton Post author

      Heh-heh … well, at this point, you’re more actively opposed to long-term ketosis than I am. I don’t think it’s the ideal diet for everyone, which is how it’s sometimes been sold. Probably not the ideal diet for most people, as far as that goes. But it may be ideal for some people.

      I feel best on low-ish carb, but not VLC or ketogenic. When I saw how much I’d have to restrict my protein to stay in ketosis, that was all the evidence I needed to decide it wasn’t the best diet for me.

      1. desertwarrior

        I am admittedly lost in the weeds of this foodie nerdfest when it gets super detailed like this…I really appreciate your openness and not being a slave of dogma.

        I use Fat Head all the time in introducing low carb/metabolic resistance to people or to introduce the idea that fat isnt the enemy. I have recently been squabbling a bit with some vegans ,one of which was a known paleo blogger that was on LLVLC a couple years ago . I was just supporting a friend that is trying out paleo/low carb to lose some weight! Anyway, my innocent comment about fat triggered some ranting on youtube from this person. Down that rabbit hole I went.

        Now the Julian Bread/Primal power/Jimmy thing…
        I came to finally read your review of Keto Clarity,and I am so pleased to hear you speak to some level of moderation and acceptance that we all can’t eat the same way, and that your life cannot be all about finding out why you feel like crap as a fat burner or a sugar burner.

        Anyway…I may like the drama a bit too much…and now I see the freetheanimal guy here…so the fire is still being stoked…

        ah…fun in the food aisles. https://www.youtube.com/watch?v=qsrEAWcAvRg

        1. Tom Naughton Post author

          The Julian Bread people are proving themselves to be morons, and I think their attack-dog strategy will backfire. Any sane person will watch their YouTube videos attacking Jimmy Moore and Diane Sanfilippo (both of whom have criticized Julian Bread) and recognize it as the self-serving crap it is. I’m also pretty sure they didn’t do themselves any favors by attacking the Ancestral Health Symposium and PaleoFX. It’s roughly as convincing as watching Monsanto criticize Dr. Bill “Wheat Belly” Davis.

          And puh-leeze, they’re trying to portray Diane Sanfilippo as fat? That’s laughable. I’ve met her. She’s athletically built (as opposed to skinny) and she’s a babe. (As a happily married man with a secure wife, I can say that and get away with it.)

            1. Tom Naughton Post author

              You do know that if you go around referring to me as a sweet potato, it could spark a whole ‘nuther debate about safe starches, right?

    2. Kris

      I agree with you Richard. I think ketosis may signal the body that starvation is near, or at least food is scarce. Hence my comments about hibernation also. Slow that metabolism down… we’re in shut-down mode. Or if we need to be alert and active, time to kick in adrenaline hormones so we burn on vapor if we have to.

      Many gurus even Jaminet as I recall recommend coconut oil to induce ketosis as a good thing. It looks like several things may promote ketosis- too few calories, too few carbs, high fat,or maybe certain fats. What would induce hibernation? Perhaps the same things. Perhaps they are one in the same… both designed to sustain life.

      What’s the deal with the palpitations? I have always worked out with weights and walk btw, not a couch potato. I often had symptoms of hypoglycemia without the low blood sugar at times while low carbing, also including racing heart, lightheadedness and insomnia too. All went away after eating more carbs.

  45. Weezy

    Thanks for the great article, Tom. As a T2 diabetic and really bad family history of T2, I’ve come to realize that what works for me will most likely not work for anyone else. For me, cycling in and out of ketosis without worrying about it works best. My blood ketone meter read 2.5 this morning; two days ago ketones were so low that they couldn’t even register. I feel best having a couple ounces of potatoes a couple times a week; berries in season, and even rice on rare occasions. And about once a month I go out and eat without worrying (but still pass on desserts).

    However, even eating well and “eating to my meter” (i.e., testing blood glucose frequently to see what spikes me) won’t necessarily keep me off of medications…my diabetes is progressing despite my best efforts and I’ll probably be on insulin in a few more years. But that’s OK because eat HFLC AND being informed and educated will help keep the amputations and blindness at bay. I keep my A1C in the normal range with medications and diet and will continue to make changes and adaptations as needed to stay there–whether that means diet changes or medication changes.

    But all that said, what REALLY cracks me up about all the diet controversy is the idea that one size MUST fit all. Heck, in the education world, teachers are taught to discover the uniqueness of each child and then differentiate the lesson for that child. In other words, change the methods, rules, and sometimes even the standards to fit the child. I don’t always agree with that (which is a different long discussion), BUT why can’t we recognize that people’s bodies are different? Why must we all fit into the popular paradigm? Why can’t our doctors and nutritionists be taught to differentiate and find the best program for health for the INDIVIDUAL?

    If people all learn differently and that’s OK, why isn’t it OK that our bodies respond differently to different foods? Genetics and personal history control how our genes express themselves….so why must we be forced to fit into a standard mold and conform to it?

    And yeah, I hate any type of top-down government decrees—they never fail to be harmful and stupid.

  46. Weezy

    Thanks for the great article, Tom. As a T2 diabetic and really bad family history of T2, I’ve come to realize that what works for me will most likely not work for anyone else. For me, cycling in and out of ketosis without worrying about it works best. My blood ketone meter read 2.5 this morning; two days ago ketones were so low that they couldn’t even register. I feel best having a couple ounces of potatoes a couple times a week; berries in season, and even rice on rare occasions. And about once a month I go out and eat without worrying (but still pass on desserts).

    However, even eating well and “eating to my meter” (i.e., testing blood glucose frequently to see what spikes me) won’t necessarily keep me off of medications…my diabetes is progressing despite my best efforts and I’ll probably be on insulin in a few more years. But that’s OK because eat HFLC AND being informed and educated will help keep the amputations and blindness at bay. I keep my A1C in the normal range with medications and diet and will continue to make changes and adaptations as needed to stay there–whether that means diet changes or medication changes.

    But all that said, what REALLY cracks me up about all the diet controversy is the idea that one size MUST fit all. Heck, in the education world, teachers are taught to discover the uniqueness of each child and then differentiate the lesson for that child. In other words, change the methods, rules, and sometimes even the standards to fit the child. I don’t always agree with that (which is a different long discussion), BUT why can’t we recognize that people’s bodies are different? Why must we all fit into the popular paradigm? Why can’t our doctors and nutritionists be taught to differentiate and find the best program for health for the INDIVIDUAL?

    If people all learn differently and that’s OK, why isn’t it OK that our bodies respond differently to different foods? Genetics and personal history control how our genes express themselves….so why must we be forced to fit into a standard mold and conform to it?

    And yeah, I hate any type of top-down government decrees—they never fail to be harmful and stupid.

  47. Boundless

    Perhaps coincidentally, Bill Lagakos has lately posted on “Ketosis in an evolutionary context”, at:
    http://caloriesproper.com/?p=5078

    So we’ve inherited this capability. What are to make of it?

    We’ve also NOT inherited the ability to synthesize uricase and vitamin C, as Richard J. Johnson points out in “The Fat Switch”. These latter two apparent deficiencies enable humans to be pretty good at packing on the pounds when fructose is available. It’s perhaps no coincidence that ketosis can make use of it.

    One conjecture is that the ability to build up fat reserves, then handle an unwanted fast that might run a month or more, was a distinct survival advantage during severe winters or perhaps one or more population bottlenecks, such as the Toba Catastrophe.

    We are all descended from humans with this glycemic/ketotic metabolic flexibility. (Perhaps the Neanderthals lacked it.)

    Part of our modern problem is that
    metabolic summer never ends now, and
    metabolic winter never comes;
    metabolic syndrome comes instead.

  48. Boundless

    Perhaps coincidentally, Bill Lagakos has lately posted on “Ketosis in an evolutionary context”, at:
    http://caloriesproper.com/?p=5078

    So we’ve inherited this capability. What are to make of it?

    We’ve also NOT inherited the ability to synthesize uricase and vitamin C, as Richard J. Johnson points out in “The Fat Switch”. These latter two apparent deficiencies enable humans to be pretty good at packing on the pounds when fructose is available. It’s perhaps no coincidence that ketosis can make use of it.

    One conjecture is that the ability to build up fat reserves, then handle an unwanted fast that might run a month or more, was a distinct survival advantage during severe winters or perhaps one or more population bottlenecks, such as the Toba Catastrophe.

    We are all descended from humans with this glycemic/ketotic metabolic flexibility. (Perhaps the Neanderthals lacked it.)

    Part of our modern problem is that
    metabolic summer never ends now, and
    metabolic winter never comes;
    metabolic syndrome comes instead.

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