Ain’t That Nutritional Ketosis Thing Just Another Way Of Saying Atkins?

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Dr. Robert C. AtkinsIf I had a dollar for every time I heard some variation of the title of this column, I’d be a very rich man. Ever since I started on my n=1 nutritional ketosis experiment in May 2012 (read my four 30-day update posts: Day 1-30, Day 31-60, Day 61-90 and Day 91-120), I have seen interest that is near-unprecedented in my eight years of blogging about low carbohydrate diet and health. It just goes to show you that despite the best efforts by the media and all the so-called health “experts” trying to discredit healthy low carb living, countless numbers of people who want to lose weight and attain optimal health still believe in its amazing benefits. There’s certainly something there that warrants a closer look for those who have been struggling in their nutritional health goals.

If you’ve been following a low carb lifestyle for any length of time, you probably already understand the importance of being in a ketogenic state, where your body switches from using carbohydrates to fat — both dietary and stored body fat – and ketone bodies as its primary fuel sources. The late, great Dr. Robert C. Atkins made this key concept the centerpiece of his bestselling books. Unfortunately, dietary ketosis has been severely maligned by Dr. Atkins detractors as somehow being a “dangerous” state. “Ketosis” has a mistaken negative association with the truly dangerous and potentially fatal “diabetic ketoacidosis” that most frequently occurs in people with Type 1 diabetes. I encourage you to go listen to my podcast with Mark Sisson from the “Mark’s Daily Apple” blog in Episode 5 of “Ask The Low-Carb Experts” where we take on this misconception about ketosis.

Another problem with using the term “ketosis” alone, as Dr. Atkins did throughout his work, is that it neglects to communicate any concrete, practical meaning regarding what it takes to get there. There are true benefits from ketosis, so this understanding is crucial. This is why I believe the phrase “nutritional ketosis” is a better way of framing the idea of becoming keto-adapted or fat-adapted through the use of a well-formulated high-fat, adequate (moderate) protein, low carb diet. Until you get the macronutrient mix that is right for YOU, the health benefits of nutritional ketosis will continue to elude you.

The term “nutritional ketosis” has become popular in the low carb community in recent years thanks to a series of books written by Dr. Stephen Phinney and Dr. Jeff Volek. They first used the phrase “nutritional ketosis” in their 2010 New York Times bestselling book The New Atkins For A New You (written with Dr. Eric Westman). Phinney and Volek continued to use and define the term in their subsequent books The Art And Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance. This branding of the “nutritional ketosis” concept has been the best addition to the low carb vernacular since many stopped calling low carb a “diet’ and started calling it a “lifestyle.”

So what’s the difference between “nutritional ketosis” and the ketosis that has been a part of the Atkins diet for the past four decades? It’s a subtle but very important distinction. First, though, let me express my incredible gratitude to Dr. Atkins for helping to change my life through his diet. Starting at 410 pounds in 2004, I lost 180 pounds that year and my life has never been the same. I’m honored and blessed to have a very popular health blog and three podcasts dedicated to spreading the message of low carb living to the masses.

Though I never had the privilege of meeting him, none of that would have been possible without the inspiration and education that came from that amazing man. His legacy is still making ripples in the world nearly a decade after his tragic death following a slip-and-fall accident on an icy New York City sidewalk. His memory lives on through those of us who have picked up the baton and continued the race. God bless you Dr. Atkins for saving my life, and the lives of millions of others who benefit from your passionate zeal about low carbohydrate nutrition, and what it can do for those who want to become healthy.

If Dr. Atkins were still around today, I’m sure he’d be all in favor of this notion of “nutritional ketosis.” So what exactly is the difference and distinction between nutritional ketosis and Atkins? Nutritional ketosis (measured by blood ketones) is ketosis, but ketosis (measured by urine ketones traditionally by Atkins and low-carb dieters) may not necessarily be nutritional ketosis. Traditionally, ketosis has been measured with urine testing strips. These turn some shade of pink or purple when you are excreting ketones (acetoacetate) in your urine. But in their Performance book, Drs. Phinney and Volek recommend measuring blood ketones (beta-hydroxybutyrate) as a better and more reliable way of gauging ketone levels, allowing you to aim for the optimal range of 0.5-3.0mm. The two most popular brands of blood ketone meters are Precision Xtra and Nova Max Plus. Both provide invaluable information about your level of nutritional ketosis. While test strips for these meters can be pricey, ranging from $1-6/strip, it’s so worth knowing exactly where you stand when it comes to your low carb lifestyle. A Google search will help you turn up the cheapest sources for a monitor and strips.

If you haven’t yet tested your blood ketone levels and wanna take a peek at how well you are doing on your chosen low carb plan, I highly encourage you to pick up a meter and test for yourself. Back in May, when I did this for the first time, I was shocked to see my blood ketones measuring in at a paltry 0.3. I’d been eating what I thought was a pretty good high-fat, moderate protein, low carb diet for close to nine years! In my next CarbSmart column, I’ll be sharing more about the mistakes I believe I was making in my low carb plan that prevented me from attaining nutritional ketosis and what you can do to get there to experience the incredible health benefits that come from it.

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Comments

  1. Kisha Majors says

    So what’s the difference between “nutritional ketosis” and the ketosis that has been a part of the Atkins diet for the past four decades? It’s a subtle but very important distinction.

    Then you stop and distract from the question and never actually answer it. So what is the difference?

    • says

      From what I gathered (read copy-pasted) from this article: “nutritional ketosis” is a better way of framing the idea of becoming keto-adapted or fat-adapted through the use of a well-formulated high-fat, adequate (moderate) protein, low carb diet.

      Thanks for this article Jimmy! I heard you mention this when you were filling in for Sean Croxton. I can’t wait to read your next article! Its likely that I will do an n=1 for myself after reading more :)

        • cancerclasses says

          “Ketosis” is kind of the wrong word to use to describe this physiological condition, read somewhere but can’t remember who describes it as more like just a mild ketotic state.

          From Wikipedia re Ketone Bodies: “Individuals who follow a low-carbohydrate diet will also develop ketosis, sometimes called nutritional ketosis, but the level of ketone body concentrations are on the order of 0.5 to 5 mM whereas the pathological ketoacidosis is 15 to 25 mM.”

          So ‘nutritional ketosis’ levels at 0.5 to a high of 5 mM are only one fifth of the acidosis levels, and an ‘optimum’ ketone level of 0.5 to 3mM is around 7 times lower than a midrange ketoacidosis level of 20mM.

          • says

            The more important distinction between nutritonal ketosis and diabetic ketoacidosis is that your body is balancing ketone creation with actually bodily needs. In ketoacidosis found in type 1 diabetics and those with alcohol damaged liver the body can no longer do that. They are two totally different conditions.

            You can actually get your ketones temporarily higher than 5 through hard, extended workouts, but in nutritional ketosis this will be a short blip on the map and your body will readjust. You will never come anywhere near ketoacidosis.

            Our body has a wonderful system sitting on stand by in most people to burn just the right amount of body fat for their needs. Its a true shame that ketogenic diets are so feared and misunderstood and people are discouraged from their use.

            • Dana says

              I think the reason you’re throwing ketones in ketoacidosis is that your body’s having a lot of trouble using glucose as fuel and is therefore in a panic, trying to find fuel wherever it can. I’m not clear whether the metabolic acidosis of ketoacidosis is from the ketones, or from the massively high blood sugar you also get at the same time. The Wikipedia entry on the subject is not entirely clear. Probably with alcoholic ketoacidosis it’s more likely to be the ketones causing it. In diabetics (type 1 or uncontrolled type 2), the high glucose probably plays more of a role.

          • says

            Yeah… you don’t mean ketosis, you mean ketogenesis.

            Ketosis is the state of producing excess amounts of ketones, which will appear in urine.

            Ketogenesis is the state of producing adequate ketones to keep the body fueled on triglycerides.

    • Desert Blossom says

      You need to keep reading…
      “Traditionally, ketosis has been measured with urine testing strips. These turn some shade of pink or purple when you are excreting ketones (acetoacetate) in your urine. But in their Performance book, Drs. Phinney and Volek recommend measuring blood ketones (beta-hydroxybutyrate) as a better and more reliable way of gauging ketone levels, allowing you to aim for the optimal range of 0.5-3.0mm. “

  2. says

    THANKS Kisha! The distinction was made in my column, but it bears repeating again here:

    Nutritional ketosis (measured by blood ketones) is ketosis, but ketosis (measured by urine ketones traditionally by Atkins low-carb dieters) may not be nutritional ketosis. So just because you are eating an Atkins-styled diet, as I have been for nearly 9 years, doesn’t mean you’re going to be achieving an adequate level of blood ketones necessary to produce the fat-burning effects your body will need to perform in a fully keto-adapted state. Like I said in my column, I LOVE and admire what Dr. Atkins did to get my life back on the pathway to health. Nutritional ketosis simply takes that understanding to the next level so we can make this low-carb lifestyle change as optimal as it can possibly be!

    THANK YOU for reading!

  3. Carol says

    I would also like to point out that when Phinney and Volek first used the term “nutritional ketosis” in 2007 in their book entitled “A New Atkins for a New You”…. it was used as a synonym for the Atkins diet protocol… they were simply using it to differentiate the Atkins diet from ketoacidosis that occurs with Type 1 diabetics… and they were making the point that the ketone levels were much lower with the Atkins type diet.

    It doesn’t matter how you measure ketosis…. all ketosis that derives from eating a diet low in carbohydrates is nutritional ketosis. Jimmy can’t just start saying that because he’s lowered his protein content, that it is something new… because even Atkins in his 1971 ( or 72) book says that individuals will have to adjust portions as needed to remain in ketosis.
    Atkins also emphasized a high fat component was crucial to remaining in ketosis. In fact, he said if you were having trouble maintaining ketosis, his perfect food to put you back in ketosis is cream cheese.

    Also, measuring something with a different device does not change the “thing” that’s being measured.

    My ultimate beef with all this… is that even with this write-up Jimmy extols the virtues of the Atkins diet in 2004 and highlights his 180 pound weight loss…. Yet, he seldom mentions that he regained approximately 80 lbs and went up to 308 lbs (according to his first n=1 graph) over the next 6 years. I did read one of his blog posts acknowledging this weight gain (I think due to public pressure) and he mentioned that Christine has never had a weight problem and that he began being more lax and not following his original way of eating where he lost weight. Whatever the cause, obviously something was different to cause the regain of 80 lbs.

    So now, in 2012, Jimmy is once again eating the Atkins diet, albeit with lower protein and he has added carbs back into his diet… on one of his podcasts or interviews he said he was eating no carbs at all … I think that was last year. And now he is using a ketometer to measure his ketone level… and he is losing weight … and et voila!! He is attributing it to something he is calling “nutritional ketosis” as if it’s some miraculous new discovery… and doing his n=1 posts as if it’s something totally new that has allowed him to start losing weight again.

    Obviously, being keto-adapted was and is the heart of the Atkins diet…. Phinney and Volek used the term “nutritional ketosis” as a synonym for the Atkins diet to differentiate it from dangerous ketoacidosis in Type 1 diabetics… in their book called “A New ATKINS for a New You.”

    I just think it’s disingenuous of Jimmy to once again tout his 180 lb weight loss on Atkins but make no mention of gaining 80 lbs back (how can you ignore that?)…. and now that he is measuring ketones more accurately than with urine strips … he is calling it a “new” kind of ketosis… it is not.

    All ketosis (except for that in Type 1 diabetics) is nutritional. Just be honest and say you have tweaked the Atkins diet a little (as of course Robert Atkins recommends over and over in his 71 or 72 book) and are following it more strictly, have added back in some carbohydrates and are now losing weight again… and we will all say Hooray Jimmy! Cus truly I am thrilled you are losing weight and feeling good…. but I don’t like this semantics game when what you are actually doing is following the Atkins diet again, and are measuring it differently.

    • says

      Carol, I’m not disagreeing with you on Atkins being all about nutritional ketosis. But the clarifying nature of using the phase “nutritional ketosis” is helping a whole lot of people understand what true Atkins is all about whereas it might have been muddied before with the notion to cut carbs to 20g or less and eat unlimited fat and protein. The excessive protein may be an issue for some…thus, nutritional ketosis discoverable from measuring blood ketones. Nobody is claiming to have invented anything new here. It’s simply using the tools of modern technology to become more precise with discovering what works for the individual. This is no game to me. It’s serious, real life stuff that I am seeking to help others who are struggling as I am. I’ll say it again…what I’m doing with nutritional ketosis is NOTHING close to the Atkins diet plan that helped me lose 180 pounds in 2004. At the appropriate time, I’ll reveal exactly what I’m doing. In the meantime, I encourage you to stop being so critical of the minutia and start focusing on the big picture of the millions who could stand to benefit from the quality information this concept of nutritional ketosis is providing. THANK YOU!

      • Carol says

        Thanks for your reply Jimmy.

        But I honestly feel I am not being critical of the minutiae. I am a scientist and to me words matter… so when you say “Nutritional ketosis (measured by blood ketones) is ketosis, but ketosis (measured by urine ketones traditionally by Atkins and low-carb dieters) may not necessarily be nutritional ketosis.”

        it is simply a false, and misleading, statement. IT DOESN’T MATTER HOW YOU MEASURE KETOSIS, IT IS STILL KETOSIS, AND ALL KETOSIS IS “NUTRITIONAL”…. giving it this label, you are clearly implying it is something new. It is not.

        • says

          Thank you again, Carol. However, my use of the term “nutritional ketosis” isn’t “implying” anything. It’s simply acknowledging and repeating the scientific language that was used by Volek/Phinney in their last three outstanding low-carb books. There’s no need to make a mountain out of a molehill here. The phrase is not mine. I’m simply highlighting it for the benefit of those who need to know about it.

          So let me get this straight: Are you saying that Volek/Phinney are making “false and misleading” statements whenever they use that term “nutritional ketosis” to describe what they are talking about with this way of eating? And does it really matter at the end of the day if you use “nutritional ketosis” or “ketosis” as long as people are seeing weight loss success and health improvements? Isn’t that the ultimate goal of anyone following such a plan? The answer is a resounding YES which is why your criticism is that much more baffling.

          Sounds like your real issue is with two of the world’s foremost authorities on nutritional health for using the phrase “nutritional ketosis” in their books to describe the end result of a well-formulated low-carb diet and not with Jimmy Moore who is simply reiterating what they are saying. Who cares really what you call it if people can find success doing it. I’ve never implied this is new. Not once. Not ever. But I do appreciate your comments.

          • Martin says

            Here’s my take at the difference between Phinney & Volek’s “nutritional ketosis” and the Atkins diet.

            Atkins diet is defined through exclusion and inclusion of the foods (or food groups) that you can and cannot eat. P&V define NK as a state with the blood ketone levels in the range of approx, 1-3 mmol/L. According to the sudies they have been dooing for over 2 decades, that’s the optimal range (please refer to their books for details what that means). They do give recommendation for the foods to eat, but the definition is, again, blood ketone levels-based. It’s purely quantitative, i.e. could never look at the diet someone eat and determine whether they’ve reached it or not.

            The difference is quite important: one can follow Atkins diet and NOT reach this level of ketones, e.g. if one overconsumes protein or due to huge stress causing cortisol release causing gluconeogenesis or due to some metabolic disease or due to specific medications. Notice that the last 3 are diet-independant. On the other hand, it’s quite unlikely that one could reach the 1-3mmol/L ketone levels while not being on Atkins. And PP&V state openly that the diet they recommend is in fact a version of Atkins, with the constraint on the amount of protein. Let me restate: P&V advocate Atkins diet!

            I’m also pretty sure that there exist outliers who could consume much more carbs and protein (i.e. non-Atkins) and still reach the ketone levels that qualify for NK. My bet would be, for example, that Anton Krupicka (an ultra runner) enters ketosis at least during his races even though he does not limit carbs. I believe it’s the case since he states that he actually does not need to eat often during races. Well, he needs to get the energy from somewhere. For the rest of us who are not like Anton, we have to follow Atkins, possibly with the protein-constraints recommended by P&V to get our ketone blood-levels to the range that qualifies for NK.

          • Lynn says

            I have been measuring ketones both ways. urine strips and with a meter. They only show up on the meter. I have bought several kinds of strips and they never change color.

    • Ian Ippolito says

      Carol,

      No idea why you’re hatin’ on Jimmy so much. He’s already disclosed everything about his weight history in his blogs. What he’s doing now is a step beyond what is covered in even the new Atkins book. You need to read the last Volek book so you can understand what he’s actually doing (and how it’s different than the basic Atkins most people do). Then you can make intelligent criticisms about the differences, if you still want to.

      From my persepctive, Jimmy’s excited because he’s found something new that worked for him, and that many others could benefit from so he wants to share it. He’s not claiming credit for the ideas…just sharing. And sharing real-life experiences in information is never a bad thing.

    • Ralph Waterley says

      Thank you Carol, I was confused on the very same question. You have clarified far better than Jimmy, whose enthusiasm i nonetheless admire greatly. Jimmy: learn from this smart lady, she can help you communicate better.

      Ketosis is a fine word, we don’t need to make it more complicated. There are lots of books about ‘keto’ diets for example. The concept is clear to those who want to understand it. For those who intentionally want to misunderstand in order to condemn low-carb, no level of name-changing will chase them off.

      But adding unnecessary names does confuse those who are eager to learn what low-carb is truly all about. Don’t throw out the baby to get rid of the bath water.

      If Phinney wants a new buzzword to distinguish & publicize his variant of Atkins, why doesn’t he just call it ‘Do the Phinney, You Ninny!’ There would be no confusion about that. Or he could take the time tested approach like that South Beach guy and choose a glamorous name. ‘The Bel-Air Diet’, ‘The Full Monte Carlo Diet’, ‘The Arctic Diet’ (since Eskimos eat a lot of fat), etc.

      There are lots of options to choose from, instead of messing with the core concepts of low-carb.

  4. Jonathan Swaringen says

    Quote from comments section by someone other than me in this post
    http://jackkruse.com/brain-gut-12-dare-to-disagree/
    “BobWayne, I think someone mentioned that ketosis is iodine dependent. Perhaps that is an issue?”

    I’m curious Jimmy if your Iodine might have been lacking when you weren’t losing weight. A possible factor? This is the first I’ve heard of Iodine being linked to ketosis.

      • says

        Jack Kruse makes that case that ketosis is iodine dependant in that you should be sure to get adequate iodine to make the most of it, not that you require iodine to produce ketones and become keto adapted.

        Dr Kruse, whom I respect greatly, also has a niche to defend and his niche diet heavily promotes iodine based foods and he is finding all kinds of reasons to call it a requirement.

        Many people are losing weight just fine without specifically seeking out iodine and they are in nutritional ketosis.

        I would describe Dr. Kruse advise as a way to optimize, not required. And I agree with him, iodine is very important.

  5. donny says

    There’s a precedence in science for terms to not have the same meaning as they do in basic english. “High fat diet” comes to mind. When researchers write about a “high fat diet,” they often have a very specific high fat diet in mind–often with just enough sugar added to the high-fat chow to send palatability through the roof. Journalists get a hold of these studies, and we get headlines about the effects of a high fat diet—but they don’t write about the specific high fat diet used in the study, somehow between here and there, the specific high fat diet becomes more generically “a diet that is high in fat” as if any diet high in fat would have given the same results.

    The phrase “nutritional ketosis” bothered me for a while–but I sort of got over it. We have a limited number of words in the language, large as it is–and many words have different meanings according to context. I take nutritional ketosis as used by Jimmy to just mean a deeper level of ketosis than will usually be achieved by simple eating meat and eggs to appetite. I think Jimmy defined his term pretty well.

    I think something new absolutely has been added with the blood ketone meter. It might just be a matter of accountability… or it might just be easier to see where your going with your eyes open, more information makes it easier to steer.

  6. says

    Jimmy,

    It’s working for me. I have been following your updates. I have lost a total of 21 pounds. The keto n=1 experiment is going well. Just eating low carb/paleo 80/20 was not enough. Days where I would eat at friends homes or at birthday parties and potlucks were throwing me back to being a sugar burner. In April after seeing a picture of me with a nice round apple middle…(scared me. Heart issues, stroke and type ll is in my family) I continued to research. After reading your blog and listening to you, hearing about your n=1 experiment on yourself, I read The Art and Science of low carb living. I have been very mindful of staying in ketosis and after about a month of it, I began to lose my middle. The weight did not start to fall for about a month…I have lost so far a total of 9 inches around my rib cage as of this morning. Unlike most women, I did not carry excess weight in my hips and thighs, but in my belly , back and chest.. In April, Under my bra line measured 43 inches. My back was rippled like a marshmallow with creases. Today it measures 34. The inches loss seems to be much more than the amount of weight I have lost. My exercise is walking once or twice a week stand up paddle boarding a couple times a week.Relaxing. Nothing strenuous. My stomach/waist measurement has gone from 41 to 34. That is a BIG difference. I had been lifting weights and doing cardio 6 days a week, to no avail.
    Keep preaching it Jimmy. You have given me the missing like for me. It may not be for everyone…but for me..it is finally doing the job.

    Lynn

  7. Mary says

    In one of your interviews Jimmy, someone (sorry, can’t remember who) said of the difference between testing with urine as opposed to blood, “it’s like looking in the garbage to see what’s in the refrigerator.” That makes sense to me.

      • says

        Same for testing urine pH to determine body & system acid-base balance, it’s like testing the pH of your sewer line outflow after flushing the toilet. Urine pH has NO bearing and doesn’t reflect intra & extracellular & blood serum pH or anything on the upstream side of your kidneys. That’s their job, system pH is TIGHTLY regulated and is ALWAYS between 7.35 & 7.45, if it were so easily adjustable we’d have killed ourselves and died off as a species long ago. System pH can’t be changed with ANYthing you eat, all that does is change the pH of the digestive tract & system, and neutralizing the acids in the stomach & digestive system is NOT good, it operates at it’s own pH level FOR A SPECIFIC REASON, DON’T mess with it.

  8. Ian Ippolito says

    Bravo Jimmy, I’m excited by this topic and looking forward to more!

    After reading Dr. Volek’s book on low carb sports performance I ran into your n=1 experiments and loved them. They inspired me to get my own ketone meter and test. After eating low carb for several years and myself hitting a plateu its great to finally have real feedback.

    After adding more fat, my morning blood ketones are “okay” (from 0.6 – 1.1) but nothing to write home about. And certainly nothing compared to the ketone levels you’ve been achieving in your experiment. I’ve tried Dr Volek’s suggestion of lowering protein to the bottom of his suggester range, but it hasn’t make much of a difference yet.

    So I’m hoping in future articles you talk about what you adjusted and did to get your ketones to the impressive levels you have…and what tweaks you did when you wanted to move things one way or the other.

    Looking forward to reading more and keep up the great work!

    Ian

  9. EV Lynne says

    Carol gets it (and I’m actually quite surprised her comments/questions were even allowed to see the light of day). What you call “minutia”, Jimmy, is what science is all about. Sorry you find it to be a waste of time.

    • says

      EV:

      Carol’s comments were “allowed” because even though she strongly disagreed with Jimmy, she was able to display her comments without adding nasty comments or personal slurs.

      We encourage everyone to join the discussion here, but our Blog Comment Policy states that:

      2. Comments including profanity will be deleted.
      3. Comments containing language or concepts that could be deemed offensive will be deleted.
      4. Comments that attack a person individually will be deleted.

      So feel free to comment, stay civil, and be heard.

      Andrew

  10. Julie says

    Jimmy –
    Thank you for making this distinction. I’ve been following your N=1 experiments and have learned a lot…way to go, with your health stats and weight loss!

    I think the woman above was possibly hung up on a semantics issue. The bottom line is that any form of ketosis is the SYMPTOM of your body burning fat. From my understanding from – and please correct me if I’m wrong – KETONES are released ANY TIME your body is burning fat as a fuel (instead of glucose/sugar).

    This is true whether it is caused from a “good” healthy, LC diet, or “bad/dangerous” conditions in the body [i.e. Ketoacidosis, or starvation!]

    (1) In “ketoacidosis” (which is NOT dietary ketosis, as we know), the end result is the production of ketones: “Diabetic ketoacidosis is a problem that occurs in people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.” [REFERNCE LINK: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001363/

    (2) In starvation: "...During prolonged fasting or starvation, acetyl-CoA in the liver is used to produce ketone bodies instead, leading to a state of ketosis/During starvation or a long physical training session, the body starts using fatty acids instead of glucose..." [REFERNCE LINK: http://en.wikipedia.org/wiki/Ketosis

    (3) In dietary ketosis/nutritional ketosis, ketogenic diets like Atkins, paleo, and very low carb diets "ketosis merely means that our bodies are using fat for energy. Ketones (also called ketone bodies) are molecules generated during fat metabolism, whether from the fat in the guacamole you just ate or fat you were carrying around your middle. When our bodies are breaking down fat for energy, most of it gets converted more or less directly to ATP. (Remember high school biology? This is the "energy molecule.") But ketones are also produced as part of the process..." [REFERNCE LINK: http://lowcarbdiets.about.com/od/faq/f/whatisketosis.htm

    So, in short, I believe the tension above was purely semantic. Nutritional Ketosis is not a different ‘process’, nor are you trying to brand a new form of ketosist, but merely defining the ‘sweet spot’ in WITHIN ketosis. (if that makes sense?) It’s still the same Ketosis process, but Phinney/Volek have defined the ideal range, or condition. (For example, water is water is water, whether it’s in liquid, gas, or solid form. But water is only formed as ICE, when kept at 32 degrees or below, and kept there long enough for the enthalpic (sp?) change.)

    So, that’s my 2 cents….I’m just left with a couple of questions. I cannot afford a blood ketone monitor and strips right now (I only work PT for mere peanuts, and live in the depressed MI economy!)…I do, however, have the urine strips and so I know I am keto-adapted and burning FAT for my fuel, instead of burning SUGAR.

    (1) What is your recommendation for grams/day or ratio(%)…based on weight, age, sex for approximates for grams of Fat/Protein/Carbs? [I’d really like to test my blood ketones, to see if I’m in my ideal range, but it’s cost-prohibitive at the moment.]

    (2) My other question, which is correlated to the one above, have you come across any recommendations on the # of calories from FAT you should intake, based on one’s weight. Instead of the sheer calories in/calories out dogma, I’m curious if anyone has come up with an LC formula for the # of calories (and calories from fat) one needs for their weight for energy. This way, one could possibly create deficit of FAT grams, knowing that their body is using them for energy, thus forcing the body to burn it’s own fat because of said deficit.

    I really want to be eating as efficiently as possible and believe I’m eating good, high-quality (and a sufficient volume) of FAT, moderate protein, and minimum carbs, but would like to find my own ‘sweet spot’, so to speak.

    • Margaret says

      I’ve been reading anything that I can get my hands on to help me understand what you are doing differently, Jimmy. I have a big old hernia that needs repair, and have to lose a good 70 pounds before that can happen. It’s a race against time for me, trying to get the weight off before my entire abdomen turns in to a giant hernia. The stakes are high for me.

      Using what I think might qualify as “muddied Atkins” I average about half a pound loss per week; I’ve been at this almost 6 months. I need to do better than this.

      So here is what I think has been said in all of the above:

      1) Atkins works mainly from food lists and urine strips. Neither are enough to tell you exactly what is going on inside the body.

      2) Aside from the “known” culprits of carbs and dairy, protein may also be a culprit if you eat too much of it. Exra protein turns into a type of sugar that presumably sets off the insulin chain.

      3) Over time, it is very possible to become non compliant with Atkins, or to kid yourself that you’re on it. Without some really clear feedback format you can believe you’re operating in the right territory, while in truth you are not. You may be in the right continent, but you’re only operating at the edges of the territory.

      4) You’ve got to keep tweaking to move towards what is perfect for you, and (especially in women) that may change based on hormone fluctuations, stress, etc.

      5) Urine strips are easy to ignore (The Atkins book tells you that not “peeing purple” isn’t so bad, so I’ve not been too concerned). That means it isn’t a reliable feedback system for tweaking purposes.

      6) The scale is a feedback system all right. Unfortunately, it only tells you that something is off. It doen’t say squat diddly about what it is.

      7) Blood ketones are an accurate feedback measure, and once you see where you really stand you can begin tweaking more precisely. The blood ketone measure is responsive enough to tell you if you are getting closer to the right formula.

      8) It “doesn’t matter” what Jimmy is eating, ’cause Jimmy’s body is pretty unlikely to operate exactly like my “pushing 60, menopausal, female chassie”. I’d have to find my own combination through experimentation.

      9) I’m not completely operating in the dark though. There’s research out there that tells me what might optimize both my physical performance and weight loss. The only thing I have to do is try to stay abreast of what is developing.

      Have I got this even CLOSE to correct????

  11. Johnnie Owen says

    A low carb diet is expensive, you have have the keep buying (smaller size wardrobes). I went from a 40 waist down to 34.

  12. benny says

    just another catch phrase title to sell things..most studies I have read clearly state the only advantage of being in a keto state is about -130 calories..study after study states keto diets are no miracle and still is about calories in vs out.till this day this has never been unproven ..

    • benny says

      The conversion of carbohydrates or protein into fat is 10 times less efficient than simply storing fat in a fat cell, but the body can do it. If you have 100 extra calories in fat (about 11 grams) floating in your bloodstream, fat cells can store it using only 2.5 calories of energy. On the other hand, if you have 100 extra calories in glucose (about 25 grams) floating in your bloodstream, it takes 23 calories of energy to convert the glucose into fat and then store it. Given a choice, a fat cell will grab the fat and store it rather than the carbohydrates because fat is so much easier to store.

    • says

      Benny, I don’t necessarily disagree with you. However, to me being in nutritional ketosis goes well beyond calories. It’s the satiating ability of this that naturally controls your calorie intake with the need to arbitrarily cut calories. That’s the beauty of doing this. Whether it’s the cut in calories or the ketosis, who cares? The fact is it is working.

    • Tim Conway says

      Calories in/calories out has been disproved over and over again. Research done by Kekwick and Pawan in the 1950′s, as mentioned by Dana, is only one example. Gary Taubes sites many more examples in “Good Calories, Bad Calories.”

      • ben says

        and calories in vs out has been proven over and over also,good cals bad cals I agree,but the guy who ate McDonalds every day lost what 24 lbs ? granted he felt like crap but he still lost weight,how can everyone agree it takes 3,500 cals to make a pound of fat but but burning 3,500 cals dont lose a lb a fat? the biggest loser uses the calorie counter ,they eat less they lose fact..gastric by pass is cals in vs cals out..fact you can not lose weight if you eat over your maintenance, FACT and no one can prove this wrong..even Atkins finally admitted he diet was based on the fact that if they ate more fat they would lower calorie intake and lose weight…fact…how do you think all those nutty diets work..

        • says

          No one disagrees that there are 3500 calories in a pound of fat. What we disagree with is the idea that the human body is a bomb calorimeter that burns all calories identically. Your car will run at 60-per right up to the moment it sputters and dies for lack of fuel. Your body will not; if you simply reduce caloric intake your body will slow your metabolism to burn fewer calories.

          You want a more recent study? Here’s from Scheider’s Children’s Hospital on Long Island — they put obese adolescents on either a low fat or a low carb diet for 12 weeks. The low carb kids lost significantly more weight than the low fat kids, while eating, on average, sixty percent more calories per day. They also had a greater improvement in blood work. Here is a study that appeared in this past June’s Journal of the American Medical Association, suggesting that a low fat diet lowers basal metabolism considerably more than a low carbohydrate diet does with the same caloric input.

          Oh, and here’s an article about a study funded by Jenny Craig, a company that has largely made its money on helping people control portions by providing pre-packaged meals — where insulin resistant women on a low carbohydrate diet lost twenty one percent more weight than insulin resistant women on a low fat diet, again, while eating the same number of calories, and that was with 45% of calories from carb, considerably more than the average Atkins type is getting.

          Here’s one from 2004, from the Journal of the International Society of Sports Nutrition, concluding that yeah, low carbohydrate diets do affect hormonal signaling, resulting in greater weight loss.

          I could do this all afternoon, but I have an article to write.

          Having handily demonstrated that physiology hasn’t changed much since Kekwick and Pawan were doing their thing in the 1950s, I will say that if the only reason a low carbohydrate diet worked was because it made people less hungry, and they therefore ate fewer calories, that would be sufficient reason to recommend it. It is entirely unrealistic to expect people to spend their lives feeling hungry. You think telling teenagers to wait to have sex has a low success rate? Try telling people that they’re going to have to go hungry for the rest of their lives. The end of that awful, gnawing, driving hunger that made me feel insane has been been, and continues to be, a great gift to me.

          That a low carbohydrate diet not only reduces appetite, but also does confer a metabolic advantage, just as Dr. Atkins repeatedly asserted, and also is superior for improving risk markers, makes it by far the superior strategy.

          • ben says

            no one has ever proved that eating more then maintenance levels of calories causes weight loss,its 100% IMPOSSIBLE..are you claiming biggest people eat low and no carbs ? 100% no..gastric bypass people lose because of low carb or maybe the low cals ? IT IS 100% IMPOSSIBLE TO LOSE WEIGHT EATING ANY FOOD GROUP IF YOU EAT MORE CALORIES THEN YOU BURN,and the biggest study in years just ranked atkins and low carb dead last…so your studies are true but the ones I can post? how do I eat over 700 grams of carbs (all types_) and when needed lost over 45lbs ?

            • says

              The question is not whether people can lose weight eating more calories than they burn. The question is whether the quality of those calories influences how many calories are burned. That it does has been demonstrated over and over again. Yes, if you eat little enough you will lose weight, but you will very likely have to eat fewer calories than you would on a low carbohydrate diet, and you are very likely to feel hungry, a state that most people find unpleasant. There are also repeated studies showing a dramatically greater improvement in metabolic syndrome with carbohydrate restriction.

              I don’t know of the study you mention, because you gave no citation, but generally these ‘studies’ aren’t based on any clinical evidence, but rather “Oh, that diet has too much fat! And any diet that requires you to give up a whole food group is bad!” (Interestingly, they rarely feel this way about vegetarianism.) Too, cohort or observational studies are notoriously meaningless. Here, however, is an actual 12 month clinical trial comparing Atkins, Ornish, LEARN, and the Zone. Guess which diet turned out to work best?

              What I’m trying to figure out is why you’re wasting your time reading a website that doesn’t interest you or serve your needs. Eat what you like; no skin off my nose.

              • ben says

                what about the same stud that only on the 1st 6 months low carb was better. ? and at 12 months was dead last..NO ONE can prove more calories then MAINTENANCE causes weight loss. FACT..again are you denying gastric by pass weight loss low cal ? how about the biggest loser which is a joke sort of but they expensive arm band tell them how much to eat and they lose,again cals in vs out..I am a pro athlete that has lived by a scale for over 18 yrs and have done every diet there and every so called trick,and at the end of the day it was always cals in vs out…and ate anything I wanted,I just ate with in my calorie maintenance..as I said NO STUDY not from people selling something has ever proven you can EAT MORE THEN YOUR MAINTENANCE and lose weight…ok I once lost 12 lbs in 3 hrs..lost and regained 35lbs 6 times in 1 year..lost 30 lbs in 28 days not good yes but the point is I ate 500-700 GRAMS OF CARBS ! EVE% THE SO CALLED BAD kind…next you will tell me the HCG diet works .ok there is a nice metabolism machine they sell now,its not to much $$ get your resting metabolic rate..then eat 500 cals more then that a day,take video and if you lose weight Ill give you $10,00.no exercise allowed. here’s how this nonsense and fake science started…..ATKINS admitted this also in a court of law “we knew if we told people to eat more fat and lower cabs,they would eat less calories…FACT ,next is…the protein so called secret power is no more then these FACTS my #’s might be off as its been a while but eating fat uses 0 calories to break down..carbs use 2-3 cals and yes protein uses the most cals per 100 to beak down food,at 3-5 hardly worth celebrating …and the fallacy of the metabolic advantage ha ha Ill laugh to hard,being in Ketosis is no miracle at all at best you only get maybe a 125 calorie ‘advantage’ if that..but again only if you eat below maintenance..

                • Colin says

                  Keto works because, when done properly, it induces ketosis which make fat-burning more effecient and increases the satiety of your diet. It’s bloody hard NOT to eat below maintenence while in ketosis.

  13. ken says

    if everyone including Atkins people admit thats its about calories…why do ketosis as this been reported that you MIGHT only get a 132 calorie advantage.

    • says

      I’m not Jimmy, but I can field this question:

      First of all, I don’t know where you get the 132 calorie figure. In the original research done by Kekwick and Pawan in the 1950s, subjects gained weight on 1000 calories per day when 90% of calories came from carbs, lost a little weight on 1000 calories per day of a mixed diet, and lost a little more on 1000 calories per day when 90% came from protein. But the subjects who got 90% of their calories from fat — still 1000 calories per day — lost twice as much weight as the group who were getting 90% of calories from protein. See the original article from The Lancet here.

      Kekwick and Pawan also found that many of their subjects gained weight on 2000 calories per day of a mixed diet, but they lost on an average of 2600 calories per day when they ate very low carb. That’s a long way from your 132 calorie figure.

      Secondly, ketosis has a very powerful muscle-sparing effect. In the 1960s, Frederick Benoit tried totally fasting subjects for two weeks; they lost an average of 21 pounds — but only 7.5 pounds of that was fat, with the rest coming from lean body mass. That’s very bad ju-ju. But on 1000 calories per day, with 90% fat, the same subjects lost an average of 14 pounds in two weeks, with only 1/2 pound coming from lean body mass. That’s a big damned advantage right there.

      Third, as has been pointed out, ketosis has a massive hunger-suppressant effect. Simply restricting calories makes people hungry, as anyone who has tried it can testify. People like to call carbohydrate restriction unrealistic, but I think asking people to go hungry for the rest of their lives is far more unrealistic.

      Fourth, as Alfred Pennington wrote, energy levels remain high on ketogenic diets, indicating that basal metabolic rate is not dropping. This, he posited, is because fat is flowing freely out of the fat cells, allowing for a constant supply of fuel to the body, as opposed to the ups and downs of a glucose-based metabolism.

      That’s why ketosis.

      • ben says

        1950′s ? plus some of the top people on nutrition and sports science clearly say that being in ketosis creates at best only a deficit of 130-200 calories. You are aware that Atkins finally admitted that he knew telling people to eat all the fat they wanted would automatically get them to reduce there overall calorie intake…what about the big study that clearly states Atkins wins only in the 1st 6 months but not 12…check out the this page..from non paid people…http://health.usnews.com/best-diet/best-commercial-diets so we all agree it takes 3,500 cals to make a lb of fat,but not to lose a lb hmm…look at the show the biggest loser..cals in vs out..gastric by pass cals in vs out..FACT…

      • Margaret says

        Particular thanks @Dana for a lucid explanation of how a diet formed mostly of fat works. As much as I read, I always have an underlying niggle that high fat is going to kill me, and that a mixed, low calorie diet is “best” depspite my actual experience. I am clearly the victim of years of misinformed propoganda, and while you can intellectually make the conversion, at a visceral level it is so much more difficult.

        Ben is unlikely to be convinced by individual experience, but I feel a need to say this. If it were as simple as calories in/ calories out I would be thin as a reed. I have gone for YEARS living on 1200 calories p/day or less, along side a high activity level and ridiculously high calorie defecits. That does not lead to weight loss in this body. Once I got rid of the carbs, moderated the protein, and increased the fat I began to get a steady weight loss – AND got to eat more calories and feel infinitely better too! (Thanks Jimmy, the adjustments did work!)

        I wish people could get it in to their heads that bodies are complex biochemical organisms, that some of those organisms appear to have an inherent intolerance for and poor utilization of carbohydrates, and that no one diet approach will EVER meet everyone’s needs. People who continue to bang the calories in/out drum actually stand in the way of better health in the general public by perpetuating lousy information along with lousy attitudes.

        • says

          One of the most fascinating things I learned in Gary Taubes’ Why We Get Fat and What To Do About It:

          There are rats bred specifically for obesity research, called Zucker rats — they are genetically programmed to put on fat. If you put a Zucker rat on a low calorie diet, it will still store fat — at the expense of the size of its organs. When they “sacrifice” (nice way to put it, huh?) the rats, they find they have as much fat as the Zucker rats who ate ad lib, but smaller internal organs.

          For that matter, if you take female rats and surgically remove their ovaries, causing the equivalent of menopause, they will gain weight. You might think, “Well, the reduction in estrogen makes them eat more.” Nope. Carefully limit their food, and they still gain weight.

          Too, as the Zucker rats demonstrate, it’s not simply about weight loss. If you wanted to get the leanest steak in the grocery store, you wouldn’t just buy the lightest one. Benoit’s work in the 1960s showed that a total fast caused rapid weight loss — 21 pounds in 10 days — but on average 2/3 of that weight, or fourteen pounds, was lean body mass. 1000 calories per day, 90% from fat, led to “only” 14 pounds lost in 10 days — but 13.5 pounds of that was fat. That’s why calorie reduction is notorious for slowing basal metabolism, but low carb diets do so to a far lesser degree.

    • says

      What Dana said! Plus, the satiety I’ve experienced while in nutritional ketosis could not possibly be attained eating for calories. It most certainly is about the source of those calories and more fat while reducing carbs and moderating protein has been the sweet spot for controlling calories naturally.

  14. SixtyYearsYoung says

    I had an episode of Halloween Candy overdose and am now back in ketosis. 1.1 on the meter. I think that’s good? I’ve been doing LCHF and lost about a two pounds in two months, rebelled and got into candy. Here’s what I learned. Asthma symptoms came back at night, immediately. Had four nights of tight chest, using nebulizer for relief. Fog brained and fatigue too. The cravings were back big time. I decided I had to get back into ketosis whether I lose weight or not. Then I added a test. I stopped dairy and followed Jimmy’s lead..stop the habit of food, on regular schedule to see how it feels. i didn’t eat dinner tonight and I feel fine. Lost 2 lbs last week, less hunger. Can’t locate the blog note on good ketone level. Jimmy, this site is a godsend! Thank you!! Ps) coconut milk in coffee is tasty!

  15. says

    I’m at the infancy of switching to a 90% fat diet. Thanks Jimmy for such a fantastic site. I just wanted to share my views on energy levels and amd impact on lethargy. Historically, on a low calorie, low fat diet, my wife and I are usually ‘knackered’ by 9:00pm. However, after switching to high fat we feel incredibly energised and rise without feeling exhausted at 5.00am.

    I am mostly getting fat from dissolving 100g butter in coffee twice per day.

    The only downside is feeling very hot and sweaty… With a slight buttery scent!

    Any good alternatives to butter? Andy.

  16. graphxgrl says

    I have followed your n=1 experiment with great interest and I do low-carb a lot of the time just because it feels good. I have no blood sugar issues, however, and I’m wondering if living in nutritional ketosis would be of any large benefit to me. I noticed in your last post of the experiment that you said just eating a bit more of something other than fat (not even carbs) can raise your blood sugar levels now. I am afraid of causing problems by living in NK or even making it impossible to go back to eating carbohydrates at all if I don’t experience great benefits. Any thoughts? Love your work!

    • says

      Great question! I don’t think this is about not being able to eat carbohydrates at all as much as it is determining what level of carbohydrate tolerance you have. We all have varying levels of it depending on how metabolically damaged we are. I was severely damaged by my 400+ pounds days and that requires me to keep my carbs around 25-30g daily so I don’t suffer ill effects to my weight and health. Others can eat more. So NK in and of itself isn’t going to make it “impossible to go back to eating carbohydrates at all” as much as show you their impact on YOUR weight and health. Hope this helps!

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