Wednesday, October 17, 2012

My Nutritional Ketosis Disaster

Photo of a Steak Topped with Herbed Butter

With all of the talk about ketosis going on lately, I couldn’t help myself. I just had to take a peek at the latest low-carb craze called Nutritional Ketosis. At first, I used the excuse that I needed to know what it was in case I wanted to write about it and suggest it to my low-carb blog readers. I get a lot of email from those struggling to make a low-carb diet work for them.

Upon taking a closer look, I got a bit bowled over and distracted by the success that many people are having following this way of eating. I know that I said earlier I was letting go of the low-carb dream and switching to the Old Weight Watchers Old Exchange Program, but life has been hectic and I haven't gotten a chance to do that yet. That was a big mistake!

What is Nutritional Ketosis?

If you just type “Nutritional Ketosis” into a search engine, the number one result is going to send you to a blog written by someone who doesn’t believe that eating too much protein can cause the liver to go crazy with gluconeogenesis. The reason why that blog’s author doesn’t believe in the theory is because there are no scientific studies to back up the notion, and because when they ate too much protein, their blood sugar didn’t rise excessively.

For those with metabolic syndrome, we all have different degrees of insulin resistance or sensitivity to carbohydrates. Not everyone has metabolic syndrome, so blood glucose reactions are extremely individual – even among pre-diabetics and diabetics. The degree of insulin resistance you have and the amount of beta cells that function correctly plays a large role in the way your liver handles the protein you eat.

For those who don’t have a normal insulin response or don’t respond to glucose properly, you can end up with too much glucose in the blood from eating a low-carb diet.


Because of gluconeogenesis. That's the Nutritional Ketosis theory. Restricting carbohydrates lowers your body’s carbohydrate stores. When those stores get too low, the liver pulls fat out of your fat cells to fuel the conversion of protein into glucose to feed the brain, kidneys, heart, and other organs and body tissues. Some of the fat pulled out of your fat stores is also used for fuel.

The body will release insulin when you eat protein to help the glucose made by the liver get into your cells. That's a normal body reaction. If you didn't release insulin, you'd die. If you’re insulin resistant or you don’t make enough insulin to handle the excess glucose, that blood sugar will back up in your bloodstream. That’s what happens to me when I eat very low carb (20 net carbs per day or less). My blood sugar goes through the roof.

Nutritional Ketosis is similar to what Dr. Atkins called Dietary Ketosis, but it's a bit different. It means that you are in ketosis due to dietary means, rather than ketoacidosis, but it's talking about the number of ketones that have built up in the bloodstream. In addition, Nutritional Ketosis is also the name of a high-fat, low-carb program that is popular with the low-carb community right now. When people use the term Nutritional Ketosis, they are usually talking about the high-fat low-carb low-protein diet associated with that term.

This diet is NOT the ketogenic diet used by those with epilepsy. 

This is a diet that fine-tunes the macronutrients one eats in order to reach a deep state of ketosis. Most people who have gone to the expense and effort of checking their blood for ketones, rather than their urine, have discovered that they are not in deep ketosis. At least, not to the extent that Nutritional Ketosis requires of those following that diet plan.

Using a blood ketone meter for data, these individuals have played around with the amount of protein, fats, and carbohydrates they eat in order to arrive at a particular concentration of ketones in the blood. During these experiments, many have discovered that there is a close relationship between the amount of protein they eat and being in deep ketosis. That's because the body secretes insulin when you eat protein, so the less protein you eat, the less insulin the body needs to process it.

What to Eat to Get Into Nutritional Ketosis

The theory behind Nutritional Ketosis is different from what Dr. Atkins taught. Nutritional Ketosis says that most low-carb dieters are not in ketosis due to gluconeogenesis interfering with their diet. If you eat too much protein, the plan says, your body will convert that protein into glucose and you’ll predominantly burn glucose for fuel rather than fats. To date, I haven't found any scientific evidence to back that theory up.

If your insulin response to protein is normal, your body will release insulin to handle the protein, so you won’t see a rise in blood sugar. The glucose will be escorted into your cells where it will be burned for fuel or stored in your fat cells if there is more than you immediately need. Therefore, a lot of people who turn to the Nutritional Ketosis diet plan are either severely insulin resistant, don't make enough insulin to process the amount of protein they are eating, or they need a visual token to keep them on plan.

Man eating a large pork roast

The idea behind a Nutritional Ketosis program is to lower the amount of protein you eat and raise your dietary fats. Basically, it’s a very high-fat, low-carb, low-protein diet, far lower in protein than most low-carb dieters realize.

In our super-sized society, we have taken our overly large portions with us into a low-carb diet. The consequences for doing that will eventually result in the amount of calories you eat catching up with you. Many low-carb dieters believe they can eat all of the low-carb foods they want and still lose weight. That isn't true. Dr. Atkins' nurse has said many times that when calories catch up to your current metabolic needs, you will begin to maintain.

You can throw yourselves out of Nutritional Ketosis by continuing to eat the large amount of meat, cheese, and eggs you could eat when you first started your low-carb program. Initially, your calorie needs will be quite high. If you live a very active lifestyle, calorie needs will be higher than your average low carber. How well your thyroid is functioning also matters when it comes to the amount of calories you can eat and still lose weight.

Most low carbers who have tried Nutritional Ketosis have found they can only eat between 50 and 72 grams of protein a day, or it will lower the amount of ketones built up in the blood. A large man like Jimmy Moore can eat closer to 84. Those following this plan believe it's the number of ketones in the blood that gives them the benefits of burning fatty acids for fuel, even though fatty acids and ketones are not the same substance and biochemistry doesn't work that way.

Being in ketosis drops your cravings for carbohydrates and significantly lowers your appetite, so the deeper into the state of ketosis you go, the fewer cravings and hunger you'll experience. I learned that myself when I experimented with a no-carb diet. No hunger can be a benefit of the program, provided your body is primed or capable of using all of that dietary fat for fuel.

Keep in mind that after the first 3 to 4 weeks, the body generally saves the ketones (hence their build up in the bloodstream) to fuel the brain and uses dietary fatty acids for its energy needs instead. The body doesn't use those ketones for fuel. In addition, excess body fat is only tapped into when the supply of dietary fatty acids or glycogen in the liver gets too low.

My Own Nutritional Ketosis Experiment

None of this is new to me. I’ve tried several ketogenic and zero-carb diets before. Always, with bad results, but none of my zero-carb or ketogentic experiments ever monitored the amount of protein grams I was eating. I always ate to hunger or followed the ketogenic ratios that epileptics use.

Since Kimkins, an HCG diet, and even Lyle McDonald’s Rapid Fat Loss Plan (a protein-sparing modified fast - PSMF) all limit the amount of protein you eat to one degree or another, just not as much as Nutritional Ketosis does, I thought I’d give protein restriction a try.

The main difference between the diets that worked well for me in the past and Nutritional Ketosis was the amount of fat you eat. 

Avocado Cut Open
I gave the program a two-week trial. However, since I'm very short (only 5-feet tall) and my goal weight was 125 pounds, I was only supposed to eat 52 grams of protein or less per day. I have more lean body mass than the average woman my age, so I raised that maximum limit to 60.

I was very nervous about the protein content of the diet because Lyle McDonald recommends a minimum of .8 grams of protein per pound of lean body mass for women. That would have been around 84 grams of protein per day for me. Cutting it down to 60 was pushing it, but everyone else I knew who was doing the program was only eating 50 and encouraging me to drop my protein intake down to that level.

I ate 1200 calories per day to make the test fair. I limited my carbohydrates to 20 grams and I ate the rest of my calories in fat even though they played severe havoc with my digestive system. Fats included:

extra-virgin coconut oil
grapeseed oil
real butter
cream cheese
hard cheddar

I even ate peanut butter to test out the Fat Bomb craze as well.

The results were a disaster! 

I gained five pounds during that two-week trial, which my body decided to store around my abdomen. It was one of the worst two weeks of my life. The gastrointestinal repercussions from eating all of that fat was extremely uncomfortable. I spent far too much time in the bathroom, and I found myself craving real food!

And yet, Nutritional Ketosis advocates continued to pressure me into sticking with the diet for a few more weeks since two weeks wasn't long enough to adapt to the state of ketosis. Others (which included low-carb gurus) ridiculed me because I wasn't using an expensive blood ketone monitor like they were. Still others told me I was either in a severe state of malnutrition and needed to gain weight before my metabolism would repair itself or I was doing the diet wrong.

What Does Nutritional Ketosis Look Like?

Sixty grams of protein isn’t very much. It’s about nine ounces of meat, cheese, or eggs per day. If you eat extra fatty meat, you can eat a little more than that. Although the Weight Watchers Original Exchange Program only allows you that same amount of meat, eggs, and cheese per day, with Weight Watchers you're also counseled to drink 2 cups of milk per day. That adds another 16 grams of protein to the diet for a total protein count that is closer to 80.

People on low-carb diets need MORE protein than those on moderate-carb diets like Weight Watchers or South Beach.

In addition, Weight Watchers gives you 2 servings of starches, and 3 fruits, along with those 2 servings of milk. If you subtract the starches, fruit, and milk, as well as the extra 550 calories for extras per week, you're left with very little real food. It's just 9 ounces of protein and 20 carbs worth of veggies. Most of your diet is fat.

To meet that very low level of protein, most people only eat once or twice a day. Those who eat more are living on Fat Bombs, avocados, salads with no protein added, and homemade protein shakes where the protein powder is drastically reduced or totally eliminated.

Cream Cheese Roll
Fat Bombs are basically cream cheese, butter, and peanut butter mixed together and frozen into small cubes. Some people add coconut oil, unsweetened chocolate, or dark cocoa powder and some sugar substitute to the mixture as well. Others are eating straight butter or coconut oil right off the spoon or dishing themselves up slices of cream cheese in order to get the amount of calories and dietary fats they need to get through the day.

Surprisingly, it’s working quite well for a lot of people, but for me, that two weeks was all I could stand. At the very least I can honestly say that I gave it an honest try. Granted, I didn't go to the expense of buying a blood ketone meter and blood test strips, but even if I had, that wouldn't have stopped me from gaining the weight I did. Nor would it have made the diet any more tolerable. Limiting myself to 60 grams of protein per day was low enough.

Now the only problems is – How do I get rid of the extra five pounds I gained in my belly from eating all of that dietary fat???

The obvious answer is to return to what works for me!

However, if your experience differs from mine, I'd love to hear from you. Just leave a comment below or pop on over to my low-carb blog: What is Nutritional Ketosis? and leave me a comment there.

UPDATE: I received a lot of flack for doing this diet review. Some people ridiculed the name of this blog and said its name proved to them I wasn't serious about low carb, so it wasn't a fair test. Others said I wasn't doing Nutritional Ketosis if I wasn't using a ketone meter that measured the ketones in my bloodstream. Still others told me that 2 weeks wasn't a long enough test.

Although this diet review is written from the vantage point of me quitting after the first 2 weeks, I didn't. Despite the discomfort, I continued with the diet for several weeks -- long enough to adapt to the state of ketosis, which I never did. If you're interested in reading that update, check out:

My Latest Nutritional Ketosis Update


  1. Hmm. Similar issues with me and a history of using high protein, low everything else diets for weight loss. I'm guessing this primes your body for gluconeogensis.

    I think that once you've adapted (and I've lost 100 pounds using high protein diets) to protein burning, that it can be harder and take longer to adapt to ketosis.

    I would also suggest that you weren't getting enough saturated fat.

    Additionally, for me, I can't do coconut oil. Especially virgin. It messes me up.

    I stick with fatty meat (ribeye cooked in butter for example) and eggs cooked in butter with cream cheese, sausage, bacon, etc. etc. Liverwurst is a special treat, too.

    I would move away from the veggie sources of fat (especially peanut butter), and embrace saturated fat. Especially from high quality pastured butter and grass fed meats.

    Also, couldn't hurt to try adding some enzymes to your diet until you adapt to high fat. And maybe some liver supplements. Milk Thistle is a good one.

  2. It's interesting that you could eat enough to gain weight. When I'm in ketosis I have to force myself to eat anything above about 1000 calories. I'm just not hungry, which is a plus as I don't like being hungry.

    It's amazing how different we all are.

  3. Have you read "Art and Science of Low Carbohydrate" or "Art and Science of Low Carbohydrate Performance" by Volek and Phinney

    Also, try Paleo first it might work well for you then once your adjusted to that then try Nutritional Ketosis as describe by Volek and Phinney

  4. If you haven't yet I couldn't recommend Jack Kruse more highly.

    His blogs on Leptin, Epi-Paleo, CT, and myriad of other health issues are very interesting and informative.

    I wouldn't doubt there is something in his blogs or on his forum that might help you. Either with whatever issue you had or something else. He also has an attached forum where you can post about various things if your interested.

    Good luck

  5. Cody,
    Thank you so much for your comments. I haven't thought about how high-protein diets like Atkins could prime you for gluconeogenesis, but that would definitely make sense, since I've been doing low-carb diets of one form or another since 1972.

    You don't think I was eating enough saturated fats?

    I only tried the peanut butter one day because I wanted to understand "how" those eating this way were making it work for them. The majority of the time, I ate bacon, eggs cooked in bacon grease, full-fat cheese, cream cheese, pork chops, steak, hamburger, dark meat chicken with the skin, and a little bit of mayo in my homemade salad dressing. Grass fed meat is not available here, but I do eat grass-fed butter.

    I don't have a gall bladder, so I don't know if I would ever "adapt" to high-fat eating. I was testing the high-protein theory, but find that it's more complex of an issue than just protein.

    Milk Thistle is a good idea.

  6. Craig,
    I have always gained weight from eating fat, even when I've kept my calories very low. I've read that most people with celiac disease have fat malabsorption issues due to the inflammation. I don't know how true that is, but I seem to fit that pattern.

    1. I think this is very true as I have some issues with my gut and have been on many forums related to celiac and crohn's. Possibly you could use a very good fat focused digestive enzyme like Lypo Gold, or you might have to use a different option.

  7. Butch,
    I have not read those books myself. I've just been following several other people who have read them and are doing the diet.

    I've tried Atkins, Protein Power, Kimkins, PSMF, Paleo, the old Weight Watchers' Exchange Program, SugarBusters and several diets of my own making.

    Diets that include a high amount of fats, grass fed or otherwise, have always caused me to stall or gain weight. Always.

    1. I was on a stall too for a long time, like 6 months or so. Until I read that book. Apparently needed to bring down the carbs to about 25 to 35 and protein to 75-100.

      Also,I started to used a software called Fitday to track my carbs and protein exactly, NOT necessarily counting calories, I also bought a food scale because my eyeballing was way way off. And yes I have to up the ante on fat from 75% to 82%-85%

      Result in 4 weeks after the tweaks to the carbs and protein - lost 5 pounds.

    2. I'm glad to hear you found something that works for you. That's basically what I tried for several years: about 35 carbs per day and protein somewhere around 90 or less. For me, the fat content of my diet really matters. The only time I've been able to lose anything has been when I've taken my calories and fat grams extremely low. Your experience matches many, many others though. Congratulations on the weight loss!

  8. Jonathan,
    Thanks for the link to Jack Kruse's website. My Leptin levels do crash fairly quickly whenever I try to diet anymore. After losing over 100 pounds on various forms of low carb, my body started to defend itself pretty violently. I'll definitely check it out.

  9. I added a link to my Nutritional Ketosis post at my low-carb blog at the end of this post. My zero-carb attempts haven't faired any better than this experiment did, and I was on zero-carb long enough to adapt. I just kept getting fatter and fatter. I was hoping the problem was too much protein, but I was obviously wrong.

  10. Have you ever done Zero Carb or VLC without the dairy? That can make a big difference.

    1. Yes. When I did zero carb it was without the dairy, and I gained quite a lot back then too.

  11. Vickie, do you take digestive enzymes or anything to help you break down fat? I understand this is a major issue if you've had your gall bladder out. I was just hearing something today on Dave Asprey's podcast to do with that. Let me check it out.

    1) Lipase

    2) oxbile extract

  12. Thanks for the links. I'll check them out.

    I tried taking digestive enzymes several years ago and it didn't work. My last round of research said that it was because fat is broken down in the small intestine, not the stomach, making enzymes by mouth worthless, but I'll read your links and see if they've discovered anything new about that yet.

    I'm always interested in everything that has to do with fat or dietary metabolism. I get a LOT of mail from people who have exactly the same problem I do. Most of them have told me that they gained weight when they attempted to follow the rules of Nutritional Ketosis. So even if this won't work for me it might work for someone else.


  13. Ah! looks so yummy and delicious.. Though natural food sources all necessary elements to our body, still it needs vitamins and minerals in a right quantity.


  14. Technically a two week trial isn't enough time for your body to enter ketosis, maybe a very low level, but not full.

  15. This comment has been removed by the author.

  16. Yeah, to enter ketosis, you need to start out by eating a lot of fat (like... a lot) and it probably needs to be longer than two weeks. You nutritional ketosis experiment likely failed because you weren't actually in nutritional ketosis. What you did was basically tantamount to eating a calorie resticted diet on nothing but M&M's. Also, you can't really say you were in nutritional ketosis without properly testing your blood ketones.

  17. Ketogenic is calorie restrictive but because of all the fats, it does not really matter. I think if you have an eating disorder and perhaps a might not help to know you can eat so many fats...My own problem is with metabolic syndrome. Because of my insulin resistance, I simply cannot tolerate all the carbs recommended by the ADA. Ketogenic was the first diet ever that reduced my blood glucose levels to normal and reduced my triglycerides without medication. Statins are so bad for your brain. this diet is imperative for metabolic issues. If you don't have it, it really does not matter. However, no matter how you look at it, over time, aging with cause you to become insulin resistance sooner or later due to all the carbs you are you end up needing ketogenic. Thank goodness someone discovered the benefits of this diet for the metabolic disorders. I can finally live a normal life.

  18. Too bad this didn't work for you for weight loss. Sometimes it doesn't work for women in the beginning especially if her hormones are out of balance and have been that way for a while. The high fat balances hormones and some women need extra help such as "The Hormone Cure" (a book) to get higher fat options to work for them. I am disappointed however that your article is too shallow and doesn't mention the medical uses to which this diet is put. For example, epilepsy and other neurological diseases, and nowadays even cancer are treated sometimes with this diet. It's really a medical diet that is sometimes used as a weight loss tool, not the other way around.