Ketogenesis, Measuring Ketones, and Burning Fat vs Being in Ketosis

This post is long overdue.

I cannot tell you how many emails I get from people fretting over their ketone levels. It’s time to set the record straight on this issue. I wish there was someplace I could refer people for reliable information on this subject, but I haven’t come across a blog post or podcast interview that explains things satisfactorily. At least, not to my satisfaction. And that is and always has been my goal in writing my blog: I explain things the way I would want someone to explain them to me, if I were new to all this. And since no one—as far as I know, anyway—has tackled this subject the way I would, I finally had to just sit down and write this. If you feel it’s educational, please share it in the low carb and/or ketogenic circles you frequent, because I know this issue comes up all the time in ketogenic forums and Facebook groups. (And if you know of other good resources on this topic, feel free to provide a link in the comments, and I’ll update this post to include it.)

Okay, here goes.

There are few issues more controversial regarding ketogenic diets than whether you should measure your ketones. There are valid reasons to measure, but there are also a lot—a lot—of misconceptions about measuring ketones and how to interpret the data. So let’s get into when and why it’s a good idea to measure, who doesn’t need to measure, and most important, what the numbers mean. (I said who “doesn’t need to” measure rather than who shouldn’t measure because if you want to measure, then go ahead. There’s really no should or shouldn’t here. But if you choose to measure, you need to understand how to interpret and understand the numbers so you don’t jump to illogical and false conclusions.)     

I will also be covering the difference between being fat adapted versus in ketosis. I tried to do it in a few posts awhile back, but I think I the way I explain it here is much better because I will show you the biochemical pathways involved so you will be able to see how it actually works. My hope is that this will go from a vague concept in your mind to, “Oh! NOW I get it!” And you will understand very clearly how you can absolutely, positively have a fat-based metabolism and lose body fat even if you’re not in ketosis. 

How to Cut Fat on a Ketogenic or Low Carb Diet (and Why You Might Want To)

Reduce fat intake? On a low carb or ketogenic diet?

Amy, have you done lost yo' mind?

You know people use the abbreviation “LCHF,” right? And that means low carb high fat, right?

Yes. Yes, I know. But remember what Ted Naiman, MD, said:

I’ve heard from many, many people who are struggling to lose body fat on a low carb or ketogenic diet. And while there are many possible reasons for this, the simplest, most obvious, and most common one is, they’re eating too darn much fat.

Too much fat?

On a ketogenic diet?

What is this madness you speak of?

Too much fat. On a ketogenic diet.

This is possible. It is, as they say, “a thing.”

Remember: when you reduce your carbohydrate intake to the point that your body must switch over to running primarily on fat for fuel, you go from being a “sugar burner” to being a “fat burner.” But what this means is that you’re burning fat. It doesn’t mean that the fat you’re burning will automatically and unfailingly come from your love handles and thunder thighs adipose tissue (your stored body fat). It could be coming from your fatty coffee, avocado smoothie, fat bombs, or a heavier-than-you-realize hand with nuts, cheese, and ranch dressing.

Bottom line: the more fat you eat, the less of a need your body has to tap into its stored fat to use for fuel. If you’re already lean and happy with your weight, this is no problem. You might need a bunch of fat just to maintain your weight. (I hate you. Lucky you.) But if you’re struggling with fat loss on low carb despite doing “all the right things” and being on-point with your diet, there’s a chance you’re simply overdoing the dietary fat.

It’s true. If your carbs are very low, then insulin will be pretty low, which is what allows you to get into “fat burning mode.” But just because insulin is low doesn’t mean you’ll magically drop body fat regardless of how many calories you take in. Even if you’re in ketosis, the food energy you take in still has to go somewhere. It has to be used or stored. And if you’re using the fat from your food, you’re not going to be using the fat from your hips or belly. After all, that’s what stored body fat is there for: as an energy supply to be used when there isn’t enough energy coming in. If you drink a cup of coffee loaded with 400 calories of butter and coconut oil, your body has no reason to use its backup supply of fat.

Am I saying it’s all about calories? After writing a post like this one, am I actually saying that?! No. It’s not all about calories, but it’s maybe a little about them. Contrary to popular opinion, you cannot eat unlimited fat and still lose body fat on a low carb or ketogenic diet. If you are following a strict ketogenic diet and adding extra fat to things in order to arrive at a “ketogenic ratio” in the ballpark of 75-80% of your calories from fat but you’re having a hard time losing weight, stop doing this! This is the single biggest mistake I see people making with this way of eating. (And I’ve done it, myself. Believe me; I’ve learned the hard way. The running joke on this blog is that I’m not allowed to keep mayonnaise in my house, because it starts as a spoonful with my food, but then, before I know it, it’s me, the jar, a spoon, and 3000 calories later...)

If you’re using a low carb or ketogenic diet for the purpose of losing body fat, you do not need to eat a super, super high-fat diet. If you’re using this way of eating to manage a specific medical condition that might require a high level of ketones for efficacy, that’s a totally different story. (See here for details on this.)

So, if your goal is weight loss, but you’re having a hard time, here are some tips for reducing fat intake while still keeping carbs low:

Book Review: The Salt Fix (and a look at sodium)

“Modern medicine diverted us from our evolutionary path when it decided that salt was a toxic, addictive, non-essential food additive. The seeds of this destructive myth were sown one hundred years ago, but we are still bearing the costs now.” (p.30)

“As is clear from the medical literature, as well as the population-based studies, low-salt guidelines are not ‘the ideal.’ They are not even innocuous. We may someday discover that the low-salt guidelines created more heart disease than they ever prevented.” (p.89)

Those are some pretty hefty claims, and it would take some pretty hefty research to back them up. Fortunately, James DiNicolantonio, PharmD, has done the heavy lifting for us in his new book, The Salt Fix: Why the Experts Got It All Wrong--and How Eating More Might Save Your Life. That’s an ambitious title, but after reading the book, you might find it hard to refute.

Before I get into the review, in the interest of full disclosure, allow me to declare that I received a courtesy copy of this book. I also collaborated with Dr. DiNicolantonio on my very first peer-reviewed journal article, so obviously, I respect him and his work. That being said, if I thought the book was lackluster, I’d tell you so. Fortunately, that is not the case, so I can give you my honest assessment of the book and still stay in my friend and colleague’s good graces.     

On to the details!

More Than You Ever Wanted to Know About Protein & Gluconeogenesis

My dear readers, the website/blog update has run into some snags. Rather than continuing to keep you waiting, though, I’m going to publish new posts and I’ll worry about transitioning them over later on. And since it’s been a few months since I last posted anything of substance, I’ve decided to drop this enormous, enormous post on you to make up for that lost time—and it might take you equally long to read it. Sorry about that, but hey, I haven’t written anything meaningful since May, so, depending on your point of view, this post is either a gift or a punishment. As I’ve said in the past, if you’re an insomniac or a cubicle dweller with lots of time to kill, you’re welcome. (The rest of you, go get yourself a cup of coffee or tea, come back, and get comfy.)

I’ve been meaning to write this post for over a year, but it’s such a big topic and so much can go wrong that the thought of tackling it all was enough to make me not write it. But it’s gotten to the point that I’m tired enough of seeing the same questions asked and the same myths propagated over and over on various keto and low carb forums that I’ve decided this needs to be done, no matter how painful I might find it. Because seeing nonsense and fearmongering regarding the role of protein in low carb or ketogenic diets is even more painful. So if finally managing to organize my thoughts into some kind of coherent prose means I never have to read the phrase, “too much protein turns into sugar” ever again, it will be worth it.

So that’s what’s on tap today, kids: Gluconeogenesis.

That’s right, friends, it’s time to do some myth-busting surrounding the whacked-out notion that protein—lean protein, in particular (like a skinless chicken breast, or tuna canned in water)—is the metabolic equivalent of chocolate cake. (Or cotton candy, or gummy bears, or any other insanely sugary thing that might raise your blood glucose and insulin far more than protein does.) 

I'm Still Alive!

Hello my dears!

I know I said last time that it would be a week or two before the new site was up and running. Well, as you can see, two weeks have come and gone, and then a few more weeks have come and gone.

My apologies for the delay. The transition is basically done, but there are some problems with formatting right now. Basically, for some reason, the spacing in many of the posts has not transferred properly and they look like giant walls of text, with no spaces between paragraphs and sections. Oy! They’re readable, but it’s not pleasant. Once I get that figured out, I’ll make the switch and get back to posting more often. (Yay!) I have so many (so many!) posts bouncing around in my head. It’ll be on me to actually write them, but I have a couple already set to go so I won’t have to keep you waiting even longer.

I guess I’ve been waiting until I have more content for the site. Not just blog posts, but actual content. A low carb & ketogenic FAQ, troubleshooting guide, food lists, etc. All of those and more are in the works, as are the posts I gave previews of last time. What this boils down to is my own laziness. There is truly no other reason this is taking so long, except I was waiting for things to be done for which I, myself, am the only thing standing in the way. Working from home is a great idea if you are a self-starter and are motivated and disciplined. I am none of these three things, so joke’s on me. (The even bigger joke was on me when I thought I could learn to be disciplined and a self-starter by joining the military, but it turns out no one—not even drill instructors—can force you to be something you’re not.)

Okay, enough wallowing in the swamp of self-pity!

TL;DR: New site coming soon-ish. I need to work out the spacing problems and play around with the fonts and colors until I find a look I’m happy with. Sorry to keep you waiting! In the meantime, you can always find me on Twitter, where I post irreverent thoughts of my own as well as links to nutrition & health things that might be of interest to you.

   

P.S. What I’m reading now: The Salt Fix, by Dr. James DiNicolantonio, with whom I collaborated on my very first peer-reviewed journal article, Added sugars drive nutrient and energy deficit in obesity: a new paradigm. (Yes, I have an article on PubMed! How cool is that?!) The “experts” were wrong about cholesterol, saturated fat, and red meat. Could they be wrong about salt/sodium, too? Signs point to yes. Read James’s book to find out why. A physician I follow on Twitter said it’s like “a salty version of The Big Fat Surprise,” which I reviewed here.) I agree!

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to amazon.com, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.

What's in Store: Changes are a-Comin'!

Hey Everyone,

Sorry for the delay in new blog posts. (But hopefully the cute picture of the eggs on the previous post makes you smile when you see it.)

There’s a reason I haven’t posted anything new in the last couple of weeks. I’m redoing the site and it’s best if I don’t add anything new until the transition is complete. Sometime in the next week or two, the site will look completely different. Don’t be confused! You’ll be in the right place, even if everything is unfamiliar. It’ll take me a while to settle on colors and fonts that I like, so you might continue to see some changes there until I’m happy with the appearance, but since I don’t want to keep you (or me!) waiting on new posts, I’m going to go for it and sort out the details later. As much as I’d like everything to be pretty and shiny and well-organized right away, if the rest of my life is any indication, making things pretty, shiny, and well-organized is not my forte, so if I’m going to wait for that to happen, you all are going to be waiting a looong time for new posts. And since writing is my forte (or so I’m told)—not to mention I like doing it and sharing with you all the cool things I learn—I might as well just jump into the new setup and take you all with me without waiting for things to look perfect.

Here’s a sneak peek at what’s in store on the site in general, and the blog, specifically. Some of the blog posts will happen sooner rather than later, but they all will happen eventually. (Sadly, it’s looking like another entire year will pass before I crank out another post in the series on the metabolic theory of cancer.)

Coming up: