January 25, 2016

Being Fat Adapted Versus "In Ketosis" (Pt.2/3)

In the previous post, we established the difference between fat adaptation and ketosis. Now, let’s revisit the “got kicked out of ketosis” thing. 

People new to low-carbing—and also people not-so-new, but who just don’t understand how this all works—will utter that dreaded phrase when they pee on a ketostick and don’t see their beloved dark purple, or—gasp!—not even a little pink. No color change at all. They will then assume that whatever they ate sometime prior to testing “kicked them out of ketosis,” and they will summarily cross that food item off their menu forever, banishing it to their ever-growing list of forbidden foods. (They will also spread tales of woe on forums far and wide, thereby terrifying other newbie low-carbers into avoiding these foods as well.)

But here’s the thing: ketostix are fickle things. Elevated ketones in the blood, urine, and breath, are fickle things. What else was going on before testing? Was this person very acutely stressed? Did they do an intense workout? Both of these can cause a temporary rise in blood glucose (albeit a smallish one), which might trigger a temporary rise in insulin, which could put a temporary stop to ketosis. Temporary. Note: it will not put a stop to being fat-adapted; only to having excess acetoacetate in the urine or elevated beta-hydroxybutyrate in the blood at that particular moment in time.

For people who are well fat-adapted, having higher ketone levels might offer bonus effects, such as the positive mental outlook I mentioned in the previous post. But while a carb binge might “kick someone out of ketosis,” it will not kick them out of fat adaptation. I guess the best way to describe this is:

Ketosis is an ephemeral state. It takes very little to make it disappear. Fat adaptation, on the other hand, is a much hardier state. You have to work to undo it.

Long-time low-carbers—whose bodies have the enzymatic and mitochondrial machinery running full-speed to metabolize fat—actually have to work pretty hard to “break” that. One cookie isn’t going to do it. One bagel isn’t going to do it. One honkin’, mega-large slice of cheesecake won’t even do it. Not even a piece of bread or two every day for a little while is going to do it. Sure, ketosis will be a distant memory, and you might find yourself having to fight cravings for more and more starch or sugar, but a couple hundred calories of carbohydrate aren’t enough to shut off long established fat utilization at the cellular level.

Confession: I may or may not have had a major ice cream bender a few months ago. (Okay, there’s no “may or may not” about it. It definitely happened. *Looks away sheepishly.*) And sure, my ketostix were not changing color anytime soon after that. But you know what? Just two days later -- two days -- I was back to dark pink. The carbohydrate was out of my system relatively quickly and I was back to running on fat. It happened so effortlessly because as soon as the ice cream was over and done with, my body went right back to its usual fuel substrate: fat. The metabolic machinery that had been ramped up all the years I’ve been low-carbing didn’t disappear. It was still there, ready to roll as soon as insulin got back out of the way. (I will say, however, that I accelerated the process by eating very little the day after, and going for two separate 4-mile walks.)  

If I were new to this, I might have let a lack of color change on a ketostick the next day dishearten and discourage me, and make me question whether I was capable of sticking to a low-carb diet. (And question whether I even wanted to stick to one, if one night of ice cream craziness was enough to completely undo all my progress.) But I’m not new. And I know how this works. Yes, the ice cream “kicked me out of ketosis.” (*Cringe.*) But it did not at all derail my physiology at a deeper level. This is where people are just entirely missing the boat: ketostix do not tell you whether or not you are fat-adapted. They tell you only that acetoacetate is or is not present in your urine. And when it comes to losing body fat, the presence of high levels of acetoacetate in your urine and beta-hydroxybutyrate in your blood are just not that big a deal.

(There are other, perfectly legitimate reasons people might intentionally seek higher levels of ketones, such as for neurological health, but THAT IS NOT WHAT I'M WRITING ABOUT HERE. Here, I am simply trying to dispel the myth that high BOHB in the blood and high acetoacetate in the urine are some kind of magic carpet ride to automatic fat loss and blissful health forevermore.)

Being in ketosis versus losing fat

Let’s move on to another important point – the one I mentioned at the beginning of the previous post and said I would probably repeat. Well, here it is again:  

You can be in ketosis and not lose body fat, and you can lose body fat without being in ketosis.

At the risk of making this post all about me, me, me, allow me to share some examples from my own life, because I have experienced both of these situations firsthand. We’ll start with the first: being in ketosis but not losing body fat. (Aside: please note how careful I am to say body fat, rather than weight. Having worked with women who base their self-worth and the efficacy of their diet solely on the number they see on the scale, there is far too much emphasis on “weight,” rather than body composition.)

I have, at times, been in ketosis, but actually gained fat. This can happen if I overdo it on cheese, but especially, most especially, mayonnaise. I am way too lazy to make homemade mayonnaise, so when I really want some, I just get regular ol’ Hellmann’s. Yes, it’s soybean oil, but it is friggin’ delicious, and I have never had a homemade mayo that came close. (Not even the one from Primal Kitchen™, although that was quite good and I do recommend it.)

Copious amounts of mayo—as I am wont to consume when it’s in the house—will absolutely cause me to pack on the pounds. Sure, this might have something to do with the tremendous amount of calories unrestrained mayo consumption provides, but this just goes to show that even without affecting insulin much, and even though those large boluses of fat will keep me in ketosis, they will put the kibosh on my body releasing its stored fat. See, even if you’re in ketosis, if you’re eating several hundred (or thousand!) extra calories of pure fat, all that food energy still has to go somewhere. With or without insulin, in or out of ketosis, it’s not just going to disappear. This might be why some people have to pay closer to attention than others to total caloric intake, even on a low-carb diet. Ad-libitum low-carb works great for some; others, sadly, have to manage things a little more tightly. There’s a bit of research suggesting that, calorie-for-calorie, soybean oil is more fattening than fructose (at least, in mice). Soybean oil certainly seems to fatten me fairly easily, but again, we have the confounding variable of me sucking it down in large quantities. Doesn’t matter. All I’m saying is, you can be dark purple on your ketostix all you want, and it doesn’t automatically translate to body fat loss.

Let’s switch gears now and look at the other scenario, in which I was losing body fat without being in ketosis.

Picture it: Iraq, 2008. (Yes, this is my take on Sophia Petrillo’s “Picture it: Sicily, 1945.” And if you don’t know what I’m talking about, and you’re an American, shame on you.) There I was, deployed with the U.S. Air Force. While my diet wasn’t super-low-carb, I fared very well out there. I was most definitely nowhere close to the standard American diet. Thanks to a well-appointed chow hall and shipments from Amazon and Netrition, my diet consisted mostly of: enormous salads filled with lots of raw vegetables and big piles of tuna (plus heaps of soybean oil-based dressing); eggs; bacon; lunchmeat-style turkey, roast beef and cheese; cottage cheese; nuts; obscene amounts of peanut butter; beef jerky, occasional grilled chicken breasts or steak; protein shakes; and lots of cream cheese. (And I can pretty much guarantee none of this was organic, grass-fed, free-range, or anything like that. Military contract food? Cheapest. Possible. Bidder. Food quality? Not given the remotest consideration. When Uncle Sam needs to feed thousands, he feeds them cheaply.) And here is a sampling of other foods I ate on a regular basis, although in small amounts, and, when possible, timed strategically around my workouts and other factors designed to lessen their potential negative impact: cookies, garlic bread, fruit, ice cream, chocolate, fruit-flavored yogurt, brownies, sugary coffee creamers, and trail mix with dried fruit.

I can pretty much guarantee I was almost never in ketosis at good ol’ Balad Air Base. And yet, I was losing fat like a beast, gaining muscle like a champ, and I was in the very best shape of my life. (Also: about that weight/fat thing? I weighed more than I do now, but I was leaner. My physique was nicer. My body shape was nicer. My clothing size was smaller. My point: f*ck the scale, ladies [and gents]. F*ck it so hard.)

Here is a sampling of the myriad other things I believe contributed to keeping me fat-adapted, and therefore, fueling myself quite efficiently on both stored and dietary fat, ultimately allowing me to attain my best physique even in the absence of ketosis: 
  • I walked 3-4 miles a day without even trying. (Due to the layout of the base, I would walk this amount in the course of my normal routine, going from my quarters to and from the gym, chow, the latrine, the office, the BX, and more.)
  • I did fasted morning workouts 4-5 days per week. (Cardio and lifting.)
  • I worked a noon-to-midnight shift, which aligned beautifully with my natural circadian rhythm. (A morning person I am not.)
  • I loved my work. I felt I was doing something important and had a sense of satisfaction at the end of the day.
  • I loved the people I worked with. (Most of them, anyway.)

Obviously, the first two points there contributed significantly to the improvements in my body composition. But let’s not downplay the importance of the last three points. I talked about this at length in my (epic) post about JOY, a.k.a. vitamin J. I honestly think the role of just plain liking and enjoying your life is underestimated in the ancestral health and real food circles, much to our detriment. You can have the cleanest, most pristine, most perfectly formulated diet, and maybe you sleep in a completely dark room, and you poop like clockwork, with your stool shape & consistency the stuff of legends. Fine. Great. But will that take you all the way if you hate your job, dislike your living situation, never get outdoors, have no time for your hobbies, are crushed under the weight of financial debt, and/or feel trapped in a stale relationship?

There have been other times I have experienced losing body fat and maintaining a physique I was thrilled with in the absence of ketosis. They generally correlated to me following a good low-carb (but not ketogenic) diet, with strategically timed higher carb intake (post-workout, specifically), as well as lots of walking, and good sleep. I also seem to maintain a better physique when the bulk of my fats come from animal sources, rather than plants. (Meaning, more lard, bacon fat, tallow, and other meat fats than olive oil and nuts, although I seem to okay with a reasonable amount of nuts.) The point, again, is that seeing visible pink or purple proof of acetoacetate in your urine is absolutely not required to lose body fat, nor to be fat-adapted.

Next time, we’ll talk about what happens if—for whatever reason—you have a higher carb meal, a high-carb day, or even a week. Why do you gain so much weight when you go on even just a little carb-bender? Does one night of beer & pizza (or one morning of lattes and waffles) undo all the physiological adaptations you’ve undergone in the past several months or years to be a fat-burner? If life throws you a lemon and instead of sugar-free lemonade, you make lemon shortbread cookies, complete with sugar and real flour (with…*gasp*…gluten!), have you absolutely ruined years of low-carbing?

Based on my level of sarcasm (code orange!), you probably already know the answer. But tune in next time for the details anyway.

Remember: Amy Berger, M.S., 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.


  1. Very good post. Some great common sense in there that seems to be forgotten when eating KETO. Calories still matter no matter what anyone says...

  2. Your articles about this were just what I needed to read today. Thank you so much.

    1. Glad they helped. :) Just keep doing the best you can and don't get bogged down and discouraged by the minutia.

  3. You clearly need to grab this: http://amzn.to/1lMA7m3 Now you can have your ice cream, ketones, fat-adaption...and eat it too! ;-)

    PS. Have I told you lately how much I love your posts??

    1. Oooh! Yeah, looks like that is a book for ME! ;D
      And yes, I think you might have mentioned enjoying my blog a time or two, but hey, a girl can never hear that enough! Seriously, Carrie, thanks so much. I had a minor meltdown yesterday, but I'm feeling a little better today, and your comment, of course, warms my heart. Very glad we've connected.

  4. I LOVE IT ! GREAT AS USUAL! Especially that stuff about the scale! LOL!! I was laughing out loud at work! keep it up girl!

    1. :) Thanks! Sometimes I worry about putting language like that on my blog, but honestly, sometimes there's really no other way to say it. (Well, there *is,* but it's not as impactful, nor does it do justice to the way I really feel, hehheh.)

  5. One of your best, Amy! Thanks! :-D

    1. Thanks, Tess! Your latest few blog posts have been on-point, too. (Especially the one about the "what should I DO" on the all-carnivore group. I learn a lot from the zero-carb folks, but some of them are as closed-minded and paranoid as the vegans. They're doing a real disservice to the new people. Maybe some of them really *do* need supplements, or more vegetables, or just something else besides meat and water....)

    2. ;-) yep, but there's no way we can tell some of them.... Thank you for the kind words about my recent rants!

  6. Amy, I thoroughly enjoyed your blogs that I just found. Very helpful information. Just one thing, please, please use some other word for those who don't understand ketosis/fat burning. Ketard is one of those manufactured words deliberately bringing retard to mind. However, those with this condition and their families (I'm a Mom of a man with mental retardation) find it so hurtful and denigrating to see this done, making retard an insult. I have no doubt you did not intend to cause pain to any readers and was just trying to be amusing. This isn't about political correctness, just hurtful words. Thank you for thinking about this, and I do hope you will change your title.

  7. Loved this article. I am new to low carbing and I've been so confused but you have cleared thing up for me. And would you believe I was in Balad in 2008, also? Lol I was there as a contractor working in the Pax Terminal.

  8. such awesome info I sure appreciate it. So much to learn...

  9. This has to be one of my favorite post ever! I love the common sense approach you always provide along with the real world approach to nutrition. I think when we first start keto it's natural to focus so heavily on ketosis because of the dogma out there. You are in ketosis or you are out! As we hopefully study up on our biology and nutrition along with experience we evolve to start to understand the processes of our bodies and its not all black and white and the grey area can be effective as well and it's really about the big picture and a long term adaptable lifestyle. A meal off plan doesn't mean I failed and I can continue my desired lifestyle! Progress not perfection! I appreciate your flexibility and how well you explained all of this!

    1. Thanks! Glad you liked it. I wish everyone fretting over getting "kicked out of ketosis" would stumble upon this post and read it. Ketones DO NOT MATTER, for most people. There are situations, of course, where measuring them is important, but for most people just trying to lose weight and be healthy overall, it's a waste of time and money, and drives people completely crazy when they really don't know what the numbers even mean, and don't have any appreciation for the complex biochemical mechanisms at work in regulating ketone levels.

  10. These articles are awesome and you are hilarious (and smart)! Thank you, really enjoying this info.

  11. Finally! Some explanations I understand. However, 2 weeks in on 120p/70f/20c and not seeing any movement in body fat (well 2 lbs), eating more calories now than in the past(avg now about 11-1200))(Dr says I should be less than what I used to eat which was under 900), natural aversion to fats in general since 1980, but enjoy protein & seemingly some more energy, have PTSD for many years which caused me to go from 160 & size 16 (great for me) to as high as sz 28 in a few yrs, now down to sz 22. I think clothing sizes are a lie, Wondering who can advice me on whether I need to cut calories by cutting down on fats (which I don't like) & protein or stick to plan & give it more time or come to a point that I will be fat forever & give up....Please forward this to anyone who might be able to help me!! I do meet the protein part most days but avg less 10-20 in fat most time & around 19-25 carbs. I try but carbs in veges sneak up on me. pebbles1157@gmail.com

  12. Love this and have reposted on Facebook while tagging my friends that are doing Keto. I now know that I'm fat adapted but not in ketosis most of the time. I do love that 'Limitless' feeling in my mental clarity/mood upswing so I'll need to cut portion size or back on protein maybe. But happy to be fat adapted and trying to share that this is the answer to diets that don't work long term.

    Love ya and need to figure out how to get all your blog posts.

    Also, ex-USAF here on C-5's (out in '91.)