April 3, 2015

Food for Thought Friday: Ketosis, Carbs, and Alcohol

I have tried to make it clear on this blog that I am not what anyone could call a “low carb zealot.” If anything, I’d like to think I offer a level-headed perspective that is sometimes missing when nutritionally-minded folks draw their lines in the sand and refuse to entertain the mere thought that their way might not be the best way or the only way for absolutely everyone else on planet Earth to be healthy and have a body that feels and looks the way they’re happy with. So let this little intro serve as a reminder that I don’t think very low-carb diets are appropriate for everyone. I don’t think half a stick of butter should be used as a condiment, and I don’t think adding 3-5 tablespoons of coconut oil and ghee to a cup of coffee is the best way for everyone to rise & shine first thing in the morning. In fact, if you were to look in my fridge and pantry right now, you might even be convinced that—shocker!—I eat plenty of vegetables along with all the yummy animal fat and protein I think are so good for us. (Also: there might or might not be a pint of ice cream in the freezer. I will neither confirm nor deny.)

That being said, I am a loyal low-carber for my own health and weight management, and I find myself bothered by an argument that pops up here and there about ketosis. It goes something like this: Ketosis is an unnatural and/or dangerous state, because it is so fragile and temporary. The minute the body has enough glucose available to do so, it shuts down ramped-up ketone production and goes back to more glycolytic metabolism.

This is true; I can’t argue with this. (The part about ketosis being fragile, not about it being dangerous.) The people who point this out use it to imply that the body genuinely prefers to run more on glucose than on fatty acids and ketones, because as soon as it can stop running on ketones, it does.

But here’s why this bothers me:

Yes, this is Flat Stanley, having a good time. 
(My nephew sent him to visit 
Aunt Amy a couple years ago, 
and what can I say? After exploring the sights 
in DC all day, Stanley wanted to party!)
If we have the perspective that the fuel source the body switches to running on first when it’s available in sufficient quantities is the body’s preferred fuel source, then the number one most preferred fuel for the body would be booze. Right?

But the generally accepted theory on that is that alcohol is a “toxin,” and the reason the body metabolizes it first when it’s present is to get rid of it as quickly as possible. (But then again, among us friends here, we all know of a few other “generally accepted theories” that haven’t exactly panned out, right? Not that I’m saying alcohol isn’t harmful; I’m just making a point.)

I went through the trouble of saying what I did at the beginning of this post so you’ll understand that I am not about to say that I think glucose is toxic, or that the body uses it first in order to dispose of it immediately. I do not think this. (Refer to this post from back in the fuel partitioning series, wherein I explained that the body really does need glucose because some cells don’t even have mitochondria, and therefore couldn’t burn fats or ketones even if they wanted to.) I only want to point out that the argument that a quick switch to glycolytic metabolism from the state of ketosis upon introduction of even modest amounts of carbohydrate implies that the body “doesn’t like” ketosis, or that ketosis is some kind of dangerous, emergency stopgap backup plan when there are no carbs around, is a spurious one. I’m not saying it’s untrue that it takes very little to “get knocked out of ketosis.” I’m only saying that the next leap of thought—that ketosis is unnatural—is a shaky one.  

The body stops running on ketones as soon as it can, so therefore, ketones must not be a good way to fuel the body. The body runs on ethyl alcohol as soon as it can, so therefore, a few shots of bourbon are metabolic gold. 

Um, no. 

I don’t think it’s natural to be in ketosis 365 days a year, but I don’t think it’s natural to never be in ketosis, either, nor to have influxes of starchy carbohydrate three times a day 365 days a year. Its feast and famine, not feast, feast, feast. 

And remember: Getting knocked out of ketosis” does NOT mean you’re not still fat-adapted. Just because you don’t see crayon-bold dark purple on your beloved ketone test strips (“peetones,” as It’s the Wooo calls them) doesn’t mean your body isn’t being fueled mostly by fat, and it doesn’t mean that all your low-carb hard work over the long term has been reversed instantly because you had three Thin Mints. (Or twenty!) It means only that excess acetoacetate isn’t being excreted in your urine. That’s all. If you have spent a significant amount of time on a lower-carb diet, and especially if you have incorporated exercise and more physical activity in general into your life while low-carbing, then all the enzymes, metabolic pathways, and mitochondrial whoosie-whats-its are still in place and going well near full-speed. You can be fat-adapted and not “in ketosis.” (I sense a separate post about this coming at some point if anyone out there would be interested. I kinda just said it all right here, though.)  

To recap: Yes, being “in ketosis” is a fragile state. I absolutely agree there. But can we extrapolate that to mean that ketosis is harmful or unnatural? That part, I’m not so sure about. Very low-carb and ketogenic diets have literally saved lives. And other people feel like roadkill on them. No big deal. Different strokes for different folks. Every Jack has his Jill, and every body has its best diet. (And even then, a body’s “best diet” is subject to change, right? What works when someone’s 25 might not work quite as well when they’re 65, or under a lot of stress, or holed up with a broken leg and not moving around as much. Dammit, if I had known this nutrition stuff was going to be so complicated, I could be using my creative writing degree instead, and I’d be asking if you want fries with that, instead of asking why you want fries with that!)

P.S. If Ash Simmonds happens to be reading this, he might be saying, But booze is the body's preferred fuel source!” (After a nice, rare steak, that is. And I would have to agree. [Some days!]) Exhibit A: this awesome tweet

P.P.S. Ash's Carnivore's Creed is the funniest thing you're not following on Twitter. (Except for Los Feliz Day Care [parody].) And since it's Friday, I'll offer you up yet another way to get your pre-weekend dose of laughter: Ron Swanson Meat Eating Memes. (Suitable for work, except for one word of text. All the images are fine.)

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.


  1. Damn, Amy, I don't know whether to thank you or curse you for the Ron Swanson link. It did lead me to this one - https://www.youtube.com/watch?v=GXhJPey3i_A

    Which made me laugh for quite a while. So, thanks.

    I'd never thought of the 'body's preferred fuel source' thing, so thanks for that, too.

    Have a good one.

    1. HA! Thanks for that video. A good laugh to start the day. :)

  2. My understanding is that the body switches to burning the carbs - if they are eaten- because it wants to get rid of the sugar flooding the bloodstream as quickly as possible.mit definitely does not mean that burning carbs is preferred. Amber Wilcox O'Hearn made this point of one of her blog posts.

  3. I looked through Amber's articles and bother her websites and could not find a post precisely about this issue. It might have been Dr. Stephen Phinney who discussed this somewhere or other. I have read and listened to so much material on ketosis that I can't remember exactly where I heard it, but you're right...switching to burning carbs doesn't mean carbs are the preferred fuel.

    1. Right. The body absolutely does require some glucose, but that doesn't mean CHO is the preferred fuel source. (Nor that we have to ingest exogenous sources of glucose. We *can* get glucose that way, but we don't *need* to, in the biochemical sense of the word "need."

  4. Sugar is so important we have an organ to make it (liver) through gluconeogenesis. Same thing with fats being created via de novo lipogenesis in the liver. Same with ketones (ketogenesis).

    What is bothersome is this meme of dietary CHO being necessary to 'form mucus' (Jaminet) & 'tears' (Asprey)...right, I forget Eskimo's or certain Hadza tribes (depending on seasonality) can't cry or have high rates of GI cancer. [oh, wait....they don't]

    1. I try not to become too religious about any of this. If the history of "nutrition science" has shown us anything, it's that deeply held beliefs can lead to some pretty terrible blanket policies & recommendations, and once incontrovertible "facts" seem to be anything but. (Even though that's not true. The facts are the facts. It's only the *interpretation* of them that changes with the political, economic, and social climate.) Can you imagine anyone dirt-poor during the Great Depression turning their noses up at meat and preferring to eat beans and lettuce?

      As for Jaminet, I'm not a huge fan, but the guy does his homework, and I'd be stupid to ignore the success people have on his program. Lots of people on low-carb diets who were not getting the results they wanted (with weight, body comp, and/or health issues) seem to do much better with a bit more carbs. No skin off my back. To each their own. My problem with all this comes when someone insists that their way is the *only* way -- for *everyone* on the planet. That screams of fundamentalism & extremism -- as bad in nutrition as they are in religion.

    2. "I try not to become too religious about any of this" ==> your writing shows no signs of that (your many caveats & 'what if' thinking is a door to alternative explanations).

      "Can you imagine anyone dirt-poor during the Great Depression turning their noses up at meat and preferring to eat beans and lettuce?" ===> No :)

      "I'm not a huge fan, but the guy does his homework" ==> We're on the same page then. IMO he's guided by a philosophy of moderation & 'a bit of everything'. This isn't a problem when people come from total ignorance & a SAD lifestyle, but the moment actual medicine is being practiced or we're talking population level policies, that thinking just won't cut it.

      "My problem with all this comes when someone insists that their way is the *only* way -- for *everyone*" ===> well that's political/religious speak - nothing to do with nutritional science. Problem is, that discourse is confused with the fair testing or falsification of the Null Hypothesis: ketosis is inherently detrimental to some human beings. I have yet to find acceptable evidence of this. My gut feeling is it is never detrimental overall but won't be optimal in certain niche parameters/instances/climates...So, is ketosis good for everyone? I'd venture yes. Is it optimal for everyone? Unlikely.

  5. Amy do you think a ketogenic way of eating is the way for a weight reduced person? I've have been maintaining my weight eating lotsa meat and veggies but I am starting to think maybe I eat far too much as my P/P BS are still too high for such a LC diet. I keep reading how good a high fat keto will be best for both insulin control and hunger issues, but I can't wrap my head around nuts/cream/dark choc/fat - those foods are danger/no brake foods for me and very dense in energy. Have you done keto?

    1. Can keto work? Yes. Is it the *best way,* for *everyone?* Probably not. I know that's not the answer you want to hear, but without knowing more about your history, I can't really say. Keto is a miracle for some, yet others seem to do exceptionally well on Paul Jaminet's Perfect Health Diet -- including people who saw their blood glucose creeping up on very low carb, and it seemed to regulate better with a little more starch. Don't feel pressured to eat super high-fat if you think it's not right for you. I've done keto here and there but not for long term. I'm thinking about giving it a go again, though, because I've been putting on weight recently and need to nip it in the bud. (Then again, I'm not getting anywhere near enough sleep and there's definitely some "carb creep," so probably just getting my act together would help a lot.)

      And then, the question is, how high are you talking when you say your PP blood sugar is "too high?" This is a relative term. For a T2 diabetic, we could be talking 250. But some very healthy people who eat low carb get (unnecessarily) freaked out if they see, say, 110 after a meal. So I'm not sure what your definition of "too high" is.

      Also: have you tried vinegar with your meals? ;-) Very helpful for blood gluc & insulin:

  6. Hi anonymous,

    Maybe there's a simpler approach to the question "Should I do X, Y or Z". I'd 'forget' purposeful ketosis for starters & focus on diet basics.

    Ask yourself a question that requires the least amount of uncertainty & opinion. For example, "What things must I eat that I cannot live without?" The answer is animal proteins & animal fats. There is no such thing as an essential carbohydrate.
    Another is, "Is variety important?" Seems to be the case.

    Generally speaking, it seems reasonable, logical & probably *safer* to start by prioritizing that which is essential on your plate. If you eat fatty protein (meats, fish, shellfish, eggs etc.) until you are sated, that's an excellent start! Then, you will (most likely, as the majority of people do) want some vegetables or nuts. High fibre-high nutrient vegetables & nuts *may* help improve your ratio of calories:nutrients, which maintains (or even improves) the nutrient density of your diet. Next is fruit - do you need it or do you want it? No one "needs" fruit but incorporating it in your diet can add to hedonistic aspect of eating (which has its place) and increase your appetite if you feel like that will help your eat more & thus put on some muscle mass.

    Amy's advice about vinegar is excellent - I'd certainly heed it :)

    Good luck!

    1. GREAT advice, Raphi! (In fact, I would do well to follow it, myself. To be completely honest, I'm looking to make some changes with my own diet, and I'm feeling a bit overwhelmed by information..."paralysis by analysis," as they say.)