Pages

January 21, 2016

Being Fat Adapted Versus "In Ketosis" (Pt.1/3)

UPDATE!! (9/20/2017)
I have a new post that explains how and why the body produces ketones, It will help you understand much better the difference between burning fat and having a fat-based metabolism, versus being "in ketosis." It's very long, but I think it's worth reading if you'd really like to understand this -- and if you want to stop freaking out about your ketone levels. (If you click over to that post and want to read only the section that explains the difference between ketosis and running on fat, scroll way down to where it says Ketogenesis: How and Why Do We Make Ketones? Also: Fat Adaptation versus Ketosis.) Happy reading!





“I got kicked out of ketosis.”

If I never hear or read those six words, in that order, ever again, I’ll be one happy individual.

Based on what I come across on low-carb forums, blogs, and videos, there is a lot of confusion about the correct use of urine ketone test strips (which I’ll sometimes refer to as ketostix, since “ketone test strips” is a mouthful, even when you’re only reading). So allow me to ‘splain a little bit about how to interpret these things, and what role they should play—if any—in your low-carb life.

First and foremost is the most important thing you will read in today’s post. (And it is so important that I will likely repeat it in all the posts to follow in this little series. Plus, you can tell it’s important because it’s red, bold, in italics, and all caps, hehheh.)

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

Here is an exhaustive, comprehensive list of everything urine ketone test strips tell you:
  1. There is acetoacetate in your urine.

That’s it. Nothing more. Nada más. Game over. Finito. The fat lady has sung, and Elvis has left the building.

Here is what they do not indicate: 
  • Your worth as a human being
  • The efficacy of your low-carb or ketogenic diet
  • What your level of ketosis was an hour ago
  • What your level of ketosis will be three hours from now
  • Whether a specific food you ate “kicked you out of ketosis” (or, rather, caused there to be less acetoacetate in your urine)
  • Whether you are fat-adapted
  • Whether you are losing body fat

I’m not saying ketostix are useless for providing any other information besides whether or not there is acetoacetate in your urine. We can certainly use ketostix to speculate about issues other than the presence of acetoacetate, but that’s all it is—speculation, based on your diet, activity levels, stress levels, and more. They provide information, but they do not always provide answers. Are you showing deep purple on your urine test strips but not losing body fat? All that tells you is that being in ketosis doesn’t guarantee fat loss. (Which you already knew, right? Right?!) It doesn’t tell you why you’re not losing fat.

Ketostix are a tool. They give us one measurement, and one measurement only—the approximate concentration of acetoacetate in urine. This single measurement is helpful for hinting at other things we might be interested in, and we can use this acetoacetate indicator to help us arrive at logical conclusions, but we must not let ourselves become beholden to these reagent strips as the end-all and be-all of how we’re doing on a low-carb diet. They’re good, but they ain’t that good, people. (And really, we can say the same thing about blood ketone meters. They tell us only the concentration of beta-hydroxybutyrate [BOHB] in the blood. They tell us nothing about whether we’re losing body fat. And in case you didn’t know, they’re not even really a great indicator of blood glucose levels. There’s a surprising bit of variability in people’s ability to reach and sustain high-ish levels of BOHB. Some people can have a blood glucose in the 90s and still see ketones of  >2.0 or 3.0 mmol/L. Others might have blood glucose in the 70s but blood ketones of <1.0 mmol/L. So there is not an automatic correlation between the two, and we can’t necessarily use one as a proxy for the other. We can, however, assume that blood glucose is relatively low if BOHB and acetoacetate are elevated even slightly. BG might not be as low as the 70s, but it’s unlikely to be, say, 130 mg/dL)  

There’s a lot to cover on this. (So much, in fact, that I ended up having to break this up into 3 parts. I seem to be physically unable to write anything short.) It’s a bit overwhelming, so let’s just ease into things, and little by little, we’ll get to all of it.

Probably the single most important thing to clear up first is:

Being “in ketosis”
versus being fat-adapted


They are not the same thing. You can have one without the other.

Let’s talk about the simpler of the two first: being “in ketosis.” (I’m going to stop using the quotes now, but you can picture me making the little marks with my fingers every time you see that phrase.) Being in a ketogenic state means that you are breaking down fatty acids at a fairly decent rate, and some of them are being converted into acetoacetate, acetone, and beta-hydroxybutyrate. For those of you who follow low-carb or ketogenic diets, think back to when you first began your low-carb lifestyle. If you jumped in with both feet and went low-carb quickly, rather than making a gradual transition, you likely experienced the “induction flu” or “keto flu” – pounding headache, dizziness, nausea, and some other fun stuff. This is what happens when you are in ketosis but not fat-adapted. Your body is deprived of the copious amounts of carbohydrate it’s accustomed to, and your insulin levels have fallen low enough that you are beginning to break down fats for fuel instead of that endless stream of glucose. However, because it’s only been a couple of days, your body has not yet fully ramped up the enzymes and mitochondrial machinery required to properly and effectively utilize those fatty acids and ketones. So you’re in this hellish limbo we call the induction flu. Your body is producing ketones, but it’s not using them (or fatty acids) very well just yet. (It is still wanting to use glucose. Glycolytic enzymes are going crazy looking for—but not finding—glucose.) This is probably the simplest example I can give of being in ketosis but not being fat-adapted.

We could probably say the same thing about the use of exogenous ketones in an individual who is not following a low-carb diet. Their urine (and blood) would indicate that they are in ketosis, but they don’t have the physiologic machinery in place to keep that ketosis going after the exogenous amount has been metabolized, never mind having their bodies fueled primarily by fat. The state of ketosis induced by exogenous sources is entirely temporary and has nothing to do with the processes the body uses to generate ketones naturally, not to mention ramping up the enzymes and metabolic pathways that make someone a "fat-burner." (I'm not saying exogenous ketones have no role at all in metabolic therapies. I believe they do, but that's a subject for another time. Or maybe I'll see you at this conference!)

Now, let’s look at the other side of this.

You can be fat-adapted without being in ketosis. I know for a fact people can be fat-adapted but not in ketosis because I have personally experienced this many times. In fact, I would say this is my default state most of the time: fat-adapted, but not in ketosis. I follow a low-carb diet, but I’m not always at ketogenic levels of carbohydrate intake, and some days I probably consume enough protein that I wouldn’t see a noticeable change on the ketostix. My carbohydrate intake and resultant insulin levels are low enough to allow my body to be fueled primarily by fat, but my carbohydrate intake is not so low as to have excess acetoacetate perpetually registering in my urine.

Here’s how I gauge my fat-adaptation:  
  • I can comfortably go several hours without eating and feel no hypoglycemic effects whatsoever
  • I have good, steady physical energy levels
  • My mind is sharp and my thinking clear
  • When I do finally start feeling some hunger pangs, I am just that—hungry, rather than hangry. I will seek a protein- and fat-rich meal, and have no desire to jump head-first into a half-gallon of ice cream or consume a cheese danish. (One of my former favorites, waaaay back in the pre-low-carb days.) I have no interest in sweets or starch. I genuinely want something high in fat and protein—something like a burger, a fatty pork chop, sausages, etc. But if I were to pee on a ketostick, there would be no indication of ketones.


The most striking difference I notice when I am in a more deeply ketogenic state, versus just generally running on fat, is my MOOD. I am quite the gloomy Gus, the negative Nancy, the Debbie Downer, and all those other glass-is-half-empty people. (If you follow me on Twitter, you’ve seen this in action a time or three.) My natural state is one of almost crippling pessimism, self-doubt, and self-loathing. But something rather magical happens to my emotional outlook when my ketones are higher. It’s like someone flips a switch on my spirit, and suddenly I feel like I can accomplish anything—and more, that I am worthy of accomplishing more, and that I deserve to have a happy life. Since this is so different from my normal state of mind, this is basically my non-mathematical way of “knowing” I’m in ketosis. I don’t have to check; I can feel it. But sometimes I do check, if only to corroborate what I already know, and the test strips typically confirm that I’m keto-ing pretty hard.

Okay. Sorry for that little tangent into the dark recesses of my mind. My point is, there is a difference between being fat-adapted and being in ketosis. Maintaining a perpetual state of ketosis (especially deep-ish ketosis) may be particularly beneficial for certain conditions, such as cancer, Alzheimer’s, multiple sclerosis, epilepsy, and other neurological & neurodegenerative conditions. But as many of us know quite well, ketosis doesn’t guarantee fat loss. For fat loss, it is far more important to be fat-adapted than to shoot for high ketones all the time. This obsession with chasing ketones for the sake of bragging about them on social media has got to go. I feel like we’re getting to a point now of blood glucose & ketone “shaming”—whose are the lowest and highest, respectively. And if your blood ketones aren’t at 2.0+, or your A1c is above 4.8, you’re “doing it wrong.” Sh*t stuff like this makes me want to quit this industry altogether. It’s ridiculous. 










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.

81 comments:

  1. The bullet points referencing a solid ketogenic state are dead on. Energy, mood, appetite control... it's a big difference/advantage over any other style of eating. Eat even a balanced amount of so called GOOD carbs and i will still ride the energy/mood/appetite rollercoaster, needing afternoon coffee etc...

    In addition I pay close attention to the research on various disease states that a ketogenic diet may help. Call it potential prevention or insurance against cancer, alzheimers, parkinsons, etc...

    But ultimately my energy, mood,appetite control, and healthy weight maintanance give me the here and now benefits that most people desire...

    Great post

    ReplyDelete
    Replies
    1. ME TOO I just cannot believe I didn't hear of this until a month ago when I decided in just two days that I would take the plunge. I will never go back.

      Delete
    2. Is it possible to change body composition on ketogenic, without losing weight, but still stay fat adapted? I want to reduce my body fat by 5% but I am at my minimum ideal weight. I tried cutting down the fat percentage but had to increase protein to maintain weight. This seems to have an adverse effect on ketosis...blood ketones have dropped to 0.3mm/l. What should I do?

      Delete
    3. What should you do? Stop measuring your ketones. Not necessary. You can absolutely be running on fat and lose body fat without being in ketosis. Please read this and dn't worry about the reduction in ketones. It doesn't matter if your goal is fat loss: http://www.tuitnutrition.com/2017/09/measuring-ketones.html

      I also recommend this macro calculator, which will probably give you different numbers than you're currently eating: https://ketogains.com/ketogains-calculator/

      Delete
    4. Thank you. The calculator sure did throw out some interesting numbers. Apparently I should be eating twice as much fat as I am, as well as a bit more protein. Seems kinda counter intuitive to eat more fat when you want to lose body fat. I assumed I would just be burning the fat I ate, rather than reducing adipose tissue. I already eat avocados, butter and coconut oil, it's a struggle to see how I can get much more in! Fat bombs here I come.

      Delete
    5. As long as you're sure you toggled the "calorie goal" widget to "fat loss," and also entered your weight and body fat percentage correctly.

      Delete
    6. Sorry for being dense, but this still doesn't make much sense to me. When I toggle to fat loss, it puts me in a 20% calorie deficit. This would surely make me lose weight wouldnt it? If I am losing 1.7lb fat per week, in order not to lose weight, I would have to replace this with something. Muscle? So shouldn't I use the 'maintain' or build muscle selections instead?

      Delete
    7. I'm not sure what to tell you. Sorry. I recommend asking the KetoGains experts directly, as it is their calculator. See here for info on coaching: https://ketogains.com/coachingconsulting/

      If you really just want to ask some questions about the appropriate macros for your goal(s), scroll down in that link to where they mention a one-time consultation. That will probably be the best thing for you to do.

      Delete
    8. Actually, after re-reading your comment, I think I understand better what you’re looking for. If you want to have a lower body fat percentage, there are two ways to do this: lose body fat, or add lean muscle mass. If you do not want to lose weight in terms of scale weight, but you want to have a lower body fat percentage, then what you probably want to do is gain muscle. Your scale weight could stay the same or possibly even increase, especially if you’re starting from the very low end of the range but your fat percentage will be smaller because of the increased muscle. So you might want to revisit the Calculator and change the goal to gain muscle and actually use a caloric surplus. What you are really going for is “body recomposition.” Probably still best to consult the KetoGains guys directly though. They will be able to guide you much better than I can.

      Delete
    9. Thanks Amy, that makes more sense to me now.

      Delete
    10. Hi Amy, Thank you very much for your Article it is very helpful, but how can i know if Im Fat adapted when my ketosis is low . BY the way im in keto for 6 weeks and i had used the sticks to verify that but the color kept changing while im eating the same way , i really do not care about that if im fat adapted . thank you in advance :)

      Delete
    11. The color changing and not being the same all the time is NORMAL. Your ketone level isn't the same all the time every day, so neither will the color on the urine strips. Don't stress out about this. You are fat adapted as long as you're eating very low carb, even if you're not in a deep state of ketosis. There isn't an official way to be *sure,* but there are things to watch for -- are you mentally sharp/clear? Can you go several hours comfortably without eating and not feel irritable, shaky, angry, dizzy, or light-headed? All that is a good sign that your body is being fueled by fat.

      Delete
  2. I love this post! The confusion and misinformation out there makes me feel all stabby. For me, though, knowing that I get a "report" every morning on my Ketostix really does help me not reach for crap, and think more strategically about what I am going to put in my mouth that day. That's a big win in my book. Ketostix are my accountability partner.

    ReplyDelete
    Replies
    1. Yeah, they can be helpful. (I get to that in part 3.) I don't mean to imply that people shouldn't use them at all. I just want people to stop obsessing and literally basing their self-worth for the day on whether or not they see pink/purple. ;-) I find I tend to be darker a little later on in the day. Morning is usually only light pink, unless I have a bunch of coconut products before bed, which does happen now and then, hehheh. Then, the strips are darker than usual when I first wake up.

      Delete
    2. I should also note that I didn't start KETO for weight-loss, but for my brain, so keeping the peetones at the darker end was actually important, and what we were trying to achieve. I can testify to KETO not necessarily causing you lose weight, because I didn't. I started to lose weight when my peetones were at the lighter end.

      Delete
    3. Your information has been most helpful, I have never tested for ketones, I’ve just gone with how I’ve felt. I know when I’ve had too many carbs. I know this is a lifestyle change and I am committed. I know when I first started out I missed my sugar😭 but now, I don’t even like anything with too much sugar... I thought I would “ treat” myself with a cooler to drink last night and had a few sips before I dumped it😊
      Thank you for your clear advise. Keto on👌

      Delete
  3. Great Post Amy! A fantastic Job as usual!

    ReplyDelete
  4. My understanding is that you CAN be in ketosis, but not spilling excess acetoacetate into your urine, so a negative ketostick does not necessarily mean you are NOT in ketosis. I see people on social media being very upset because their ketostick was negative, but a negative may not mean anything at all.

    ReplyDelete
    Replies
    1. If you look closely at that little pink/purple "pillow" on the stick, some areas are lighter and some darker -- Wooo believes that it's the darkest little specks which report your true reading, too.

      Delete
    2. I've read - in Jimmy Moore's "Keto Clarity" if memory serves - that once the body is, for lack of a better term, used to being in ketosis, the kidneys will keep the ketones in the body instead of letting them spill over in the urine which would result in far less acetoacetate in the urine and therefore a decreased ketostick result. Have you found this to be true Amy?

      Delete
    3. I have been constantly in ketosis (eating very low carb) since mid-July - so 6 months - and I still register on ketostix.

      Delete
    4. I am fat adapted and I have no readings on ketostix. And I only have when I started

      Delete
    5. I have read the same thing that Windy mentions and I am curious about it too. I wonder if it is common to have the ketostix show negative acetoacetate eventhough one is in ketosis and also fat adapted. I believe that I read this in The Obesity Code.

      Delete
    6. Some people do report that after a while of being on LCHF/keto, they no longer register on the urine test strips. This is not true for me and other keto people I know, so it seems to be an individual thing. You can certainly still be fat-adapted and have a fat-based metabolism without showing high ketones, so I wouldn't stress about ketone levels.

      Delete
  5. Very nice post, Amy! I don't use ketostix often; actually, most of the time when I use them it is because I know I ate something that is incompatible with my remaining in ketosis, and I'm verifying how fast I return to that state, and the other is when, on occasion, my body has gone acidic, and I'm peeing too much. I actually get to the darkest color on the scale. When I go and check that, it is because I'm not feeling well, a paradox despite the high level of acetoacetate / ketones. In that case I take some baking soda in water and some potassium gluconate for a couple days and I'm good to go. When I see light pink or no change at all, my heart aches, because it means that there are no ketones available for my brain to use as fuel when my glucose level goes down. When I picture my brain cells going without fuel, I know that's too high a price to pay for a bit more steak than I know I should eat or a single slice of pumpkin pie on Thanksgiving.

    ReplyDelete
  6. Ready to read parts 2 and 3! After losing 50 lbs I'm not losing any more.

    ReplyDelete
  7. Thank you for posting this! I say ALL the time...ketosis does NOT equal fat loss! I will be at the conference next week :)

    ReplyDelete
  8. Hi Amy.

    The reason you feel great is norepinephine levels go up. Try fasting, they go up more.
    Feeling great is a nice thing, well a great thing actually and high ketone levels carry great benefits. But, and there is always a but...right? You can be a candidate for adrenal fatigue or thyroid problems. So glad you feel great but as always listen to your body.

    ReplyDelete
    Replies
    1. Yes, I most definitely have thyroid problems. (Guess you haven't stumbled upon me mentioning that yet, even though it looks like you're going through all my posts like a speed-reader!) ;-)

      Delete
  9. I think I may been a candidate too, although I was never diagnosed, I guess because I never went to see the doc. I used to be a coffee hound, 15 to 20 cups/day and always high stress jobs, plus inter racial marriage (try that for stress) and raising kids and constant travel. Plus I used to hit the booze pretty hard, especially on road trips. I remember I burned out once, took me over a year to get back. But all's well that ends well. Looking back however I would definitely have done things differently.

    ReplyDelete
  10. Hi Amy,
    Great post as always. I eat a high fat, moderate protein and low-carb diet (carbs coming from veggies and a small amount of fruit only) and can easily fast for 16-20 hours without any issues other than sometimes feeling a bit peckish; so I would imagine I am fat adapted and possible in ketosis fairly often. But hey; I can still put on weight in the form a belly fat and thunder thighs without even trying! Oh the joys of being a menopausal woman!

    ReplyDelete
  11. I am "fat-adapted" on a potato diet as well. No need to eat high fat. To be fat adapted, all you have to do is to be alive. Fat is used all the time as energy. Depriving yourself of dietary glucose is ludicrous. All you need to do to lose weight is to eat less and / or be active so that your energy balance is negative. You can achieve that by eating carb sources as well such as potatoes without adding anything to them. The "fat-adaptation" myth is just that, a myth.

    ReplyDelete
    Replies
    1. Absolutely. I fully support people finding what works for them. I certainly believe there is no one-size-fits all approach to this, and I try not to get dragged into zealotry from any side. And potatoes are plenty delicious...especially the purple sweet potatoes! Oh, man...delish. http://www.tuitnutrition.com/2015/06/keto-carbs-stop.html

      Delete
    2. How I envy you.

      I love mashed potatoes but dare not touch them (glucose spikes and insulin too). So your solution is calorie restriction "All you need to do to lose weight is to eat less and / or be active so that your energy balance is negative." How do you square this with the fact that calorie restricted diets simply don't work? The overwhelming majority of people on calorie restriction eventually give up and any weight lost is regained. Calorie restriction induces two metabolic responses, reduced energy output and increased hunger

      https://intensivedietarymanagement.com/category/lectures/the-aetiology-of-obesity-lecture-series/ see part 1.

      I'm glad it works for you, sadly not for anyone else.

      Delete
    3. Way to assume everyone is the same.. I did what you suggested.. worked out and eat moderately and healthfully but for 7 years I failed to lose weight. After 3 weeks and becoming fat-adapted I've lost almost 10 pounds and I'm working out too with weights so it might even be more bc I'm sure I gained muscle weight. (but also some lost is water but that's cool.. I bloat too easily)

      I think everyone has their own perfect way to eat that suits their body's needs.

      Delete
    4. "All you have to do to,lose weight is eat less and or be active".....not true for everyone!
      I spend 9-10 hours in the gym every week, run 3 miles a day and,l was eating lean protein, complex carbs and veggies with proper portioning for two years and didn't lose a pound. I started the keto diet and lost 21 pounds in the first three weeks and now that I'm fat adapted I am steadily losing still

      Delete
  12. Amy what happens if I have 2-ketogenic meals and 1 non-ketogenic meal every day? I know I will not be in ketosis so I won't burn fat as my source of fuel. But will the 2 high fat meals per day negatively impact my lipids by increasing my cholesterol and LDL? Is it better than having a slow carb diet?

    ReplyDelete
    Replies
    1. Only one way to find out! (Honestly, though, this basically sounds like Carb Backloading, so it can be effective, but it is *very* context-dependent. I wouldn't recommend it for a sedentary person trying to repair years of metabolic derailment. For a bodybuilder? Maybe.

      Delete
  13. Amy,

    very useful three pages. However I do have one area which still isn't clear.

    Being "fat adapted" presumably means that your body has switched to being able to burn fats as a primary energy source. If you are doing this then I assume also that the "fat energy" is being burned as ketones, and these ketones are being transported around the blood stream to the brain. [I'm not sure if the muscles take in fats from the blood stream and burn them directly.]

    So if you are fat adapted - for example you can exercise vigorously for a couple of hours in the morning without eating any carbohydrates beforehand - I assume that there must be some level of ketones in your blood stream at all times. However ketones showing on Ketostix (or keto breath) indicates that your body has too many ketones in the blood stream and is getting rid of some. So the lack of colour change when testing may just mean that your body is in balance and isn't throwing away a potential energy source.

    It would be good to see some testing with Ketostix and a blood ketone meter to show what the levels of ketones in the blood are when the urine test isn't showing ketones.

    ReplyDelete
  14. So grateful for this article! My ketones have been very low but I have not had the craving s either. .I have most of the benefits of being fat adapted. .been doing keto x 2.5 months. My only concern is I just don't seem to have the limitless energy others talk about. I have been working 50 hour weeks with excessive stress for the last several months. .not sleeping well at night. Just would like to have the energy. .do have the mental clarity. The appetite is decreased. Cravings gone. Etc..just this one thing. .

    ReplyDelete
    Replies
    1. Glad my blog has been helpful. :)
      Based on what you've said here, I'm not surprised you're not bursting with energy. The ketogenic diet is not magic, despite what other people might claim. It is very powerful in a number of ways, yes, but it can't "undo" the fact that you work 50 hours a week, have excessive stress, and don't sleep well. At least you're experiencing many of the *other* benefits of eating this way, but, sadly, it ca't fix *everything,* y'know. ;-) You can't "out-keto" a very stressful life and chronic sleep debt. Try to work on those other issues to the best of your ability. Easier said than done, I know, but don't look for a ketogenic diet to fix your entire life.

      Delete
    2. Honestly I don't even bother with ketostix.. haha I eat keto-friendly as much as possible and exercise regularly and drink plenty of water.. and the weight is falling off.. so I don't even bother with the stix. Whatever the levels are, they're working :)

      Delete
  15. GARRR. I've been fasting 48hrs+ (black coffee and water with a few drops of lemon juice, ONLY) Ketostix negative everytime. I shouldn't be keto adapted, since my diet has always been HCLF. I understand, trust me, the theory, use and limitations of Ketostix – I've read enough dismissals of this testing device. It is still frustrating never having had a concrete confirmation that my body is making ketones adequately enough to generate some detectable ketonuria! That's all I desire, folks, a touch of confirmation, a smidgen of affirmation – is that too much to ask?

    I'm weighing, seriously, ending this fast I'm on (when I do, in a day or two) with a tub of butter. Just in hopes of getting some purple on the 'stix, provoked by my ketogenic piss.

    ReplyDelete
    Replies
    1. ...Or, you could get a blood meter. After a 48 hour fast and already being low carb for a long time, I would imagine your blood ketones would reflect elevation, even if your urinary acetoacetate doesn't. I'm not necessarily recommending a blood meter -- if anything, I would recommend just chilling out about this -- but if you really want to see what your body is doing, the blood BOHB might be more interesting for you.

      Delete
    2. Fasting after 24 hour decreases the value, no reason to fast moe than 24 hours at a time.

      Delete
  16. Hello Amy,

    I am trying to find any info on the impact (if any!) of following a ketogenic diet on secondary adrenal insufficiency. Should you be able to point me in a direction, my gratitude to you. I keep reading that keto diet is no good for people with adrenal fatigue (which to my rather limited knowledge is not SAI), so I got worried. Like you, I got thyroid issues (pre-keto) and I can honestly say that eating the keto way has given me my old self to quite a degree (pre-thyroid issues). So I'd really like to keep at it, with a clear conscience that I'm not burning down my adrenals.

    Great article, congratulations. It's great on so many levels, many of which I haven't considered before.

    ReplyDelete
    Replies
    1. Hi there,
      I don't know much about about SAI, so I can't comment intelligently on this issue. Do you know what your adrenals are being insufficient secondary *to*? Meaning, *why* are your adrenals not producing adequate hormones? (Cortisol, I assume. Have you actually had it tested, or are you going by assumptions based on your symptoms?) It's hard to comment without knowing what else is going on with your endocrine system. It's obviously not only the adrenals, since this is "secondary" to something else. (Something else is out of whack, and the adrenals are getting "messed up" as a natural response to whatever that other thing is.)

      Delete
  17. Loved this post. I "feel" all the symptoms of fat burning, but ketostix say I don't have ketones in my body. Thank you for a great article. Informative ❤

    ReplyDelete
    Replies
    1. No, the beauty of this is that the ketones are in your BODY, being USED, so you don't have to pee them out! Remember -- the ketones measured in urine are being *excreted* -- meaning, your body did not use them for fuel. You're almost better off *not* having very dark keto strips. If you're experiencing the many benefits of a low carb diet, don't let the ketones (or lack thereof) psych you out.

      Delete
  18. Hello! Im a 5'11 male, 190lbs with about 23% body fat! How much carbs per day should I eat for maximum fat loss? Do I need to eat fruit before and after weight lifting sessions?

    ReplyDelete
    Replies
    1. Fruit nit necessary.
      For best macros, see here: https://ketogains.com/ketogains-calculator/

      Also check out the KetoGains Facebook page. They are #1 in this area.

      Delete
    2. Im sorry but ketogains is macros for keto, not low carbs? Im not sure how it will help me determine how much carbs can I eat to be low carb and fat adapted vs keto

      Delete
    3. You asked specifically for "maximum fat loss." If you use the KG macro calculator and set your goal to fat loss, choose a good-size caloric deficit, I think those numbers will help you. It has less to do with the carbs, maybe, and more to do with limiting dietary fat a little bit if you are looking to get shredded. If you are trying to lose body fat -- especially if you don't have a ton to lose in the first place, then be very careful with added isolated fats -- butter, cream, MCT oil, etc. You want your body to have to tap into your own body fat stores, so loading up on fat is counterproductive for that goal. Protein is your friend, keep carbs low. I'm sorry I'm not more helpful. It just sounds like you would do well with that calculator -- you can toggle the carbs a bit higher if you like. They're not set amounts. You can increase it manually. As for how many, EXACTLY, you can eat and still get "maximum fat loss," I can't say with certainty. My apologies.

      Delete
  19. Hi Amy

    I’m 47, male, 6'7" and 264 lbs. I would say that I'm overweight by about 40 odd pounds. I started eating the keto way 3 months ago when I was 282 lbs. I determined my macros and tracked everything in an app. I have lost about 20 lbs but I'm now stuck in a 3-5 lbs band for the last 3 weeks or so. The weight goes up and down but doesn't go below my lowest so far (264). That said, I can confidently check of all the boxes in regards to one should feel when fat adapted (I can easily go 18+ hours without eating. I have steady energy and I'm never hangry and gravitate towards the fatty stuff when I eat). I have also lost several inches off my waist and have started wearing clothes several sizes smaller. I didn't let the stall get to me and even started with intermittent fasting over the last 2 weeks but no luck. Then I got the Precision Xtra last week and the best ketone reading I got on that over the last week is 0.4. Blood glucose is in the normal range. I would like to get past this plateau and experience real fat adaptation since I don’t know where the heck I am right now : - ) Should I reduce protein intake from under 1g/KG? Increase fat? Do a multiple day fast? Try and jump start ketosis somehow? I love the loss of inches but I'd like the scale to move just a wee bit every once in a while. Thanks in advance.

    ReplyDelete
    Replies
    1. Hi there,
      (I would address you by your name, but I don't know what it is. And I don't want to call you Locomotive breath, haha!) This is a lot to unpack here in the comments section. Please email me privately and I'll be happy to give you some advice. (I have many thoughts for you, none of which involve you worrying about being in ketosis or going to extraordinary lengths to do it. Stop measuring your ketones. Total waste of your money!)

      Look for the "Contact me" section in the sidebar on the right of my website. Send me an email -- you can just copy & paste what you've written here if you want.

      Delete
  20. Amy,

    This was a great read. I have been using exogenous ketone supplements for just over a month. They have put me into ketosis for sure but I have no weight/fat loss to show. I do, however, have energy, appetite reduction, and great mood which I did not have before without the help of other supplements. I thought maybe I was just imagining things. Based on the cravings I've been having, I think my body is trying to get into a fat burning mode, but I'm just not quite there. Thanks for the insight.

    ReplyDelete
  21. I have a question. I am in my 2nd week of keto, and I will never look back! It’s been awesome. But I know, some point in the future...not anytime soon, but like during a holiday, the chance of me having an off, carby day will come. Once you are fat adapted and you have been keto like, 6 months, and you have a carb day...does that knock you off your game and do you have to start over? I do not plan on ever having “cheat” days...this change is a lifestyle change for me and one I have decided that i can do easily. But I also want to know how the body handles these mishaps. Is a very rare indulgence so bad that it ruins what your body has adapted to?

    ReplyDelete
    Replies
    1. Hi there, this is a good question, and it's funny you should ask, because I have a blog post coming up about THIS EXACT ISSUE. :) It's already written, but I'm not sure when I'll post it. (I have others that I think I might post first.) If you'd like to read it before then, feel free to send me your email address and I'll email you a copy. (You can use the "Contact Me" form in the right sidebar of the blog, or email tuitnutrition (at) gmail (dot) com.

      The short answer to your question, though, is NO. Once you've been fat-adapted for several weeks or months, one "treat" meal or "cheat" meal really, truly, isn't the end of the world, and it does not undo all the progress you've made during all the time you were low carb/keto. A treat meal or treat day will put you out of ketosis, yes, but only temporarily, until you've used up that carbohydrate and back to running on fat. (It does NOT undo fat-adaptation, though.) So unless you have a serious medical *requirement* for remaining in ketosis constantly, 24/7, indulging *once in a while* isn't really a big deal, as long as it's kept to only occasionally. Some people have to stay strict simply because one little taste of something is enough to send them off the rails for several days, weeks, or even months. But if you're the type who can have whatever your favorite thing might be, enjoy it, and then move on and go right back to low carb, it's not a problem.

      Delete
  22. Thank you so much for answering that. I have had a hard time finding an answer. And I would love to read your blog post about that. I’ll send you an email requesting it ☺️ Thank you!

    ReplyDelete
  23. Hello again! Thank you sooo much for the email...the info was so helpful! And now I have another question!

    I’m in about 3 weeks now with the keto diet. And still not looking back. A few things I’ve noticed and wasn’t sure if they were anything I needed to be aware of. So my first week keto, other than the 2nd and 3rd day of Keto flu, I noticed I was barely hungry. I had to make myself eat for breakfast and I wasn’t dying to eat at dinner either. I was hungry, but not so hungry I couldn’t think about what I wanted to eat. Into my 2nd week, I noticed that, even though I’m still not “starving”, I definitely eat 3 meals a day and a snack to boot. I track my food in MyFitnessPal, mostly just so I can see what my normal eating habits are turning into. I’m not denying myself food when I’m hungry, though I do pay attention to when I’m getting close to my carb limit. Is the increase in appetite something to watch for? I stay well within a 2,000 calorie diet...and stay at or below 25 grams of carbs. Is the increase of appetite maybe my body just adjusting to the new eating habits? Or is it a sign that maybe my carb intake was so low at first, and now that I’m edging closer to my limit that my body is getting little carb cravings back? I’ve stuck to all keto friendly foods, and I do jog every day...roughly 20k steps a day. I drink plenty of water and, per my keto stix (which I know are not always to be relied on), I’m in ketosis. So, I truly am not too worried about this, just wondering if the increase of appetite is something to watch.

    Also, and I’m prepared for the possibility of you not being able to answer this, but also...I have noticed on my MyFitnessPal, my carb intake goes up! So I track my steps with my fitbit, and my fitbit sends the steps to MFP and lets me know how many calories I have left each day. I have set MFP to focus on my macros, so at the top of my app it shows how many calories and each macro I have left. So as I excercise throughout the day, my macros increase. I haven’t overstepped my 25 grams of carbs each day, but I was also curious if that should be ignored or if when we burn more calories each day, if that carb goal is increased as well. I am comfortable eating within my 25 carb grams, so even if the increase is ok I dont think I would want to go over it. Just another thing that I was wondering about!

    ReplyDelete
  24. I just want to know, how to begin reading the process on the stick thingy. All this information is so confusing to me. I think I was born fat adapted as I force myself to eat. But I need to lose 47 pounds from wrong foods. BUt I need someone to help me with a 1. 2.. 3. this is what you need to do in these certain steps. everything seems to be so much reading to learn to do step one, step 2 and step 3. thanks for help

    ReplyDelete
    Replies
    1. I'm not sure what you mean y "the stick thingy." Are you talking about a ketone test strip? It sounds like you are not sure where to start with a ketogenic diet. Read this. I think it will help you: http://www.tuitnutrition.com/2017/12/start-with-atkins.html

      Delete
  25. I am so glad that I stumbled across this!! Finally keto in a language I can understand.

    ReplyDelete
  26. I am so glad I stumbled across this. Finally! Keto in a language I can understand.

    ReplyDelete
  27. Several years ago I lost 30 pounds in 3 months on a pasta & chicken breast diet plus a can of chicken noodle soup. I was in a caloric deficit and after day 3 had no appetite and had an altered euphoric state of consciousness. This sounds like ketosis but I don't see how it could have been with the 150 or so carbs I was ingesting daily. I was wondering what the explanation might be for this. Thanks.

    ReplyDelete
  28. Hi

    I am in ketosis with dark purple colour but weight is stalling , how should I been fat adapted
    need suggestions

    ReplyDelete
    Replies
    1. If you're in ketosis but not losing fat, then you're likely consuming too much dietary fat. Cut back on the added fats in your food and let more of that fat come from your own body stores: http://www.tuitnutrition.com/2017/08/how-to-cut-fat-on-keto.html

      Delete
  29. Question: if you are in a complete carb deficit, say around 10-15g p/day and fat adapted, would you then also have a higher ketostix reading? This is just out of curiosity. I know I am fat adapted, it happens super fast for me but I am also pretty high on the keto meter.

    Thank you for this article. It’s unfortunate that there isn’t a test we can take for far adaptation as well. That, the body does not provide internal, chemical or hormonal clues. But, I suppose reading your changes is great, too, as you are learning to listen to your body more and be in tune with your own system, since You ARE the one fine tuning and wiring yourself.
    Thank you for taking the time to write this blog.

    ReplyDelete
    Replies
    1. People's ketone levels vary. Some people will have high ketone readings, while others are almost always relatively low no matter what they do. High ketones are not always "better," and having low ketones doesn't mean someone is doing something wrong or is not fat-adapted and running on fat. I think this will be very educational for you: http://www.tuitnutrition.com/2017/09/measuring-ketones.html

      Delete
  30. Great tips! I really love the keto diet and I've made a lot of progress in changing my eating habits in the past year.

    One thing that really helped me get started was having access to a quality ketogenic diet cookbook.

    Recently I found one that offers 148 ketogenic recipes complete with meal planning tips.

    It also provides you with handy list of high-carb foods to avoid and advice on how to neutralize your cravings for those foods.

    The recipes are amazing and there's enough recipes there to keep you from getting bored with your diet.

    I highly recommend it.

    Just click the link below to get instant access:

    http://clickmeterlink.com/ketocookbook

    ReplyDelete
  31. Hi Amy,

    This article has been super helpful. I'm in the middle of training for a marathon. I started out strong with keto in May and June, made it through the first few weeks of running with no energy and broke through feeling like superwoman. I'm assuming that means that I'm "fat adapted"? I'm wondering if I eat carbs before a run, or if I carb-load before a race, what kind of impact that will have on my "fat adaptation."

    Do you have any experience with this or any resources you've found that talk about how to handle intense physical activity and performance while on keto?

    I'm also just curious how quickly do you fall out of being fat adapted without the intense activity component? If I go on vacation for a week and eat french fries, and ice cream, am I going to mess it all up and have to start over? It all feels very elusive and uncertain.

    Thanks in advance! I'm excited to check out the rest of your blog.

    ReplyDelete
    Replies
    1. Hi Devon,
      Regarding athletic performance and keto, I recommend the book "The Art and Science of Low Carbohydrate Performance," by Stephen Phinney and Jeff Volek. They've been researching keto for athletes longer than just about anyone else on the planet. Many endurance athletes find they do just fine without carb loading at all, but some choose to "train low, race high" -- train on very low carbs, but add back in some carbs before and/or during a very long endurance event, or maybe on some of their longer training runs. Athletic performance is not my area of expertise, but I know of keto endurance coaches who can help you if you'd like a referral.

      As for going on vacation, throwing caution to the end, and eating whatever the heck you want for a few days, unless you have T2 diabetes or some other serious medical condition, it's honestly not that big a deal as long as you get back to a better diet once you're home. See here for a post I wrote about this issue (links don't work in the comments here, so just copy & paste this into your browser) -- http://www.tuitnutrition.com/2018/03/lowcarb-cheat-meals-.html

      Delete
  32. love the article, unfortunate title. Ketard? *sigh*

    ReplyDelete
    Replies
    1. Several people have called me out on that long ago. I changed the title of the post, but I am not able to change the hyperlink, because it has been linked to many times over in various places, and if I change the hyperlink, none of those links will work. Rest assured, though, you are not the first to take me to task for this, and I won't use the term again.

      Delete
  33. I have been trying to lose weight for about 2 wks now with the Keto plan. Before that, for about 4 months I was high protein and lost about 20 lbs. Since I started Keto, I have been "stalled." Therefore, I started researching how to best do keto. Well, I did pee quite a bit but only the first couple of days.... NOW, i almost pee none at all and we're going on about 2 weeks, while tweeking to lower protein, carbs are about 10%, and i added LOTS of things i wasn't having before: bacon, bacon, bacon,... no nitrates, pink himlayen salt (cause I was getting migraines), cococnut oil in my coffee, trying to drink more water. Test strips say I went from trace (sorry - i read your posts and not being compulsive on the test strips but i'm needing SOME KIND of feedback) to moderate for the past couple days. My ATTITUDE STINKS - been very low emotionally, negative,... etc. (not my usual nature)and quite wide awake at night (even though I'm usually a night owl, too), but have bad brain fog - that's been me anyway on hi carbs. I'm rambling, I know, and here's where I'm TRYING to stay on food: 10% carb, (now) 20% protein, the rest fat sources (avocado, bacon, chicken, some red meat, fish, nuts/seeds). I think the added fats maybe made me go crazy over on the calories and sometimes my calories are minimal and have to force myself. I swell with all this added salt (my usual intake is about 1,000 mg/day - any thing more like restaurant food makes me swell for a week). My legs hurt, I'm dragging on energy, yet can't sleep at night. I am MOSTLY concerned that my pee is almost non-existent (after LOTS of pee first few days) and even though I'm doing some workouts (resistance training and swimming) my scale is stuck. Went from 263 to 233 on hi protein/low carb in 2 months. wanting to keep going on keto, need to lose another 80-90 lbs and heading on 60 years old. Thanks so much for tolerating my rant. I hope this post goes through - I'm not tech-savvy. ~ Shannon

    ReplyDelete
    Replies
    1. Hi Shannon, are you asking for help? I can't give personalized advice for a complex situation here in the comments section of my blog. If you're interested in a private consultation, please contact me via email. (Contact me form is on the right if you scroll down on the blog.)

      Delete
  34. Thank you for this! You had me laughing out loud with tears running down my face. My favorite line: "What keto strips will NOT tell you... Your worth as a human being". Great stuff, much appreciated. Let's not forget that laughter is the antidote to many ills

    ReplyDelete
  35. I love this blog. Much great Information.
    I have a question: Can i get fat adapted, without staying in ketosis for some time.
    Maybe when i start eating High fat/High Protein no carbs .....

    ReplyDelete