Nutritional Ketosis is an Oxymoron

This is going to be a rather short post, and I'm not going to reference it.  I simply don't have time.  (As always, feel free to contest any claims you feel are erroneous in the comments.)  But something has been bothering me for a long time about the whole nutritional ketosis thing, or what I call NuttyK, and I just couldn't put my finger on it.   And then it hit me, as I was looking into the buffalo hunting thing ...

Humans likely do have a long history of being in ketosis for periods of time.  Ketosis ... as in the metabolic adaptation to starvation to preserve lean mass and reduce glucose consumption by the brain by providing a fat-derived alternative fuel.  These humans were in prolonged periods of caloric deficit without a "need" to be ... in other words they weren't overweight dieters getting most of their energy from surplus stores.  They were in starvation ketosis.

Humans around the globe have historically subsisted on the foods available to them.  It is rather interesting when you think about it, how different these diets can be for groups of humans who have settled even in very close proximity to one another.  While trade may not have always had a positive impact on the health of various populations, humans seem to be an eager bunch to do so, rather than to starve or even settle for monotony.  There is little allegiance to dietary purity in the face of starvation -- except for a few religious martyr types -- throughout the course of human history.

The plant v. animal subsistence seems to be largely (but not entirely) dictated by climate, with popuations at higher latitudes consuming more animal foods with a shorter to non-existent "growing season" for edible plants.   There are also various patterns based on terrain and such.  While there are apparently no strictly vegan populations, there are some nearly-vegetarian ones, and while there are some populations that are nearly, if not entirely, carnivorous seasonally, there exists none purely animal-consuming either.    In some regions, the scarcity is water, in others it is food.   While Jared Diamond claims agriculture is the biggest mistake in human history, his ideas are premised with some misplaced idea that hunter gatherers were a leisurely bunch, picking and choosing from year round abundance of preferred dietary staples.  Not so.

Sticking to North America, native tribes, especially in the north, suffered periodic if not seasonal stints in starvation.  STARVATION ketosis.

These would have been alternated with periods of being replete with nutrients, perhaps the occasional feast, but almost invariably including sufficient carbohydrate and calories so as to be nowhere near ketosis.

Most of these tribes expended a great deal of effort in preserving foods for the impending famine.  One might even say it was an obsession.  Preserved foods included animal fat tissue, which for the land mammal hunting tribes was NOT a year round abundance, or even a guaranteed seasonal abundance.  Why would anyone presume that other animals were somehow exempt from seasonal famine and hardships (doughts, floods, heat/cold waves, etc.) that humans endured?   

Pretty much EVERYWHERE in the literature you see references to starvation = presumed ketosis.  And in periods of abundance (not late winter-early spring) you had carbs = no ketosis.  Pretty much NOWHERE do you find examples of nutritional ketosis.  

Nutritional Ketosis is an oxymoron and NOT part of the natural human condition.


charles grashow said…
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Eight thousand years of natural selection in Europe
Shedding light on
Nina Jablonski explores how it evolved—and what
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Gordon said…
It isn't only carbs that will kick you out of nutritional ketosis as defined by the ketiots, even a moderate protein intake will do it, too. Eat an all-meat diet, and you won't be in nutritional ketosis either. Not even close. Our best evidence shows that the Inuit were not in ketosis because of protein. Another piece of evidence that ketosis is a temporary back up mode for humans is that gluconeogenesis is so poorly regulated in the absence of insulin. Were it normal to be in ketosis with adequate calories, that feedack loop would work a lot better ...
carbsane said…
Exactly! The Inuit ate a roughly 55% fat to 45% protein diet to which they are apparently adapted, and/or the nutritional content of rotting raw seal flesh is not quite that of prime rib and butter. (e.g. glycogen content, organic acids that are "carb like", etc.)

It's pretty clear that the Inuit weren't in "nutritional" ketosis, though they may well have been in starvation ketosis from time to time (especially late winter - early spring).

The NuttyK's love to claim others are stupid and don't understand the difference between ketoacidosis and ketosis. They then try to convince folks that the presence of ketosis in starvation means ketosis in a eucaloric state would have been the norm or at least commonplace.
billy the k said…
"Nutritional ketosis is an oxymoron..."

While I agree that ketogenic diets are, as you say, pretty much commonly found
nowhere, it doesn't follow that "nutritional ketosis is an oxymoron." During fasting—or starvation—the body consumes a metabolic mixture of constituents, comprised, as we all know, primarily of fat and protein derived from endogenous sources. If one supplies this same caloric mixture with an exogenous caloric mixture of similar nutritional composition, then the ketotic state will now be maintained without requiring any starvation. When one is getting calories and nutrients exogenously from food, then it's not, I think, a combination of contradictory words—an oxymoron—to say that such a person's ketotic state is, in fact, a case of nutritional ketosis. While the internal metabolic state—compared to a normal carb eater—certainly doesresemble that of fasting, the person is of course NOT fasting or STARVING at all,—but rather is EATING FOOD.

Indeed, it was just this point that gave Robert Atkins the idea for his original low-carb diet, that he later worked up into his first Diet Revolution book. He said he was going through the medical literature looking for an easier way to lose some of the weight he had gained, and came across Walter Bloom's 1963 paper in the Archives of Internal Medicine:
Similarities of Carbohydrate Deficiency and Fasting. Archives of Internal Medicine; Vol 112, Sept 1963; p 87-97.

Part 1:
and Part 2:

The second diet that Bloom used in this study: ~2000 calories:
Breakfast: 2 eggs and 2 strips of bacon fried in 2 teaspoonfuls of oil.
Lunch: 8 oz of steak fried in 2 teaspoonfuls of oil, and lettuce, tomato and cucumber salad with one tbsp of oil dressing.
Dinner: Dinner was the same as lunch.

There was the start of the Atkins Diet, the induction phase of which, like the meals in Bloom's study, produced a ketosis without starvation,—i.e., "nutritional ketosis." N'est-ce pas?
carbsane said…
Aww cut me some slack on poetic license here. :-) I get your point, but the idea of nutritional ketosis (as a natural and/or common metabolic state) is not "normal"
billy the k said…
Hey, I'm right with ya, Evelyn,—certainly insofar as ketogenic levels of carb restriction being not "normal", in the sense of (as you aptly put it) "commonly found nowhere". I just think that the terms "oxymoron" & "not normal" can have a way of ssuggesting somewhat of a physiological insanity on the part of those experimenting with ketogenic diets, when that term would be more appropriate for, shall we say, "fruitarians", or,—heaven forbid—"breatharians".
Vikram said…
I think the nutritional comes from the fact that the ketosis is supported through the nutritional choices of the person (macro breakdown of 80-85% fat??).

I tend to think Keto gets a bad rap - certainly has some use for medical conditions and it does have quite a cognitive boost on some (for me at least). There's no way I could do it for more than 2 days - pesky carbs got in the way.

By the way, I hope the term NuttyK goes viral or catches on - I catch myself using it from time to time and people are like "What? What did you just say???".
carbsane said…
LOL I love NuttyK :-)

Yeah it is nutritional choices, but in caloric deficit, the macros (past carb restriction) don't really matter. While some are doing this for weight loss (well, let's face it, most are doing it for that reason) , the idea behind it is for performance, disease treatment, prevention, etc. A chronic weight maintaining ketogenic diet doesn't really exist for long. It is damned hard to keep it up, and therapeutic diets are higher than the 0.5 mmol threshold assigned by V&P.
Kitty said…
Starvation explains all the terrible side-effects of "nutritional ketosis." In a famine, it's good to be lethargic, slow your metabolism and - especially if you are female - lose your libido and have insomnia.

There's a lot of talk about how low-carb diets are worse for women, and when viewed as starvation, it makes perfect sense. Women's bodies have evolved with more famine protection, since they carry and care for offspring. I read a study about starving rats where the males had increased libido and slept just fine, since they needed to just mate and die to carry on their genes, but the female rats lost their libido and had insomnia.
carbsane said…
Interestingly, when I wrote the 11 Unexpected Things post, I received lots of feedback from young men in regards to losing their libido on long term VLC.

Nutritional ketosis is confusing to the body at a minimum. Even Feinman knows this, but he ignores it as he promotes LC as the bee's knees of diets. Very early on in blogging I linked to this paper Carbohydrate restriction regulates the adaptive response to fasting
( ) Over the long haul you've got a body that thinks it's in conservation mode and under duress but it's being fed perhaps even hypercalorically.
LWC said…
In your reading, have you ever found evidence for a starvation effect on thyroid function? (Or maybe you'd already blogged on it and I missed it?)

In that woeful diabetes summit appearance, Moore specifically pointed to his thyroid panel. In an upcoming Paleo conference a woman presenter is going to make the case that women should never VLC, and my guess is the reasonings going to be related to thyroid function (dysfunction).

Hashimoto's syndrome is something I've only seen discussed in LC sites, mostly by female sufferers. Vegans and fruitarians have issues, but Hashi's doesn't seem to be one of them.
carbsane said…
The number of women with Hashi's in LC communities is frankly rather frightening at this point. And you're right, though I haven't spent much time in other circles, I do have friends in these communities and do not see this in high carb circles.

I looked into this a while back w/o blogging specifically about it, mostly because what I found was regarding starvation, caloric restriction, etc. So you get the Jimmy Moore retort like from that diabetes summit, that it's not relevant if you're not hypocaloric. But it seems to happen irrespective of weight loss. In fact some who are recently diagnosed are gaining weight on keto when it happens.
Emmie said…
The number of women with Hashi's in LC communities may simply be a function of the fact that these women are trying to lose weight, and Hashi's (hypothyroidism in general) makes it more difficult.

I've had Hashi's for about 20 years, long before I ever ate low carb, and I know other women with Hashi's who eat the SAD. My endo says there are NO scientific studies that correlate hypothyroidism with diet. Certainly Hashi's, an auto-immune disorder is about as likely to be the result of low carbing as MS, Lupus, or other auto-immune diseases.

In fact, it's been pointed out that a naturally lower T3 among low carbers is simply due to their reduction in triglycerides--making it less necessary for T3 in the body. Scientists were somewhat surprised at this discovery, but it also affirms a long-known fact--that the healthy body self-regulates as needed.
albie_cilliers said…
iIt's been pointed out... "

Really ? By whom ? What ? It seems that you don't really understand all what T3 actually do ?
carbsane said…
I'm specifically referring to the numbers of new diagnoses. I've always wondered if the high rate is due to selection bias for those who might try LC for weight loss, but there are many cases like Mrs. Moore's out there. I also noticed lots of folks on meds needing to up them on LC which seems contradictory.
Emmie said…
As someone who requires supplemental T3 (Cytomel) for survival, I am quite aware of what T3 does in my body. The deficiency I experienced when conversion problems (characteristic of Hashi's) first surfaced caused quite dramatic symptoms.

If you Goggle The Ketogenic Diet for Health, you'll find that the O'Hearns have a rather extensive analysis of T3 and ketosis, which is well documented with specific scientific citations. I have read their basic these elsewhere but have never seen it presented this thoroughly.
albie_cilliers said…
True. What most seems to forget, or don't know, is that in order to be in ketosis, the body needs to be in a certain hormonal state to enable this. This is a stressfull state where catabolic hormones like cortisol and adrenaline, etc are elevated. The long term effects of this stressfull state have many "side-effects" in many people in different ways. I don't think the human body is meant to be in "starvation" mode for long perdiods of time without negative metabolic or other effects like thymus, thyroid and/or other organ / tissue size reductions.
albie_cilliers said…
I stand by my original observation. I don't think you really understand all that T3 do, and saying I need to read the "analysis" of someone selling a book on Ketosis needed for health (!), just confirms my point further.
Emmie said…
Believe what you want; it's obvious that facts won't affect your bias.

And just for the record, I suggested you read a "blog post." It's free,and no one is selling a book.

Please don't bother responding to this, as you comments are not worth my time.
albie_cilliers said…
I always find it amusing when someone takes the time to post comments and then say to others to not comment because it's not "worth their time" How ironic.

And just so you know. I am well aware of the ketotic blog. I had to point out to them one time how they missed the "obvious" facts of retarded growth in children of ketogenic diets ...

I have no bias. I believe in science and facts only. I have been on both sides of the fence. First when ignorant like you and most LC'ers and then later when I learned the truth and regained my, my wife and my children's health. Viva Sugar, Viva !
Andre5001 said…
Somewhat ironically, you are getting very little nutrition when 80% of your calories are fats.
carbsane said…
Good point!
StabbyRaccoon said…
Has Jimmy ever tried a diet where he actually met the RDA for all of the nutrients, particularly the ones that improve insulin sensitivity? I know he takes magnesium, well, that's something...
MacSmiley said…
Isn't weight gain typical for untreated hypothyroidism?
Hello_I_Love_You said…
Albie, I think you're on the same wavelength as me. The issue is that we're mislabeling the side effect of a VLC diet to be "Hashimoto's" when it isn't. It's been variously described as "Euthyroid State" or "Low T3 Syndrome" but those terms don't describe the phenomenon well either. It's a state of hormonal and immune dysregulation, not necessarily Hashimoto's, for which you usually need to be diagnosed with one of the 2 antibodies. But the state mimics hypothyroidism and people believe it's hypothyroidism, when you're actually euthyroid, i.e., your TSH < 5.0.

Then they claim that it's a T3 phenomenon when most such people are around midpoint or even in the 2nd quadrant. These people then claim that FT3 is what matters and that TSH doesn't tell anything. Read Chris Kresser's excellent expose of the phenomenon. It's not really about the hypothyroid.

It's a disease state induced by VLCing which mimics hypo symptoms like cold hands, low body temperature, dry skin, hair falling out, slow wound healing, etc. It's melange of hormonal and immune dysfunctionalities. The cold hands may not be from low T3 but from nascent Raynaud's, which is a sign of impending autoimmunity.

In Emmie's case, she may have been dx'ed with Hashimoto's proper before her diet. In such people, the low T3 may be a separate and independent phenomenon. The reason for the confusion is that both states respond to T3 medications like Cytomel and Armour; even Raynaud's respond to them. So they commingle them and say it must be hypothyroidism even though TSH is completely normal, even optimal. But I agree with Chris that this is a disease state that's possibly more deleterious than "mere" hypothyroidism and could lead to immune and hormonal issue down the road. Most people with such euthyroid states also have hypercortisolemia and immunodeficiency, like slow wound healing, low WBCs, Globulins, and declining immunoglobulins.
albie_cilliers said…
The problem with you type, that include the O'Hearns, is that you have confirmation bias and will latch onto any piece of info (I specifically don't want to call it evidence) to comfirm your fixed stated view. Imagine for a second what would the O'Hearns be without Keto ? ( By the way, Amber of Ketotic is a self confessed Bypolar, and who knows what she swallows everyday. But hey, you're welcome to think she's an expert on health )

Did I ever said that cortisol don't have any positive functions ? NO, I did not, but you WANT to read into it that I did.

You should do some proper research and study what the true professionals and scientists ( not celebrity bloggers) say about the degenerative effects of long term elevated cortisol and adrenaline levels and general stressed state in the human body.

Also, take a good hard critical look at some before and after pictures of people on longer term Keto diets. Apart from weight loss, they generally look like sh*t and show signs of accelerated ageing.

I can impress you too by citing pages of scientific references, but that will just put me on the same level as you.
billy the k said…
a. Amber was not the author of those published papers.

b. "I can impress you too by citing pages of scientific references, but that will just put me on the same level as you."
But you didn't say whether citing scientific references would thereby raise your level or lower it.

c. Did I advise you to stop proclaiming "Viva Sugar, Viva!"?
No, I did not. By all means, chow down as you think best.
albie_cilliers said…
“It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.” - Mark Twain
You just opened your mouth.
billy the k said…
Speaking again of "levels", I don't stoop to initiating personal insults.

And then there's my innate politeness and courtesy which prohibits me from responding in kind.

And because I have learned a great deal from reading Evelyn's postings—as well as from the comments and links posted by some of her many smart readers, I do try to have consideration for not wasting her time or boring those readers with a series of insult-exchanges that experience shows ends up being as lamentable as it is ludicrous.

Q. Did your personal insult here help to illuminate the topic at hand?'
A. No, it did not.
Neddam said…
I did a thing on cronometer before and you can meet every RDA on 80% fat if you are diligent. Liver helps, and an absolute load of non-starchy veg, which to be fair any right thinking LC advocate should recommend.
Catweazle said…
The centrally driven cortisol rhythm showed
a phase delay one and six weeks after dietary switch to LC/HFD as well
as an amplitude increase.

No wonder the lavidaman and all the other lowcarbers going nuts over the time.
Vikram said…
Yeah - I stayed in NuttyK about 2-3 days tops. I'm a failed bio-hacker!
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