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Why do people consider ketosis "stressful" to the body?

by (18671)
Updated about 1 hour ago
Created March 01, 2011 at 1:36 PM

I've been asking people this in comments whenever it comes up, particularly in discussions of adrenal issues, but no one seems to want to answer. The only idea I can think of is that there is an assumption that gluconeogenesis is stressful. But why would that be? The body is breaking down and building up different substances constantly. And it's not like consuming glucose gives it to you for free. It still has to be digested and broken down.

I realize that the zeitgeist has changed recently regarding ketosis. Paul Jaminet considers it a powerful tool, but with costs, such that one should only use it if necessary for its therapeutic value. He has written extensively about his ideas as to why it may be dangerous, but though I deeply respect his experience, knowledge, and contributions, I don't find his arguments compelling. They seem to be based on anecdote, followed by much thoughtful speculation on plausible mechanisms. This is very valuable, but still hypothetical, and it's important to carefully distinguish hypothesis-forming science from evidence.

Kurt Harris has lately roughly quadrupled his own intake of carbs, I infer because he judged it to be affecting his energy levels when highly active, and now states that one shouldn't be in ketosis all the time. Presumably, like Jaminet, he would make an exception for those who are deriving specific important benefits. Of course, he owes no one a justification, but I would like to understand his ideas better. There are plenty of people who report feeling more energized in ketosis, and even some of those who do find they need a carb boost for high intensity exercise (which again, isn't everyone) can often get by with as little as 30 grams targeted at the right time.

Personally, I am one who needs the therapy, so it isn't a question for me of whether stay in ketosis, it's a given. But the more I research it, the more natural and health-promoting it seems to be. I'm not finding evidence of it being stressful to the body. If there really are significant costs, that are shown by actual evidence, I'd like to know about it. I'd also like to hear more about where people are getting the idea, that for instance, if you have cortisol regulation problems, ketosis is too stressful, or other sources for people to hypothesize that it might be a problem, other than the two above.

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4086 · September 07, 2013 at 1:28 AM

fantastically worded question Ambimorph!

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1327 · August 23, 2013 at 11:24 AM

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376731/pdf/tacca00083-0182.pdf

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1327 · August 23, 2013 at 11:24 AM

Thinking about this further, I came across some evidence that pomegranate juice (natural antioxidant complex) lowers arterial plaque considerably when consumed over time (http://www.ncbi.nlm.nih.gov/pubmed/11481398). This is interesting to me because lipid peroxidation (easy in unstable PUFA) is at the heart of atherosclerosis.

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145 · August 20, 2013 at 8:24 PM

Ketosis of PUFA vs SF - that's a really interesting point. As you say one is stable/oxidation resistant and the other not. I'm interested to see what cleverer people than I have to say!

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578 · August 20, 2013 at 5:28 AM

I've come to conclude that long-term VLCing begets permanent health conditions and is unadvisable. What's remarkable though is that before PHD, this voice was completley stifled and everyone believed that if you couldn't VLC, you were lazy, not serious, or couldn't tie your shoelaces. And some still think ketosis is optimal for everyone.

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578 · August 20, 2013 at 5:18 AM

And they blame the failure to the failure to implement ketosis correclty and the lack of persistence. What's comical is the mantra, "It's the low-carb flu, styoopid." Well, it's not the low-carb flu. Not after 1-2 years of low carbing and you still experience anemia-like symptoms, lack of moisture, dryness, constipation, worsening of gout and increasing CRP and uric acid. Unfortunately, the vociferous minority has foisted a siege mentality on all others and when VLCing goes awry, they just exclaim, "Why can't you be like me?" The answer is, perhaps you're an outlier.

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578 · August 20, 2013 at 5:14 AM

I don't doubt that there are people who're better adapted for burning fat than carbs. But the problem arises when you apply this to everyone. The fat-burning preference seems to be limited to those with metabolic problems and those who're congenitally obese like Jimmy Moore. For those, I don't doubt that these people may function better in ketosis. And let's throw in others like Rosedale and Volek and Greenfield et al. But that leaves out a huge chunk of population who experience what PHD calls "glucose deficiency." The fat-burning aficionados regularly pooh-pooh such symptoms.

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6709 · August 20, 2013 at 4:30 AM

answer rocks and is truth

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1169 · July 30, 2013 at 9:57 AM

If we go into it every night when not eating between dinner and breakfast then the body seems set up to handle it on a daily basis for all humans.

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1169 · July 30, 2013 at 9:55 AM

Depends where we would have lived. If you are in an area with no winter, few humans, lots of meat which was probably how it was for a good long time and no winter/summer you probably went for meat/fish/eggs when you could get them ( I always naturally preferred the meat on my plate as a small child, never the potato or veg) but want some veg for variety.

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943 · January 23, 2013 at 7:20 AM

@raydawg - Yeah, I realised that after I posted it. Some might also see it like I was hijacking the thread. I started experimenting with the intake and that has helped so far hence I didn't want to pose it as a new question.

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17136 · January 23, 2013 at 3:13 AM

You should ask this as a separate question - very few people will see it here.

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78422 · October 20, 2012 at 11:31 PM

No. If you are shit talking Jimmy how about we hold up someone like Jeff Volek who is a powerlifter, Ph.D, is lean and healthy, and is vlc. How about Steve Phinney who is in his 70s and still does regular 100 mile bike rides and is lean.

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78422 · October 20, 2012 at 11:28 PM

Please shut up. You clearly haven't done your research. If I tried to do what you suggested I'd be 450lbs. Educate yourself, please.

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18671 · August 25, 2012 at 7:49 AM

Thank you Mscott. I found where it was moved, and updated the link.

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12677 · August 24, 2012 at 5:17 PM

Hey Ambimorph, I think you link to the primer on glucagon metabolism is broken.

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186 · July 29, 2012 at 9:24 PM

Great post. If ketosis was stressful and harmful to the body, then why would we enter into it every night when we sleep? I mean, people don't generally as rule have to wake up every 3 hours at night to eat - we go into very mild ketosis instead. As Dr. Volek says, nutritional ketosis is a beneficial natural state, normal for all people.

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78422 · March 23, 2012 at 4:28 AM

Why would winter=ketosis? My experience is that roots will store in a cold cellar all winter long with no problem. So will apples submerged in a barrel of water. Not to mention dried fruit... Our ancestors knew quite a lot about storing food for winter.

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50 · November 22, 2011 at 12:16 PM

I second that, very helpful indeed, thank you!

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18671 · November 21, 2011 at 6:01 PM

Phoenix, cortisol is one way of stimulating gluconeogenesis, but it is not the only way. It is definitely not required for, nor a consequence of, gluconeogenesis.

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4124 · October 31, 2011 at 4:12 PM

Ambimorph, thank you very much for the updates! I appreciate your keeping track of this topic.

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18671 · October 30, 2011 at 11:24 PM

Also, here is a paper that majkinetor pointed out to me: "Insulin, glucagon, and catecholamines in prevention of hypoglycemia during fasting" http://www.ncbi.nlm.nih.gov/pubmed/2655471 It reinforces the idea that it is glucagon, not cortisol that regulates gluconeogenesis, and cortisol only comes into play when glucagon is not working.

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18671 · October 30, 2011 at 11:20 PM

In this paper it is shown that the obese men at baseline had too much clearance, and too little regeneration of cortisol, which caused them to have to produce more in compensation. After 4 weeks on an ad libitum, high fat low carb diet, they had higher levels of circulating cortisol, because regeneration was enhanced and breakdown and clearance was reduced. In short, the ketogenic diet reversed the cortisol dysregulation in the obese men.

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18671 · October 30, 2011 at 11:19 PM

I wanted to update this with a great study that Travis Culp found: "Dietary Macronutrient Content Alters Cortisol Metabolism Independently of Body Weight Changes in Obese Men" jcem.endojournals.org/content/92/11/4480.full

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18671 · October 30, 2011 at 11:18 PM

Thank you majkinetor. That paper lists several other myths about low carb diets that have been addressed fairly well in the literature. Those who think ketosis is stressful have usually moved beyond those arguments.

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78422 · October 06, 2011 at 7:36 PM

Perhaps you would be interested in reading this: http://www.deakin.edu.au/dro/eserv/DU:30008636/crowe-lowcarbohydratediets-2003.pdf

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18671 · May 29, 2011 at 9:11 PM

Since this post was written, Lucas Tafur has written an interesting analysis of some bioenergetics: http://ketotic.org/2011/05/bioenergetics.html which shows "glucose's complete oxidation involves more complex I activity, ultimately promoting more ROS production by the mitochondria."..."ketones cause a decrease in the potential between the mitochondria and cytosol (ie. Emito/cyto) while increasing the ∆G of ATP hydrolisis, paralleled by the increase in ∆G QH2/NAD+ and ∆G[H+]. Increased efficiency." Increased efficiency and less resulting ROS doesn't sound stressful to me.

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18671 · May 29, 2011 at 9:10 PM

Since this post was written, Lucas Tafur has written an interesting analysis of some bioenergetics: ketotic.org/2011/05/bioenergetics.html which shows "The overall message is that glucose's complete oxidation involves more complex I activity, ultimately promoting more ROS production by the mitochondria."..."ketones cause a decrease in the potential between the mitochondria and cytosol (ie. Emito/cyto) while increasing the ∆G of ATP hydrolisis, paralleled by the increase in ∆G QH2/NAD+ and ∆G[H+]. Increased efficiency." Increased efficiency and less resulting ROS doesn't sound stressful to me.

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4124 · May 25, 2011 at 4:02 PM

Ambimorph, thank you very much for posting this. Chris Kresser's post on cortisol dysregulation being the underlying factor is fascinating. I, too, find that there are so many benefits to a very, very low carb diet. I find it calm, strengthening, and delightful!

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18671 · March 06, 2011 at 6:39 PM

As to the last paragraph: the point about transition would only be relevant in the first few days, but your second point may hold. What does the process of eliminating ammonia look like, I wonder? Thank you for the thoughtful reply!

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18671 · March 06, 2011 at 6:37 PM

These are important points, but I'd like to comment on a few of them. First, I suspect long-term ketosis is more common than supposed, especially seasonally. Any environment with significant winter probably had humans in ketosis half the year. Second, I'm not claiming we haven't adapted to eating starch, of course. Third, even if many people can become healthy just by avoiding fructose, it doesn't mean they are less healthy in ketosis, and it doesn't really address the question of whether long-term ketosis is harmful.

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762 · March 04, 2011 at 3:54 PM

@Pheonix: While gluconeogenesis usually follows a period of cortisolemia, the former doesn't require the latter nor does the latter only precede the former. They can each occur on their own. Cortisol levels have a diurnal patterns that, even in the most sleep-deprived individuals tested, changes less than 3-fold. The biggest spike in cortisol occurs just before (and partly causes) you to wake up.

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39841 · March 03, 2011 at 8:00 PM

Yeah, I have a bench and weights in my office at work and will do some sets here and there between calls throughout the day. I find that a spread out workout is less annoying and has far more volume per set as you rest between them. Naturally, I have no reason not to top off glycogen here and there throughout the workout.

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699 · March 03, 2011 at 7:58 PM

You eat mashed potatoes "during" your strength resistance workouts? Ew.

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4620 · March 03, 2011 at 2:41 PM

I could be wrong, but I think gluconeogenesis requires the presence of cortisol, so a spike in cortisol will most likely occur in ketosis. I believe this is the argument for people who already have high cortisol (from stress, anxiety problems) to stay away from ketosis.

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762 · March 03, 2011 at 1:33 PM

@Dr. K: What is a glycolytic exerciser? Don't we all burn appreciable amounts of sugar while exercising even in aerobic heart zones? What are your sources? I'd be interested to read them.

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762 · March 02, 2011 at 2:32 PM

@Ambimorph: You raise a good point then about why leaving ketosis wouldn't be as stressful as entering it. (Remember, don't confuse this type of stress with cortisol stress.) Although I don't know for certain, I believe, in analogy with other biochemical processes, its because destroying the fat oxidative enzymes is less tricky than creating them.

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762 · March 02, 2011 at 2:30 PM

@Ambimorph: Enzymes are proteins and each enzyme can (to a first approximation) do only one thing. You can't retrofit the enzymes for glucose metabolism to start burning fat. You have to destroy them (which requires synthesis of the destroyer proteins) and create or increase the numbers of the fat burning ones.

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18671 · March 02, 2011 at 12:56 PM

Forgive me if this is obvious, but could you spell that out more? Are you saying protein synthesis is altered to create different enzymes? But why would that be more stressful than creating the enzymes it was creating before? If it's just a matter of change, then wouldn't going out of ketosis be more stressful than staying in it?

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18671 · March 02, 2011 at 12:55 PM

Forgive me if this is obvious, but could you spell that out more? Are you saying protein synthesis is altered to create different enzymes? But why would that be more stressful than creating the enzymes it was creating before? If it's just a matter of change, then how wouldn't going out of ketosis be more stressful than staying in it?

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18671 · March 02, 2011 at 12:51 PM

That's interesting. Maybe that's why there is such a discrepancy in anecdotes about energy. But wait, what's this about a spike in cortisol? I would be grateful if you would elaborate on that point in an answer, since it is exactly the sort of claim I'm wondering about.

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25467 · March 02, 2011 at 3:30 AM

Anthony Colpo has compelling arguments for it....and I think below ten percent body fat ketosis hurts performance....and their is plenty of science to back this up. Sadly one percent of people get there so few people really care. But it your a glycolytic exerciser and fit with a body fat below ten percent there is a great argument to be made for using carbs and not ketosis for performance because of the spike in cortisol that one gets with wide open gluconeogensis.

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762 · March 01, 2011 at 4:40 PM

@Dana: Ketonuria comes from increased fat oxidation. You need more fat oxidative enzymes to oxidize more fat.

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18671 · March 01, 2011 at 4:29 PM

Yes, I'm definitely aware of many positive effects of ketosis. I'm not even considering the opinions of mainstream practitioners who are opposed to ketosis based on long-disproven mythology. I'm mainly interested in the opinions of paleo, low-carb savvy folks, who already acknowledge the therapuetic benefits of ketosis.

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18671 · March 01, 2011 at 4:23 PM

I think most people in the Paleosphere acknowledge that it is helpful for fat loss, but there is a growing faction of people who are saying it is better not to stay in ketosis indefinitely, which seems like a bit of a backlash.

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2099 · March 01, 2011 at 4:00 PM

The fewer carbs I eat, the better my body reacts. Although I haven't tried it yet, I get the feeling that if I at nothing but meat and fat, I would do just fine.

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3618 · March 01, 2011 at 3:47 PM

How does ketosis alter protein synthesis?

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762 · March 01, 2011 at 2:41 PM

@RolandPlain: Could you edit your answer? I'm not sure what your point is.

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21
18671 · March 07, 2011 at 7:52 PM

(Edit July 2012: Please see Ketogenic Diets, Cortisol, and Stress: Part I ??? Gluconeogenesis for my updated and referenced explanation of why gluconeogenesis does not raise cortisol.)

I think I have found my answer in comments from Dr. K. and Phoenix.

There is definitely a widespread view that gluconeogenesis necessarily raises cortisol beyond what is needed without gluconeogenesis. I think the evidence is softer than it appears.

It is undisputed that cortisol stimulates gluconeogenesis. See, e.g. The Physiology of Stress: Cortisol and the Hypothalamic-Pituitary-Adrenal Axis. This leads to the claim that continual gluconeogenesis requires continually raised levels of cortisol. That's not logically implied and I'm not sure it's true. For example, Dr. Eades says, in response to a related question:

[M]ost of the time during fasting, the hormone glucagon,which is the counter-regulatory hormone to insulin, drives gluconeogenesis, not the stress hormone cortisol.

This seems consistent with this primer on glucagon physiology, which says:

When hypoglycemia is produced in humans by injection of insulin, release of glucagon is stimulated along with that of other counterregulatory hormones when the plasma glucose decreases below 3.8 mM (~68 mg/dl) (Figure 11). Restoration of euglycemia is due to a compensatory increase in hepatic glucose production. Although secretion of catecholamines, growth hormone, and cortisol are stimulated along with that of glucagon, only the increases in plasma glucagon and catecholamines coincide with or precede the compensatory increase in the glucose production rate (66,67). That glucagon is the major acute glucose counterregulatory hormone is suggested by the fact that inhibition of the plasma glucagon responses by somatostatin markedly attenuates the compensatory increase in the glucose production rate and impairs restoration of euglycemia following insulin administration (Figure 12). Prevention of cortisol secretion (68), adrenergic blockade (66), adrenalectomy (65), or acute growth hormone deficiency (66) does not appreciably affect immediate glucose counterregulation. The effects of glucagon during restoration of euglycemia involves both glycogenolysis and gluconeogenesis, predominantly the former (69).

This does, suggest, however, that whenever blood sugar goes sufficiently low, cortisol rises. Note that this is no more likely to occur in a ketogenic state than a non-ketogenic state. In fact, most people report much more stable blood sugar levels on a ketogenic diet than otherwise. It may be relevant for fasting, though. If there is a regular stream of dietary protein available for conversion to glucose, blood sugar will probably not drop so low as to raise the cortisol alarm. This is consistent with Chris Kresser's post on [i]ntermittent fasting, cortisol and blood sugar, in which he says that some of his patients, already on a low carb, paleo diet, cannot successfully do intermittent fasting because of cortisol dysregulation. In these cases, he has them eat every 2-3 hours, and they improve. He never suggests, though, that they should abandon carbohydrate restriction.

Based on this information, I believe the notion that ketosis is stressful is simply a pervasive myth. Gluconeogenesis is mediated by glucagon, not cortisol. Cortisol will only be raised if there is hypoglycemia from fasting or from excess insulin. In fact, since the best way to control insulin is to lower carbs, ketogenic diets probably reduce the need for cortisol by providing better blood sugar control.

(Edited to fix a link typo.)

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4124 · May 25, 2011 at 4:02 PM

Ambimorph, thank you very much for posting this. Chris Kresser's post on cortisol dysregulation being the underlying factor is fascinating. I, too, find that there are so many benefits to a very, very low carb diet. I find it calm, strengthening, and delightful!

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18671 · May 29, 2011 at 9:11 PM

Since this post was written, Lucas Tafur has written an interesting analysis of some bioenergetics: http://ketotic.org/2011/05/bioenergetics.html which shows "glucose's complete oxidation involves more complex I activity, ultimately promoting more ROS production by the mitochondria."..."ketones cause a decrease in the potential between the mitochondria and cytosol (ie. Emito/cyto) while increasing the ∆G of ATP hydrolisis, paralleled by the increase in ∆G QH2/NAD+ and ∆G[H+]. Increased efficiency." Increased efficiency and less resulting ROS doesn't sound stressful to me.

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18671 · May 29, 2011 at 9:10 PM

Since this post was written, Lucas Tafur has written an interesting analysis of some bioenergetics: ketotic.org/2011/05/bioenergetics.html which shows "The overall message is that glucose's complete oxidation involves more complex I activity, ultimately promoting more ROS production by the mitochondria."..."ketones cause a decrease in the potential between the mitochondria and cytosol (ie. Emito/cyto) while increasing the ∆G of ATP hydrolisis, paralleled by the increase in ∆G QH2/NAD+ and ∆G[H+]. Increased efficiency." Increased efficiency and less resulting ROS doesn't sound stressful to me.

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4124 · October 31, 2011 at 4:12 PM

Ambimorph, thank you very much for the updates! I appreciate your keeping track of this topic.

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18671 · October 30, 2011 at 11:24 PM

Also, here is a paper that majkinetor pointed out to me: "Insulin, glucagon, and catecholamines in prevention of hypoglycemia during fasting" http://www.ncbi.nlm.nih.gov/pubmed/2655471 It reinforces the idea that it is glucagon, not cortisol that regulates gluconeogenesis, and cortisol only comes into play when glucagon is not working.

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18671 · October 30, 2011 at 11:20 PM

In this paper it is shown that the obese men at baseline had too much clearance, and too little regeneration of cortisol, which caused them to have to produce more in compensation. After 4 weeks on an ad libitum, high fat low carb diet, they had higher levels of circulating cortisol, because regeneration was enhanced and breakdown and clearance was reduced. In short, the ketogenic diet reversed the cortisol dysregulation in the obese men.

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18671 · October 30, 2011 at 11:19 PM

I wanted to update this with a great study that Travis Culp found: "Dietary Macronutrient Content Alters Cortisol Metabolism Independently of Body Weight Changes in Obese Men" jcem.endojournals.org/content/92/11/4480.full

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50 · November 22, 2011 at 12:16 PM

I second that, very helpful indeed, thank you!

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186 · July 29, 2012 at 9:24 PM

Great post. If ketosis was stressful and harmful to the body, then why would we enter into it every night when we sleep? I mean, people don't generally as rule have to wake up every 3 hours at night to eat - we go into very mild ketosis instead. As Dr. Volek says, nutritional ketosis is a beneficial natural state, normal for all people.

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12677 · August 24, 2012 at 5:17 PM

Hey Ambimorph, I think you link to the primer on glucagon metabolism is broken.

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18671 · August 25, 2012 at 7:49 AM

Thank you Mscott. I found where it was moved, and updated the link.

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39841 · March 03, 2011 at 7:50 PM

I've remained thoroughly unconvinced with regard to the merits of ketosis all throughout my research into various aspects of paleo. If we are to point to a specific extant HG society as a model for what we should personally eat, it seems logical that we would choose one that occupies the same location and eats the same food that we as hominins did for the bulk of our evolution. As such, our last possible choice would be an outlier such as the Inuit, unless we ourselves are descended from them. It's clear that because hominins evolved for 6-7 million years in E. Africa and because the flora and fauna present there are fairly consistent over time, we would do well (if our goal is to model our diet after that of a HG society) to use data from study of the Hadza over most any other.

Though we likely added various abilities digestion-wise over time as we moved out of Africa such as lactase persisting into adulthood etc., I find it hard to believe that along the way we lost the ability to safely digest the tubers and berries that the Hadza consistently seek out in large amounts (and sometimes eat almost exclusively for days) and in the 60K or so years that we've been out of Africa have rapidly evolved into carnivores.

That all being said, there are those I'm sure who acknowledge that we likely continue to be omnivorous but can lose body fat more effectively on a carnivorous diet + coconut or whatever the dominant protocol is currently. Similarly, I remain unconvinced that the efficacy of such an approach is markedly greater than that of an individual who simply restricts fructose as much as possible and restricts starch to whatever level stays below their glycogen storage capacity threshold. Insulin preferentially stores excess blood glucose as glycogen, likely for the simple reason that the ATP cost as a % of the energy being processed is roughly 7% to convert glucose to glycogen and 25% to convert it to fat. There's simply no way that we would have evolved to preferentially store glucose as fat when there is glycogen storage capacity free. My personal experience confirms this, as I can eat significant quantities of mashed potato before, during and after my resistance workouts without any sort of increase in adiposity, provided that I am not consuming these amounts on low-draw days. In fact, on Tues & Thurs I skip starch intake altogether and just run on glycogen stores since I don't do anything beyond walking for 4-5 miles.

As for the stress issue, I think it could be argued that at the very least, a rapid transition down to non-significant quantities of glucose could temporarily starve the brain of energy or cause rapid catabolism of muscle tissue for energy. In fact, isn't gluconeogenesis with a protein substrate either from dietary protein or muscle constantly occurring during ketosis? As such, wouldn't the toxic ammonia produced during deamination result in a greater level of stress on the body?

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699 · March 03, 2011 at 7:58 PM

You eat mashed potatoes "during" your strength resistance workouts? Ew.

Medium avatar
39841 · March 03, 2011 at 8:00 PM

Yeah, I have a bench and weights in my office at work and will do some sets here and there between calls throughout the day. I find that a spread out workout is less annoying and has far more volume per set as you rest between them. Naturally, I have no reason not to top off glycogen here and there throughout the workout.

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18671 · March 06, 2011 at 6:37 PM

These are important points, but I'd like to comment on a few of them. First, I suspect long-term ketosis is more common than supposed, especially seasonally. Any environment with significant winter probably had humans in ketosis half the year. Second, I'm not claiming we haven't adapted to eating starch, of course. Third, even if many people can become healthy just by avoiding fructose, it doesn't mean they are less healthy in ketosis, and it doesn't really address the question of whether long-term ketosis is harmful.

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18671 · March 06, 2011 at 6:39 PM

As to the last paragraph: the point about transition would only be relevant in the first few days, but your second point may hold. What does the process of eliminating ammonia look like, I wonder? Thank you for the thoughtful reply!

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78422 · March 23, 2012 at 4:28 AM

Why would winter=ketosis? My experience is that roots will store in a cold cellar all winter long with no problem. So will apples submerged in a barrel of water. Not to mention dried fruit... Our ancestors knew quite a lot about storing food for winter.

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1169 · July 30, 2013 at 9:55 AM

Depends where we would have lived. If you are in an area with no winter, few humans, lots of meat which was probably how it was for a good long time and no winter/summer you probably went for meat/fish/eggs when you could get them ( I always naturally preferred the meat on my plate as a small child, never the potato or veg) but want some veg for variety.

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1982 · March 01, 2011 at 3:24 PM

But is there any compelling reason/evidence that one should avoid it, especially if trying to lose bodyfat?

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25467 · March 02, 2011 at 3:30 AM

Anthony Colpo has compelling arguments for it....and I think below ten percent body fat ketosis hurts performance....and their is plenty of science to back this up. Sadly one percent of people get there so few people really care. But it your a glycolytic exerciser and fit with a body fat below ten percent there is a great argument to be made for using carbs and not ketosis for performance because of the spike in cortisol that one gets with wide open gluconeogensis.

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18671 · March 01, 2011 at 4:23 PM

I think most people in the Paleosphere acknowledge that it is helpful for fat loss, but there is a growing faction of people who are saying it is better not to stay in ketosis indefinitely, which seems like a bit of a backlash.

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4620 · March 03, 2011 at 2:41 PM

I could be wrong, but I think gluconeogenesis requires the presence of cortisol, so a spike in cortisol will most likely occur in ketosis. I believe this is the argument for people who already have high cortisol (from stress, anxiety problems) to stay away from ketosis.

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18671 · March 02, 2011 at 12:51 PM

That's interesting. Maybe that's why there is such a discrepancy in anecdotes about energy. But wait, what's this about a spike in cortisol? I would be grateful if you would elaborate on that point in an answer, since it is exactly the sort of claim I'm wondering about.

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762 · March 03, 2011 at 1:33 PM

@Dr. K: What is a glycolytic exerciser? Don't we all burn appreciable amounts of sugar while exercising even in aerobic heart zones? What are your sources? I'd be interested to read them.

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762 · March 04, 2011 at 3:54 PM

@Pheonix: While gluconeogenesis usually follows a period of cortisolemia, the former doesn't require the latter nor does the latter only precede the former. They can each occur on their own. Cortisol levels have a diurnal patterns that, even in the most sleep-deprived individuals tested, changes less than 3-fold. The biggest spike in cortisol occurs just before (and partly causes) you to wake up.

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18671 · November 21, 2011 at 6:01 PM

Phoenix, cortisol is one way of stimulating gluconeogenesis, but it is not the only way. It is definitely not required for, nor a consequence of, gluconeogenesis.

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1327 · August 20, 2013 at 11:03 AM

I understand you want evidence, and I'm not sure I can provide any of that, but I have some thoughts on the subject.

I've delved into Peat, and Danny Roddy et al, and although I think some of it is misled, there are some important bits I've taken from it, which the evidence does appear to support. Stuff that the paleo community is down with anyway... let me run with this and I will gratefully receive any criticism on it...

The saturated fat / metabolism thing seems to me to be very important. Simply, if you are eating mostly saturated fat, this is being turned into metabolic hormones and making you lean and energetic.

It seems that when people gain a lot of weight in the first place, the primary common denomenator is high PUFA intake, particularly the n-6 fats.

So I have to ask - is there an evolutionary reason for why metabolism slows down under these conditions? Is the organism attempting to protect itself from the damaging or carcinogenic effects of attempting to metabolise these unstable fats?

What I am guessing is that "ketosis" of coconut oil, butter etc is perfectly healthy and in many circumstances preferable (there appear to be some functions that require ketones rather than glucose, right?). However, ketosis of stored PUFA, which will happen when you put yourself into a fasting state after having gotten overweight from PUFA is probably "stressful" (the end-result of which dependent on many other factors).

What I am ultimately interested in is how to fast oneself out of a PUFA-ridden obesity (not for me, I'm pretty lean now, but just for understanding), whilst mitigating the stress of metabolising all that PUFA.

As vitamin E saturates unsaturated fats, I imagine a complex of E with other transport etc antioxidants is perhaps the required food.

And the way to find this in a wholefoods context would be through green smoothies, quite possibly.

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145 · August 20, 2013 at 8:24 PM

Ketosis of PUFA vs SF - that's a really interesting point. As you say one is stable/oxidation resistant and the other not. I'm interested to see what cleverer people than I have to say!

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1327 · August 23, 2013 at 11:24 AM

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376731/pdf/tacca00083-0182.pdf

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1327 · August 23, 2013 at 11:24 AM

Thinking about this further, I came across some evidence that pomegranate juice (natural antioxidant complex) lowers arterial plaque considerably when consumed over time (http://www.ncbi.nlm.nih.gov/pubmed/11481398). This is interesting to me because lipid peroxidation (easy in unstable PUFA) is at the heart of atherosclerosis.

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30 · July 30, 2012 at 1:48 PM

Ketosis SUCKS!

Training day without carbs = WASTE OF YOUR TIME

Consecutive deficit days = RECIPE FOR FAILURE due to fatigue, hunger and stress which cause eating spree sooner or later

The formula to leaning out quickly, successfuly and stress free is: Eat -30% maintanance on REST DAYS

Eat +10 maintanance on TRAINING DAY (Which for me is 270g carbs of GLORY) you add zero fat just some muscle - So its a win win of eating some food, and not gaining fat.

You cycle and repeat until your six pack visible in RELAXED state, then you can switch things up and eat +30%, -10% (rest day)... Until reach desired muscle size. Or just maintain lean body by eating at 0%.

1g carb = 4 cals, 1g protein = 4 cals, 1g fat = 9 cals. Average sedentary maintanance is 2100. For muscle building its 2.5g per kg body weight recommended, but if you're not into muscle you can eat more carbs instead :)

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78422 · October 20, 2012 at 11:28 PM

Please shut up. You clearly haven't done your research. If I tried to do what you suggested I'd be 450lbs. Educate yourself, please.

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6709 · August 20, 2013 at 4:30 AM

answer rocks and is truth

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762 · March 01, 2011 at 2:04 PM

Hi Ambimorph,

One may consider ketosis 'stressful' in two ways depending on whether the stress response derives from the excretion or synthesis of proteins.

We commonly equate stress with hypercortisolism or HPA (hypothalamic-pituitary axis) dysfunction. However, biology also recognizes another type of stress- an increase in defective (e.g. misfolded or mutated) proteins or the proteins needed to deal with those defective proteins.

Ketosis is stressful in that it alters protein synthesis.

Hope this helps, Mike

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762 · March 02, 2011 at 2:32 PM

@Ambimorph: You raise a good point then about why leaving ketosis wouldn't be as stressful as entering it. (Remember, don't confuse this type of stress with cortisol stress.) Although I don't know for certain, I believe, in analogy with other biochemical processes, its because destroying the fat oxidative enzymes is less tricky than creating them.

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3618 · March 01, 2011 at 3:47 PM

How does ketosis alter protein synthesis?

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18671 · March 02, 2011 at 12:55 PM

Forgive me if this is obvious, but could you spell that out more? Are you saying protein synthesis is altered to create different enzymes? But why would that be more stressful than creating the enzymes it was creating before? If it's just a matter of change, then how wouldn't going out of ketosis be more stressful than staying in it?

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762 · March 02, 2011 at 2:30 PM

@Ambimorph: Enzymes are proteins and each enzyme can (to a first approximation) do only one thing. You can't retrofit the enzymes for glucose metabolism to start burning fat. You have to destroy them (which requires synthesis of the destroyer proteins) and create or increase the numbers of the fat burning ones.

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762 · March 01, 2011 at 4:40 PM

@Dana: Ketonuria comes from increased fat oxidation. You need more fat oxidative enzymes to oxidize more fat.

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18671 · March 02, 2011 at 12:56 PM

Forgive me if this is obvious, but could you spell that out more? Are you saying protein synthesis is altered to create different enzymes? But why would that be more stressful than creating the enzymes it was creating before? If it's just a matter of change, then wouldn't going out of ketosis be more stressful than staying in it?

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1169 · July 30, 2013 at 9:57 AM

If we go into it every night when not eating between dinner and breakfast then the body seems set up to handle it on a daily basis for all humans.

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6709 · August 20, 2013 at 4:33 AM

What about the drastic alterations of hormones in men eatin VLC. Like low free T, TC, weird Estrogen levels and Progesterone issues, lethargy, TSH and T3/4 change, and total lack of sex drive.

Wait? What!? What am I talking about. Simple. google "low carb low sex drive" or "low carb no sex drive" or "zero carb no sex drive, cold all the time" look at the thousands of unfortunate souls.

And lets see, then theres the fact that not a single elite athlete, not a single one, stays zc, vlc, or lc much of the time or at all.

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578 · August 20, 2013 at 5:18 AM

And they blame the failure to the failure to implement ketosis correclty and the lack of persistence. What's comical is the mantra, "It's the low-carb flu, styoopid." Well, it's not the low-carb flu. Not after 1-2 years of low carbing and you still experience anemia-like symptoms, lack of moisture, dryness, constipation, worsening of gout and increasing CRP and uric acid. Unfortunately, the vociferous minority has foisted a siege mentality on all others and when VLCing goes awry, they just exclaim, "Why can't you be like me?" The answer is, perhaps you're an outlier.

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578 · August 20, 2013 at 5:28 AM

I've come to conclude that long-term VLCing begets permanent health conditions and is unadvisable. What's remarkable though is that before PHD, this voice was completley stifled and everyone believed that if you couldn't VLC, you were lazy, not serious, or couldn't tie your shoelaces. And some still think ketosis is optimal for everyone.

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578 · August 20, 2013 at 5:14 AM

I don't doubt that there are people who're better adapted for burning fat than carbs. But the problem arises when you apply this to everyone. The fat-burning preference seems to be limited to those with metabolic problems and those who're congenitally obese like Jimmy Moore. For those, I don't doubt that these people may function better in ketosis. And let's throw in others like Rosedale and Volek and Greenfield et al. But that leaves out a huge chunk of population who experience what PHD calls "glucose deficiency." The fat-burning aficionados regularly pooh-pooh such symptoms.

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943 · January 17, 2013 at 10:44 AM

Does anyone have any research/anecdotal evidence/opinion on how the amount of daily protein intake 'stresses' the body? I've noticed lately that my urine smells quite distinct and I suspect that is the ammonia from deamination but I can't figure out if that is because I'm eating too much protein and therefore 'burning it for fuel' or it's the other way around, that I'm eating too little protein (and not enough fat to fuel my body) and my body is breaking down muscle to get the extra energy.

I bike 10k at least five days per week, at least one sprint session (running) and one to two weight training sessions per week (the latter is more focused on a high number of reps and keeping a somewhat high intensity). I weigh 50-52kg @ 178cm so I'm quite low in bodyfat. I eat around 1.75-1.9g protein/kg per day. Which corresponds to 18-22% of my energy intake.

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17136 · January 23, 2013 at 3:13 AM

You should ask this as a separate question - very few people will see it here.

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943 · January 23, 2013 at 7:20 AM

@raydawg - Yeah, I realised that after I posted it. Some might also see it like I was hijacking the thread. I started experimenting with the intake and that has helped so far hence I didn't want to pose it as a new question.

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324 · March 01, 2011 at 2:21 PM

I believe when speaking of stress he not only means the HTPA, but the organs as well, one of the main concerns with this diet from a "dieticians" stand point is the stress on the kidneys, and their filtering efficacy. A lot of people are also worried about "high protein" damage on kidneys. It's all a crock of shit if you'll excuse my french. Look up the studies and you'll see they were all done on patients with kidney failure on dialysis. At that point almost anything would cause the kidney function of those patients to come spiraling down. If kidneys can filter acetaminophen, other pharma poison meds, and whatever else the typical american would ingest on a daily basis, it can sure as hell handle by products of the body AS IT WAS CREATED TO DO. and yes this is only speculation, but our ancestors did this for THOUSANDS of years, without body issues. CASE & POINT. On top of that there are dozens of studies out there that say the BRAIN functions MORE efficiently on KETONES, than ANY OTHER source of energy. so there's your food for though. I drink a min of a gallon of water a day, with hydration I believe comes effective and easy kidney function. So pound down that Hydrogen Di-Oxide! Do the research and piece it together for yourself.

The whole point of this paragraph was to review some positive effects and dis-spell some myth, and basically to throw my opinion in there that you're doing it right.

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18671 · March 01, 2011 at 4:29 PM

Yes, I'm definitely aware of many positive effects of ketosis. I'm not even considering the opinions of mainstream practitioners who are opposed to ketosis based on long-disproven mythology. I'm mainly interested in the opinions of paleo, low-carb savvy folks, who already acknowledge the therapuetic benefits of ketosis.

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762 · March 01, 2011 at 2:41 PM

@RolandPlain: Could you edit your answer? I'm not sure what your point is.

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2099 · March 01, 2011 at 4:00 PM

The fewer carbs I eat, the better my body reacts. Although I haven't tried it yet, I get the feeling that if I at nothing but meat and fat, I would do just fine.

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656 · August 25, 2012 at 8:00 AM

Let me put it this way: If Dr. Kurt Harris says ketosis is neither beneficial (over the long-term) nor necessary, and Jimmy Moore says the opposite, well, that about settles it, wouldn't you say?

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78422 · October 20, 2012 at 11:31 PM

No. If you are shit talking Jimmy how about we hold up someone like Jeff Volek who is a powerlifter, Ph.D, is lean and healthy, and is vlc. How about Steve Phinney who is in his 70s and still does regular 100 mile bike rides and is lean.

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