I see this advice given to new people all the time and it is simply not true for some people. It would be better to include a protein calculation statement as well. Then add a statement about possibly needing to reduce the protein amount further after a few months if needed, or for some people the carb amount. Then add a statement about not fearing fat because your body needs to get energy from somewhere and it’s not always going to use your own fat stores, especially not in the beginning.
I know it’s a few more sentences than simply saying “if you lower your carbs to this site’s recommended 20 grams a day, you will enter ketosis” but it’s a far more accurate, responsible response. If you’re one of our awesome regular responders to new people, write the sentences out on a notepad on your pc and just copy and paste.
As someone who almost always registers 0.2 ketones, who never got “the keto flu” as a possible indicator I was going into ketosis, and who doesn’t experience most of the positives listed on the internet from being in ketosis, I have constantly felt like a failure. Like what the hell is wrong with my body etc. I know I am not alone.
I’ve registered 0.0 quite a few times too. Usually test on waking, when I test at all. I’m just saying lowering carbs alone might not be the full answer for some people, and it can be easy to get discouraged when not responding like other people. Also 0.2 is considered a normal ketone reading for folks not following any kind of low carb eating plan.
I’m sorry that you are feeling like a failure. I know from experience how bad that feels.
We generally do say all that you have posted, and you are more than welcome to continue the tradition, whenever you encounter a newbie on the forums. But it’s a lot to hit people with when they’ve first joined the forums; sometimes it’s more helpful to keep it simple at first, and then help them tweak things later on.
When you get right down to it, the only carb limit that is guaranteed to work for absolutely everybody is 0 (zero) g/day, and that is a whole additional discussion. It is for good reasons that Carl and Richard decided to set the recommendation at 20 g/day, and we do generally advise people that if they are exceptionally insulin-resistant, they may need to cut the carbs even further.
The goal of ketogenic eating is not actually to eat less carbohydrate, however, it is to lower insulin and to keep it low for as much of the day as possible. We need to lower insulin below 25 μU/mL, because that is the threshold, above which we are in fat-storing mode, and below which we can begin to metabolise fat instead of glucose. Some people can get their insulin below this threshold quite easily, all the while eating an amount of carbohydrate that will keep someone else (someone more insulin-resistant) out of ketosis. There is, unfortunately, no home test for serum insulin, so we are forced to rely on the presence of ketones in blood or urine to see whether we have lowered insulin sufficiently. But the presence or absence of ketones is not the real point, they are just a marker.
There are literally dozens of threads that discuss these points, but putting all the information into one post that a newbie might be willing to read is a challenge. If you can figure out how to do so, then please, please share with us. It gets tedious writing a book to each newcomer who happens along.
Okay, some things to unpack, here. First, the “keto flu” has nothing to do with ketosis, except that it is a sign that insulin is now low enough to no longer be interfering with sodium excretion by the kidneys. A lot of people think of the “keto flu” as carb withdrawal, but it’s not; it is a sign of a lack of sodium, cured by eating a bit more salt. (This is why Dr. Phinney always advises drinking a cup or two of bone broth a day.) We do try to explain this, but the message often doesn’t seem to get through.
Also, the absolute level of ketones, as I mentioned above, is not the point of this way of eating; the lowering of insulin is the real point, and ketones are a marker. If you have cut your carbohydrate intake sufficiently and are still breathing in and out, then you are in ketosis. But measuring ketones in urine or breath is an indication of how much are being wasted, not how much are being produced. And even measuring ketones in blood only gives an indication of the gap between production and consumption, not how much is actually being produced or used.
Now, if you’ve been eating a ketogenic diet for six to twelve months, and your blood pressure and heart rate have not come down, your fasting glucose and insulin are still high, your inflammatory markers have not reduced, your triglycerides are alarming, and your HDL is woefully low, then we can help you investigate what you might want to be doing differently. There may be carbs in your diet that you are unaware of, for example, or there may be some other problem.
Fat loss, on the other hand, while a highly-prized side effect of the metabolic changes, is not actually the primary point of a ketogenic diet, despite all the hyperbole out there on teh Interwebz. We like to say that keto is not a weigh-loss diet, it is a weight-normalisation diet, and that normalisation may involve a deal of hormonal re-regulation, especially in women, before the excess stored fat starts to come off. And paradoxically, fat loss often depends on eating more, not less. But fat loss is impossible, generally speaking, if the metabolism is broken, and some people need a lot more metabolic healing than others.
I’m aware of how long this post has gotten, and if you have any suggestions about how to condense this information to a point where it won’t overwhelm newcomers, I’m all ears. There is already a wealth of information posted in the Newcomers forum, but getting it into a form that the average newcomer can easily digest is a challenge. We do try to point people to useful threads, but if they are not willing to browse these forums a bit, then they miss out on all the rich experience of those who have gone before.
But it should also be noted that the ketoadapted athletes that Phinney and Volek study also often show serum β-hydroxybutyrate around 0.2. And similarly with carnivores, who have to be producing ketones, because their only carbohydrate intake is from the glycogen in their meat. Both Phinney and Volek have admitted publicly that 0.5 or above is an arbitrary definition of nutritional ketosis.
I agree, with one caveat. Feeling like a failure, or feeling like something isn’t working for you, can be very heavy emotionally. I just wonder if some folks give up and drift away. Tho I 100% agree with you that there is a ton of info on the forums for people to read should they choose to. Just irks me sometimes to see the carb one liner when I know that is not always the full story.
Nod.
Nod again. And next to no evidence of that marker can be discouraging.
I knew it had nothing to do with ketosis, per se, or carb withdrawal. I wasn’t aware of the role of insulin in whether it happens or not. Thanks for that info. I still want a fasting insulin blood test and am going to strongly request one from my GP, jic my normal HbA1C and blood glucose the past 6 years is happening despite some level of high insulin.
I often appreciate your posts Paul, so thoughtful and rich in information.
@MeganNZ , I get ya on ‘wanting all that specific reasons and info’ for new people but it can’t be that way and won’t ever work that way. We all must walk such a personal path truly and don’t ever forget the emotional and brain side of it, that is what rules so many of us so if we ‘go all science’ at it we still ‘think’ so much mush and crazy in ‘our diets (as in menu thru food, not ‘diet’ like cabbage soup only craze’ that we can’t ever pinpoint any one ever to a such degree…can’t happen, then throw who we are medically coming into this. I came in fine. Good health but so many come with massive prescip meds and issues for healing and again, the shades of gray are so intense for each of us that best we can do is ‘give good info’, and just huge support as one changes and how much we know of an individual ya know.
just a throw out on nothing can’t ever be all science based ever on ‘people’ cause it just won’t roll that way from my experiences.
This is more or less likely, but it does depend on the person’s degree of insulin-resistance or -sensitivity.
Now Dr. Phinney denied ever saying it when I asked him about it, but I could swear that, in some of the early videos of him that I watched, he spoke of 100-125 g/day of carbohydrate as being sufficiently low-carb to get someone into nutritional ketosis.
Now, take that for what it’s worth (even on keto, my memory isn’t what it used to be—if it ever was, lol!), but I have always found that I can eat more carbohydrate than 20 g/day and still be in ketosis. However, these days I find that if I increase my carb intake past a certain point, even if that point is still low enough for me to stay in ketosis, I start to see signs of increasing insulin: my age spots start to return, I feel creaky and achey, my acne reappears and my face and scalp start to feel greasy again, and so forth. So those occasions when I yield to my carb cravings never have a good result, even if my liver is still making ketones.
I am beginning more and more to think that a carnivore diet is in my future.
@MeganNZ the issue you note that most on these forums refuse to acknowledge is that protein substantially raises insulin, and down regulates ketogenesis. They have some long ago thing about protein and cake that they have internalized as considering protein a non issue. As you point out, that simplistic viewpoint is simply false and misleading. Good luck though as i have linked to a lot of publications on this topic which these same posters refuse to read, probably as it does not fit their desired preconceived notions.
quite the walk Paul and I applaud you for seeing the future more as you live and eat each day as your body is ‘draggin’ ya’ LOL
but I also know you put in time on you and your body…this is not an overnight decision and you find you coming this way thru all the hard work of changes and all WE ALL know it takes to tackle our more healthy lifestyle walk as it suits us…more power to you!
never saying it is YOU all in cause one can be carnivore adjacent easily or ‘what is termed now Ketovore’ and do so well.
If you walk more this way I would love reading your journey for sure! I knew you were all in for your health but more I feel connected to you literally and it is such an intersting change as it is happening…don’t force it ever, just do you as ya need and walk the journey along with so many of us here It is all a good thing!! We are all ‘dragged along somewhere’ to our best on our own timeline if we just allow that to happen and go with the flow
No, I can easily eat more than 20 grams and be in “ketosis”, assuming this means any BHB at all. But it’s a complex calculation, as over time, here is what happened to me:
I wrote quite a few times I got fat adapted while eating about 40g net carbs a day. I never went below 20g in my first months… And very rarely later, until I tried out carnivore, at least. 20g is easy on carnivore, I just should be careful with my dairy but I do that anyway. Not like I care about my carb intake on carnivore (or close to it), it doesn’t seem to matter.
I totally believe some people can go WAY higher. Bigger body and activity, more muscles, even more indulgent personal factor regarding carbs vs ketosis…
Just like some people need to go below 10g, some can go beyond 80-100g and be in ketosis. Humans are wonderfully different.
Even Dr. Phinney has always stated that too much protein inhibits ketogenesis. It is Ted Naiman who started the whole “no such thing as too much protein” idea and ran with it, and a lot of people have followed him. Prof. Benjamin Bikman has a more nuanced view, with concerns about the ability to assimilate amino acids later in life, unless one has eaten a fair amount of protein all along. This idea I am not qualified to judge, but Prof. Bikman is a smart guy, so I don’t want to dismiss what he says out of hand. I am looking forward to picking Richard Morris’s brain about this, once he’s finished his doctorate and has some spare time.
Agreed. I assume that most (all?) people reading this thread wouldn’t be in that ultra-small camp that Phinney and Volek were writing about. Rather, the discussion here is about how and when regular folks like me and Meghan are seeing .2 or .3 and what that means outside of the world-class endurance athlete context.
I’m glad you mentioned this, because it’s an important post-script to some of the confusion about the green/red bell curve chart that’s out there regarding nutritional ketosis.
I’m sticking with my “20g one-liner”. It will at least get you in the game and for many (most?) of us, it really is that simple.
I have never checked to see if I am in ketosis. I never measured anything. Just kept below 20g. And I did have questions along the way and learned about salt intake etc.
I totally understand your position. And some people will need more information when they begin. They will hear from many other contributors who share your advice and approach. Between us all, I think newbies receive good and varied information.
But the point remains that a low serum ketone level does not automatically imply that the liver is not making ketones. The level of circulating ketones does not directly measure ketone production, but rather the gap between what has been produced and what hasn’t yet been consumed. There may or may not be cause for concern, and we shouldn’t let our desire to see a nice number force us automatically to the conclusion that something is wrong when we don’t see the number we want.
It is all a good thing!! We are all ‘dragged along somewhere’ to our best on our own timeline if we just allow that to happen and go with the flow 
