Long Term Ketosis - Good, Bad, Ugly?

#54

Hi Amber,

I don’t think you’re missing anything. The point of this study was to determine whether the same impaired glucose tolerance shown in previous studies would be replicated in athletic subjects, which it was.

One issue, I believe at stake, is whether long-term KD causes down regulation of insulin signalling mechanisms. Whereas, the metabolic flexibility argument revolves around the ability to transiently exit ketosis without the exaggerated insulin secretions, as shown in this study. Clearly, this is not well studied. The alternative, as Tim Noakes said, is just to remain low carb ad infinitum.

(L. Amber O'Hearn) #55

But insulin resistance (or maybe more accurately described, glucose intolerance) when in the ketogenic condition doesn’t indicate metabolic inflexibility at all. It would be inflexibility only if glucose tolerance didn’t return after a few days eating high carb.

During a ketogenic diet, multiple mechanisms make fat uptake efficient at the expense of glucose. And during a high carb diet, the reverse is true. The fact that it takes someone a few days to keto-adapt or glucose-adapt is not inflexibility. Metabolic inflexibility is when you do not adapt after a few days. I’m not sure that you can do better than a couple days turnaround to upregulate the processes to full capacity.

Does a healthy ketogenic diet cause irreversible insulin resistance?
(Bacon is a many-splendoured thing) #56

From people’s experience as described on these forums, it appears that readapting to fatty-acid metabolism usually takes in the range of six to eight weeks. I would call that a sign of some degree of metabolic inflexibility.

(L. Amber O'Hearn) #57

Re-adaptation meaning they went off the diet for awhile and are trying again?

I guess it depends on which kind of adaptations you mean. You should be able to get into ketosis within a few days. Athletic performance and uric acid might take 6-8 weeks.

(Bacon is a many-splendoured thing) #58

Yeah, whether it’s because we ate SAD for a number of years and are now trying keto for the first time, or because we ate keto, stopped, and are starting again.

We all start life in ketosis, right? So losing fat-adaptation is not necessarily the “plan,” just an inevitable consequence of eating too much carbohydrate for too long, is my guess.

(Michael - When reality fails to meet expectations, the problem is not reality.) #59

@PaulL I think it’s a matter of degree. One can adapt to cellular lipolysis quickly. I did, for example. I never experienced any discomfort going full blown cold-turkey keto. I was in ketosis by the morning of day 3 of my 4-day intro fast and hardly noticed anything different. The only major obvious thing is I haven’t felt hunger since. Closing in on 5 years.

I see @amber has already responded with what I wanted to add.

#60

But potassium is more scarce (unless you eat fish), and the more I learn about its function in the body, the less open I am to following a diet that makes it hard to get – even with supplements. Also, sodium and potassium work in balance, so I worry about the frequent recommendations to increase sodium without simultaneously increasing potassium. Potassium deficiency (or imbalance?) can lead to muscle, nerve, bone and heart problems and also stroke.

(L. Amber O'Hearn) #61

Agreed, they work in balance. The current recommendations for these were derived on a grain-based diet. Eliminate plants and suddenly added dietary salt can put you out of balance compared to a diet that may actually require added salt. Meat has potassium, as long as you don’t, for example, boil it and toss the water. I don’t think we need to try to match potassium levels from a grain diet, or that the consequences would be the same.

(Michael - When reality fails to meet expectations, the problem is not reality.) #62

I agree 100% with this. Most folks who talk about so-called ‘metabolic flexibility’ mistakenly think it’s about what goes in your mouth. It’s not, it’s about mitochondria. We always have sufficient glucose for our needs produced by gluconeogenesis (barring disease) so there is zero need to eat it. Eating glucose, in fact, prevents metabolic flexibility by interfering with fat metabolism.

26%20PM

3l10pu

(Michael - When reality fails to meet expectations, the problem is not reality.) #63

Thank you so much for these! The Inuit were really healthy people until sugar, flour and tea arrived.

@ctviggen PUFAs no less!

(Michael - When reality fails to meet expectations, the problem is not reality.) #64

Thank you for this link as well! I’ve linked it above to my previous post.

I can not recommend this presentation more strongly to all!!!

(Joey) #65

I recall the unanswered question above pertained to just how long the “stopped” event lasted. Stopped for a holiday meal? A few days? Months?

I suspect the answer as to how long it takes to get back close to fat adaptation level reached prior to ingesting carbs is highly dependent on how long the non-keto eating lasted.

E.g., a single overstuffed holiday meal might make you feel like crap the next morning … but not likely to undo your general fat adaptation otherwise. Perhaps the best evidence for this is the “feeling like crap” reaction. :thinking:

(Michael - When reality fails to meet expectations, the problem is not reality.) #66

@SomeGuy The time between my previous ketosis - likely several months after birth since my mother breast fed me - to my next ketotic episode was 70 odd years. I experienced zero discomfort or ill effects from re-entry. Just luck, I suppose. :innocent:

(L. Amber O'Hearn) #67

Thank you!

#68

Yes, and I don’t want to labour the point. As mentioned, to the best of my knowledge, some form of transient ketosis, e.g. using a targeted ketogenic diet approach, does not appear to be well-studied at all.

Anecdotally, listening to people like Peter Brukner, Paul Saladino, Jacob Wilson, etc, there appears to be some value, at least among the athletic community, in keeping ketones in the lower range through targeted carb intakes. It would be interesting to see how longer term adherents to this approach responded to a Kraft test.

(Joey) #69

Sounds like you’re a healthy omnivore. :sunglasses:

(L. Amber O'Hearn) #70

Yes, I have also played around with CKD and TKD approaches in the past. I don’t think there’s anything wrong with it, necessarily, and it could be helpful in some contexts.

#71

Oh, be careful. You may be burned at the ‘steak’ ! :yum:

(Doing a Mediterranean Keto) #72

Where could I learn about CKD, TKD and in general, cycling keto? Thank you.

#73

Try searching on Luis Villasenor of Ketogains for targeted ketogenic diet (TKD). Jacob Wilson and Ryan Lowery have also written about this and the cyclical ketogenic diet (CKD). The Anabolic Diet by Mauro diPascale is probably the most famous version of CKD. From personal experience, I would recommend a TKD only.