Long Term Ketosis - Good, Bad, Ugly?

(Bob M) #41

The infamous “insulin resistance” term rears its ugly head. This is one reason why I’m loathe to use this term.

To me, that CGM curve I show above shows I’m still “metabolically flexible”. Do I have a higher spike because I’m “insulin resistant” in the sense that I have not eaten carbs in a long time? (That is, carbs = a higher peak because insulin is not excreted/used as quickly as it used to be.) Maybe. I haven’t tested what would happen if I ate higher carb for a while and then ate the same lunch/dinner.

Does it matter? Personally, I don’t think so. I feel great not eating a lot of carbs, so I’m not sure I want to eat more carbs.

Would I feel better with higher carbs and therefore (I guess) more “metabolically flexible”? I don’t know, as I haven’t tried it.

But I doubt it’s necessary.

(L. Amber O'Hearn) #42

Hey, James. I haven’t seen anything leading to the idea that long term ketosis results in long term lack of flexibility. The “IR” of ketosis is context dependent and appropriate in that context. It only takes a few days to glucose-adapt, as far as I’m aware. Are the studies you are referring to looking at this physiological adaptation without adapting back? I’m curious to see what science you’re looking at specifically.


I have always wondered how it could be the ideal way because the caveman boys back in the day would have had a full on meltdown if they forgot to take their ketoade out with them in their packed lunches!

Surely being able to retain electrolytes is a lot more beneficial than having to keep ingesting them.

(Edith) #44

I happened to start listening to this podcast this morning with Dr. Cywes where excess vitamins is discussed. I haven’t finished, yet; but he and Judy did talk about eating too much liver.

(L. Amber O'Hearn) #45

If you’re not eating high amounts of plant material and you’re not salting your food, and you’re not overdrinking fluids and you’re not cooking all the mineral rich fluids out of your meat, you probably don’t need to take electrolytes perpetually.

(Edith) #46

Why would not salting food result in hanging onto electrolytes?

(Old Baconian) #47

If you are getting enough salt in the meat and juices you are consuming, you likely don’t need to salt your food in addition. It make sense, given that our ancestors didn’t always necessarily live all that close to a salt lick.


Hi Amber

This came up in an earlier thread. One pertinent study I cited was https://journals.humankinetics.com/view/journals/ijsnem/30/3/article-p210.xml

Here are the Kraft scores of the subjects

I have been unable to copy paste the conclusion using my phone but I am sure you can quickly reference it.

(Edith) #49

I have wondered if they drank the blood. That would also provide salt.

But that does not quite answer my question. Why would ingesting less salt (by not adding any to the food) actually result in one hanging on to the electrolytes? So… how does less salt equal less excretion of salt?

(Old Baconian) #50

My guess: it is not that they are ingesting less salt, they are simply getting enough in food, not to need to add more. It may have something to do with how much more meat people eat on carnivore, than people typically do on a regular ketogenic diet.

(L. Amber O'Hearn) #51

Unless I’ve misread (which I might have!), there was no adaptation period. It’s well understood --I think for at least a century-- that it takes about three days to adapt to glucose enough to pass a GTT. It’s similar to ketoadaptation, but the other direction.

(L. Amber O'Hearn) #52

Right. There’s plenty of sodium in meat.

(Old Baconian) #53

My impression is that fat-adaptation/ketoadaptation causes no real loss in the ability to metabolise glucose. I suspect that this is a really ancient evolutionary adaptation possessed by almost every cell. I’ve always assumed that “metabolic flexibility,” therefore, is when we are fat-adapted, since then we are capable of metabolising both glucose and fatty acids.

Surely, the loss of metabolic flexibility comes when we damage our mitochondria and those other cellular pathways deactivate themselves, for lack of fatty acids to handle. I can’t imagine a cell losing its ability to metabolise glucose, since glycolysis can occur just about anywhere in the cell.

If I’m wrong about any of this, I hope someone will correct me. This is my understanding from the lectures I’ve watched and the reading I’ve done since going keto, but I am by no means an expert.


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.

(Old Baconian) #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.

(Old Baconian) #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.


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.