Andrew, this sounds like a catch 22 to me. You need to be fat adapted to be able to fast without hunger, but you need to fast to get your insulin level down and be fat adapted and not hungry! Do you just fast and push through the hunger to get there?
No weight loss on keto
BrianL
(Brian )
#14
Generally an overnight fast—12 hrs. That is standard for checking cholesterol and fasting sugar levels also. Good luck!
BrianL
(Brian )
#15
It is really taking in enough calories in fat to provide your body with energy until the insulin level drops. According to Dr. Fung, the fasting insulin should be lower than 13 to fast without feeling bad. It is confusing stuff, you are doing great especially if you are in ketosis.
devhammer
(G. Andrew Duthie)
#16
You would need to check with the lab on that question. Insulin is one of the tests that is in the package of tests I get run periodically, and they usually request that you fast overnight. Again, though, check with the lab to be sure.
devhammer
(G. Andrew Duthie)
#17
As I understand it (as an interested layman, not a doctor or scientist), when you fast, your insulin drops pretty quickly. The first 24-36 hours can suck, likely because that’s the time when insulin is still high enough to prevent access to fat. After that, it gets easier, again likely because your insulin drops low enough to allow access to body fat. So it may be helpful to supplement pure fat (coconut oil, butter, and the like) during the first 24-36 hours to make it a little more tolerable. The goal is to lower insulin, so you don’t want to consume carbs or protein, as both will raise insulin.
Hope that helps!
richard
(Richard Morris)
#18
I have an HbA1c of 5.3 and I am really quite insulin resistant. In fact I have a fasted insulin of 13.8 mIU/l when I take metformin and 19.8 when I don’t. So your level of chronic glucose control, is not a good indicator of how much insulin you need to keep that glucose under control. Some people have an HbA1c of 5.3 and a fasted insulin down around 2 mIU/l so they would be insulin sensitive.
The reason that is a problem is that how much insulin you make when you eat nothing determines how much energy you can extract from body fat.
Along the top you have how much insulin you are making. Let’s say you eat nothing, and your fasted insulin is 2. So you have access to almost 100% of your possible energy from body fat. You can eat nothing and you will burn body fat (if you have enough).
OK Let’s say that when you eat nothing your fasted insulin is 14. Now you have access to only a few percent of your possible body fat release of energy. But you can’t burn nothing you have a brain to keep fed that will need around 600 kCal of energy every day, and you need to spend several hundred kCal just moving sodium out of cells and potassium into them, and breathing and beating your heart, and other stuff. You probably have a minimum requirement of energy around 2000 kCal/day. So where do you get your energy? You burn the only other available energy source - protein.
So clearly how much insulin you make is key to what kind of diet you eat.
Let’s get away from fasting and look at 2 low carb diets. One where you get the minimum protein requirements for body maintenance and glucose production, and then get all your energy from fat - we’ll call that diet “Calories from Fat”. The second diet is one where we restrict dietary fat and increase protein so that we compensate for that extra protein lost for energy - we’ll call that diet “Calories from protein and body fat”.
The first diet we are using protein to build our bodies (and make glucose), and fat to run our bodies - either energy in fat on your plate, or energy you have previously stored in body fat. Your body should tell you when it can’t get enough energy from body fat by making you hungry, and when it has had enough it should tell you it is sated. So the ratio of plate to body fat will be managed by your body which is sampling every possible factor all the time and adjusting your levers. If you are insulin sensitive you won’t need much energy on your plate, if you are insulin resistant you’ll need more. Your weight loss rate will be determined by that insulin status too. And the longer you are at a low insulin level the greater your insulin sensitivity. But it can take up to 10 years.
OK let’s consider the 2nd diet. In this diet we are also using protein to build our bodies (and make glucose), but now we are also getting energy from body fat and dietary protein and the small amount of fat on our plates. Obviously the calculus changes based on how much insulin you make. If you are insulin sensitive then when you reduce your plate fat, your body fat steps in to perform it’s job of supplementing your energy in a famine. If you are insulin resistant and you can’t access much body fat then you will need to eat more protein to prevent your body scavenging lean mass.
3 things happen when you eat more protein.
- You make more insulin - so if you are insulin resistant, you will make more for longer. It will affect access to body fat, it’ll also affect hunger as if draws down glucose, and you eat more protein.
- You make fewer ketones (TLDR;
Insulin, Oxaloacetate, 
Acetyl-CoA). Fewer ketones mean you need to make more glucose for your brain - you need more protein. - You make more ammonia. This is quite toxic, so normally we convert it into urea and urinate it out.
Someone who is insulin sensitive can probably thrive on this kind of diet. They dramatically draw down body fat until they have so little their abdominal muscles show up to party.
Someone who is insulin resistant however will end up having to burn more protein to make up their energy shortfall, and that can cause them to need to eat increasing amounts … and then we get to urea synthesis.
Normal humans saturate their ability to make urea at roughly 3.3 g/kg LBM of dietary protein.[Souirce: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC333026/]. In other words above that you slowly build up ammonia until it kills you.
A West Australian trainee paramedic and amateur body builder died a few weeks ago from ammonia toxicity. It turns out that she had a hidden Urea cycle disorder which means her ability to make urea is not as high as most people.
Most people with this disorder are diagnosed as children so her case must have been mild enough to escape detection. She had apparently been on various high protein diets without a problem until she went hard on a protein sparing modified fast to cut for a body building competition and then it was discovered that she had a problem - too late.
7999 people in 8000 don’t have a Urea Cycle disorder, they can likely handle up to 3.3g/kg LBM just fine. But it would still be a good idea on any high protein diet to get a blood test regularly for ammonia in circulation to see if it is building up.
There are experts online recommending 3.5-4.4 g/kg LBM as optimum nutrition … I would say that depends on whether accumulating ammonia is considered an optima.
The TLDR; version is … it depends on your insulin status. Try increasing protein and see if it helps. Might be an idea to ask your physician to add a blood test for serum ammonia every couple of months to make sure you are under your personal threshold for urea synthesis. Certainly if you are above 2.5g/kg LBM I would. But most people appear to tolerate high levels of protein in the range from 1.5-2.5 g/kg LBM.
Available calories per day per pound of body fat?
richard
(Richard Morris)
#20
You’d be wrong. There are a lot of people on high protein diets here. Our Zerocarb crew for example. When I did Atkins Induction in 2004 I went high protein because I was still fat phobic so I ate mostly lean proteins and greens. I ended up giving that away after 2 years because I was feeling nauseous all the time, and craving carbs. I recognize those now as respectively … ammonia accumulation, and reactive hypoglycemia.
akirby83
(Adam Kirby)
#22
Hmm, what would such a diet translate to? Would any kind of zero carb meat diet even get to 3.3g/kg LBM, or do you have to be guzzling down protein shakes as well? I’ve been doing mostly meat and reaping good benefits in weight loss while feeling fine, but now you got me kinda worried, lol.
richard
(Richard Morris)
#23
Yeah it’s pretty much chicken breast, shellfish, egg whites and protein shakes.
I did Burn Fat not Sugar’s macro calculator and it suggested for me to lose weight to eat an amount of protein that I later calculated is around 3.32g/kg of my lean mass. So those levels are definitely being recommended online. But I suspect most people who recommend that others eat those ranges, are probably themselves eating 1.5-2.5 g/kg LBM.
akirby83
(Adam Kirby)
#24
Ah, so bodybuilder cutting diet. Yeah that’s not me, I eat fattier cuts of meat, e.g. bacon, steak with fat, also eggs cooked in bacon grease. No protein supplementation. I feel very satiated for most of the day eating a single meal, so hopefully that’s on the reasonable side of a higher-protein diet.
richard
(Richard Morris)
#25
There’s such a broad range of human responses to minimum amounts of protein, I wouldn’t be surprised at all if we all had different maximum amounts, and ideal amounts. We have to find out for ourselves what works for us.
My only objective is to make sure that everyone gets at least the minimum adequate for nitrogen balance, and stops short of the maximum where ammonia intoxication becomes an issue … and then finds out what amount within that range works for them.
Bellyman
(Brian)
#26
Excellent point, Richard. Even defining the terms, “moderate” or “high” or “low” can be quite the challenge. And it will mean something different to the 140 pound lady who wants to lose 10 pounds, the 500 pound man who needs to lose 350 pounds and the 185 pound bodybuilder that wants to get ripped.
Isn’t this fun? LOL!!
ksubz
(Kartik)
#27
@carolT l I just am sold on the metabolic and other tertiary benefits of the ketogenic diet as a long term strategy.
@BrianL That is a great data point.
ksubz
(Kartik)
#28
@richard Thank you - really well though out, referenced and elegant response to this conundrum of mine. I wish there was a decision tree diagram that encapsulates all the lovely insights you provided up top. I will get a Fasting Insulin test and proceed from there. Thanks to everyone else as well for their thoughts.
ksubz
(Kartik)
#29
@richard Just a quick follow-up that has me in a conundrum.I got a fasting insulin test done and have an 8.8 which is bang in the midle of that normal range. Not the 2 I had hoped for but thankfully not more than 10 either. In such a case, which would be more beneficial - LC Higher Protein or continue with LCHF? Obviously, all the things you suggested to improve insulin sensitivity will be things I continue forming habits around but curious to pick your brain on this a bit since I seem to think I am in no man’s land when it comes to weight loss.
KetoLikeaLady
(What The Fast?!)
#30
Where do you live?!?! I’m dying to find an IM doc who knows keto.
PaulL
(Bacon is a many-splendoured thing)
#31
Dr. Phinney says that when stuck like this, the first thing to do is to reduce or eliminate carbs. The second thing to do is to eat more fat. If you increase protein past a certain limit, your body will start converting the excess into glucose, using a process called gluconeogenesis. This glucose will stimulate the pancreas to secrete insulin, which will knock you out of ketosis. The recommended limit is 1.0 to 1.5 grams of protein daily per kilogram of lean body mass. If you don’t eat fat until you’re no longer hungry, the body thinks it’s starving and lowers your basal metabolic rate to compensate. This is why, Dr. Phinney says, it’s important to eat fat to satiety.
BrianL
(Brian )
#32
Hi, Andrea…I am in San Diego, CA…I am trying to talk to other docs in the area to get them on board with Keto. I hope that there will be a lot in the future!