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The Science Behind The "Low Carb Flu", and How To Regain Your Metabolic Flexibility
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April 27, 2011
8:52 am
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Caution: contains SCIENCE!

Important note! For a more up-to-date exploration of this subject, I strongly recommend my 2013 AHS presentation "What Is Metabolic Flexibility, And Why Is It Important?"

Most of us who eat a low-carbohydrate diet—Paleo, Primal, Atkins, or otherwise—experience anywhere from a couple days to a couple weeks of low energy as we adjust to it, an experience known informally as the "low carb flu". And some people never seem to adjust.

Here's why—and here are some ideas that might help you if you're having trouble adjusting!

Note that low-carb isn't an objective of : it's just the usual…

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April 27, 2011
10:29 am
HeMan
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After about 10 years of being paleo-ish, I've found my body has become quite adaptable, even when I get sloppy, or eat a tonne of carbs.

I do the intermittent fasting out of preference and never seem to be hungry, even after I've had a high-carb day (sometimes gorge on potatoes/other root veggies/ice cream) or gone too hard on the wine (alcohol metabolism is a third pathway and takes precedence over all others)

It drives people nuts that I can go the entire day and never need to eat.

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April 27, 2011
10:47 am
Alyssa
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HOLY CRAP. That was LITERALLY my reaction to learning why exercise is important in this article, and also my reaction to learning about what happens when one's body adapts to ketosis. This was an extremely informative article, & I'm looking forward to your future articles! :D

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April 27, 2011
2:56 pm
Aaron Blaisdell
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Awesome post! I have similar experiences as HeMan mentioned in his comments. I typically IF by eating in an 8-hour feeding window during the day, have stable energy and mood regardless of for how long I've fasted or whether my previous day was a high-carb day (which I do occasionally just for the pure pleasure of it), or a low-carb day, or anywhere in between. I've gravitated towards the Perfect-Health Diet even before I discovered the website and book by the Drs. Jaminet.

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April 27, 2011
5:36 pm
Samantha Moore
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Excellent, clear post. Thank you!!

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April 27, 2011
5:43 pm
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Anand: 

Thank you! This was a long and difficult one to finish, because I kept getting hung up explaining things.  Really it should have been about three different posts.  I'm glad it's understandable, even though it's long.

Asclepius: 

Absolutely! I feel the same: I'll often eat one big meal a day, in the evening...and I'm definitely not keto-adapted, so it's purely a function of metabolic flexibility and being able to slip seamlessly into beta-oxidation. That's why I think a lot of people are making the transition too hard on themselves.

HeMan:

It's liberating to not have food run your life, isn't it?  One wonders how humans ever got anything done if we always got faint and weak three hours after we ate.  Answer: we didn't, because that's not how our metabolism is supposed to work.

Alyssa:

Thank you!  I learn a lot writing these articles, and I'm glad I can pass some of that knowledge on to you.

Aaron:

This is fascinating: I think quite a few of us are converging on a similar set of eating strategies.  Don't eat breakfast unless you're hungry (which, if you eat big meals in the evening, you're probably not), eat about 1.5 meals per day in an 8-hour window (or less), eat plenty of animal fat, and so long as your carbs go along with your meal(s) you don't have to watch them so closely.  

I'll probably write an article about this in the future.  Thank you, Asclepius, and HeMan for your insights!

Samantha:

I appreciate the support: it helps to know that people find my articles valuable.  The best thing you can do in return is spread them around!

JS

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April 27, 2011
7:24 pm
Katie @ Wellness Mam
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Another great article, as always. I'm passing this one on to my "have to eat granola bars to keep the blood sugar constant" friends!

I've noticed a similar experience as you guys mentioned above, with not being hungry for all three meals a day, and usually skipping at least one (and this is while pregnant!). I've done the opposite though. I love breakfast, so I eat a big meat and veggie omelet and then often am not hungry until later in the day, if at all. If I do get hungry, I eat a big salad with some meat/homemade dressing in the early evening.
It really surprises me how the ability to go without eating for more than a few hours really upsets some people!

Also interesting to note... This is my first truly low-carb grain free pregnancy, and it has been carefully monitored by my doctor and midwife because of a high risk delivery last time. My blood test results are all better this pregnancy (iron, vitamin D, etc) and I just completed a 2 week monitoring of blood glucose for gestational diabetes (since I wouldn't drink the glucose solution) and all levels are in excellent ranges. (I also did this with my last pregnancy, and my fasting and 2-hour readings were at least 10 points lower). So, despite the fact that I'm not eating unless I'm hungry (novel concept!) I seem to be healthier and baby is doing wonderful. Funny how that surprises the doctor...

I've been working on a post about the "low carb flu" also, and will definitely link to yours for a more in depth explanation!

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April 27, 2011
8:56 pm
Dana
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It's funny but even with ketoacidosis, people focus on the ketones as the cause of the problem but actually, in diabetics, what they really need to be worrying about is that uncontrolled blood sugar--the ketones are there to begin with because the body just can't do anything with the sugar, for some reason. Ketosis occurs in the absence of sugar availability and, well, if you can't respond to your own insulin anymore, that's the same thing as having no access to sugar.

Could be that the massive amount of ketones is causing the metabolic acidosis but if they don't get the sugar thing solved they won't solve the extreme ketosis thing either. But I wonder whether the glucose is not also contributing to the acidosis. I don't know enough about this to say.

I don't mind being in ketosis and in fact appear to switch back and forth into it without much problem, not much more than a day or two of grouchiness. I have a tendency to migraine and/or cluster headaches, which ketosis seems to help on top of letting me burn off my excess body fat. I don't want to have to run ten miles a day to lose the fat--that's ridiculous. I should be able to do that while sitting down, it'd suck if I broke my leg on that ten-mile run and then couldn't lose weight for six weeks while I healed up! People don't think about that when they over-focus on exercise as a weight loss method. Exercise is vital for health, obviously, but people who are temporarily or permanently disabled need to be able to not use it as a calorie-burning crutch.

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April 28, 2011
1:38 am
Asclepius
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One thing I thyink you might find intersting. Last year I wanted to test how far I could go fasted.

I completed the 'Welsh 14 Peaks' completely fasted. This involves summiting all 14 of the mountains in Wales over 3000 ft within the space of 24 hours, without using any form of transport (bar walking/running). The total length is about 24 miles, but the walks to the start point and down from the finish point take it to over 30 miles in total. Total ascent is just over 12,500ft! By the time I had completed it I had fasted for over 30hrs (IIRC). You can read more here. The ability to cycle fat easily played a massive part in my success.

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April 28, 2011
1:06 pm
Feeling constantly t
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[...] from the meat and cheese. This article is long, but very relevant to what you're experiencing: The Science Behind The “Low Carb Flu”, and How To Regain Your Metabolic Flexibility &#45... Reply With Quote   + Reply to Thread « Previous Thread | [...]

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April 28, 2011
6:12 pm
julianne
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Before I discovered the paleo diet, I was a zoner and zone diet instructor. Having taught many people how to zone and watched them through the initial few weeks, I also observed nasty transition symptoms in about 20% of people. Yes they switched from high carb to lower carb 30% carbs with calorie reduction, however this is far above the ketogenic threshhold. I.e eating 90 - 150 g carbs day. The symptoms were identical to low carb flu. Barry Sears has a different take on this. He says it is a release of archidonic acid (AA) from fat cells, from a previous high carb + omega 6 diet. This diet leads to a large amount of AA sequestered in fat cells. The sudden release leads to production of the inflammatory eicosanoid hormones which give the following symptoms - headaches, constipation, fatigue, aches and pains and more interestingly an increase in any inflammatory condition the person suffers from. Increased allergies, eczema or asthma flare up or increased joint pain if arthritic etc. Al of these are linked to overproduction of AA derived eicosanoids. There are two ways to reduce it - 1. add more carbs - it stops the fat loss or slows it down, 2. add a high dose of omega 3 which counteracts the inflammatory hormones.

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April 28, 2011
9:25 pm
» Do Calories
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[...] it is their mission to store fat and they don’t want to let it go.” In people with a healthy flexible metabolism, the collection of fat cells is more like a gas tank in a car, simply a reservoir of stored energy [...]

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April 28, 2011
11:59 pm
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Katie:

That's very interesting.  My mother, who is eating paleo-ish, does exactly the same thing: she eats an omelet for breakfast, and then nothing until dinner.  

Maybe this is a gender thing: can any of my other female readers offer insight?  What is your meal schedule?

Congratulations on your soon-to-be larger family!  I'm glad to hear everything is going well.  And it sounds like you're not getting bizarre food cravings like many pregnant women, which indicates that you're probably nutritionally replete.

Dana:

Interesting point about ketoacidosis!  I don't know enough at this point to comment usefully, either...but it seems like ketoacidosis is just the ketone version of high blood sugar due to lack of insulin.

Re: exercise, that's exactly my point.  Exercise isn't about burning calories: even if you do burn them, you get hungry and replace them.  It's about maintaining metabolic flexibility.  And I think this is why the more sedentary you are, the more you benefit from low-carb: you're forcing yourself to burn fat by simply not providing carbs instead of depending on metabolic flexibility to switch over.

Asclepius:

That's an excellent writeup...strong work!  I've done similar epics on my mountain bike (about 11K vertical feet and 60 miles, on rocky singletrack), but never on foot...and certainly not fasted.  I'll have to try a fasted epic sometime.

I have some intriguing data that suggests high-fat diets might increase the threshold of beta-oxidation (in other words, you're able to burn fat more quickly), but to my knowledge, no long-term studies have been done on this.  Anecdotally, though, it does seem like we can raise our maximum fasted output via LC/HF dieting and fasted exercise.

Julianne:

That's very interesting: thanks for sharing the data!  

I wonder about the Sears theory, though: if it's purely a release of AA from fat, shouldn't it happen with every weight loss plan?

My biggest question, though, is: let's say you're burning a few hundred calories of your own fat each day.  AFAIK it won't be any higher in LA or AA than whatever foods you were eating before that caused you to store the LA and AA in the first place!  Right?  Maybe if you were on an extreme low-fat diet before...but human fat is much like lard, perhaps 11% polyunsaturated and mostly LA, as compared to most "healthy" vegetable oils that are far higher in LA...

I'll have to look into this some more, but right now I'm not sure I buy into that theory.  Any insight you have is appreciated.

(Julianne writes the blog  Paleo Zone Nutrition, by the way.)

JS

Thank you all for interesting and constructive comments!  I'm glad to have attracted a constructive and erudite readership.

 

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April 29, 2011
1:18 am
julianne
Guest

Interesting thoughts. Well thought I'd google 'new diet headaches' and found that there were a number of people asking about their headaches on a lower cal diet, (not low carb, just standard low cal). And same kind of pattern, start off fine for 3 - 4 days then start feeling bad / headachy etc (hence the common notion of 'detoxing' when going on a diet)
http://www.rawfoodexplained.com/symptoms-during-dietary-transition/some-unpleasant-symptoms-and-their-causes.html

Also I saw a study some time back that showed toxins stored in fat cells were released when dieting. Can't find it right now - but this could also cause problems.

If not AA (or perhaps it is LA release) - why then do inflammatory symptoms increase like an eczema or asthma?

Why do only about 25% people get these symptoms? Even though they had the same change in calorie / carb on the new diet?

I'll have to back and research this some more.

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April 29, 2011
1:36 am
julianne
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About the eating - I often have a big breakfast then nothing until dinner.

Oh and I just googled jenny craig and weightwatchers and headaches and found people reporting transition symptoms similar to "low carb flu"

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April 29, 2011
1:40 pm
I am NOT My Scale (A
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[...] Thanks for the rant, it's a good reminder for me too! I just read this post yesterday, and it also helped immensely. Now I know I am working on my metabolic flexibility and [...]

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April 29, 2011
3:37 pm
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Julianne:
 

I think you're on the trail of something.  Thank you for looking into this, and please let me know what you find out!  Though I'm skeptical for the reasons above, I'm open to a mechanism by which Sears is right after all. 

I see reports of similar but more severe reactions from people who are fasting…but it seems to start more quickly and go away more quickly, usually in a couple days.  Whatever it is seems to be related to the start of fat loss, and it seems to also cease even though fat loss hasn't ceased (which is why I'm skeptical of "detox" theories).  Hmm…..

 

Back to the mealtime subject: I'm not working on a large data set here, but it seems like the women who eat less than the traditional "3x a day plus snacks" are eating breakfast/dinner, whereas the men are eating lunch/dinner or afternoon/late dinner.  I'm filing this under "things that I don't understand yet".

JS

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April 29, 2011
6:48 pm
Beth@WeightMaven
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I made this comment over on perfecthealthdiet.com, but my desire is to moderate my carbs at a level that's healthful, but flexible.

It may be the addict in me, but I'd like to periodically have a higher carb meal without it being the equivalent of an OGTT on a VLC diet ... with the kind of resulting BG spikes that will get you diagnosed as a diabetic!

I've been tossing over the idea of paleo meets carb addict's diet ... you moderate carbs a la paleo, but you keep the bulk of the carbs/starches to one meal a day.

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April 29, 2011
6:58 pm
Beth@WeightMaven
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Re AA and stored body fat, a piece I think is interesting is that LA derived GLA is easily converted to AA via insulin's upregulating delta 5 desaturase.

So it's possible that people losing weight who aren't insulin resistance experience weight loss differently from those who are (who presumably have higher serum insulin).

I've been losing a little over 2lbs/week for a while, and while I don't still have low-carb flu or headaches, I most definitely am dealing with joint pain (my age doesn't help matters). I've recently begun doing fish oil again. And because 6 months of paleo only got my fasting insulin down to 12 (from 25), I got my sedentary butt off the couch and began doing some Body by Science workouts. Will recheck the insulin in a couple months.

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April 29, 2011
7:56 pm
» Do Calories
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[...] it is their mission to store fat and they don’t want to let it go.” In people with a healthy flexible metabolism, the collection of fat cells is more like a gas tank in a car, simply a reservoir of stored energy [...]

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