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The Science Behind The "Low Carb Flu", and How To Regain Your Metabolic Flexibility
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February 6, 2013
3:12 pm
Isabela
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Just from my own experience: I read in the newest Atkins book that the headaches associated with low-carb flu are actually due to a lack of salt. Glycogen burning eliminates a lot of water, washing out a lot of salt and other minerals in the process. Seems that an extra 1/2 teaspoon of natural salt (sea, Himalayan etc) a day would alleviate symptoms.

And, a few weeks ago I went VLC, and for the first time I had a bad headache associated with it. But after a whole day of suffering I remembered the salt trick - ate the salt sprinkled on some cucumber, and consequently drank a bottle of water. The headache disappeared in a few minutes.

February 7, 2013
7:43 pm
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Isabela:

I've seen the same point made by Dr. Eades, so I'm sure it's worth a try.

JS

February 10, 2013
8:28 pm
Max
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Great read! I was wondering two things:
First, does it necessarily always take a long time to transition into ketosis, or is that just coming from a high-carb background? From what I understand via Lyle McDonald, it can be achieved in a few days, with moderate aerobic exercise (to not deplete muscle glycogen) to speed the process.
Second, any thoughts on the cyclic ketogenic diet? I'm going to check it out soon, just trying to make sure I'm low-carb adjusted first (obviously 'eating like a predator' throughout the entire process). These may be interesting if you haven't read them yet (first one is where I'm basing this comment off of…)
Cyclical Ketogenic Diet and Exercise Performance
Guide to Ketosis

February 11, 2013
12:13 am
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Max:

Ketosis happens fairly quickly: even during the overnight fast, if you're eating relatively low-carb to start with.  

Keto-adaptation, the process by which previously glucose-dependent tissues (e.g. the brain) adapt to running primarily on ketones, is the process that takes several weeks.

CKDs are a well-established method of losing weight.  The theory is that periodic carb refeeds maintain your insulin sensitivity (so your muscles are more sensitive to the effects of insulin, which drives protein into them as well as glucose and fat) and some amount of muscle glycogen (so your athletic performance doesn't suffer too badly).

Obviously you will not keto-adapt on a CKD, but that's not the point.

JS

February 13, 2013
12:03 am
Kratoklastes
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Maybe I'm being a bit hyper-sensitive, but I threw up in my mouth a little bit when I read

'“You can get plenty of energy from fat, but you have to go into ketosis to do it” are—like most nutritional claims made by veg*ans—complete bunk.'

I'm a vegetarian (I eat some eggs and some good [or great] cheese like Reggiano, Strong Cheddar and Roquefort), and I have never ever heard that particular nonsense claim promulgated by any vegetarian source that I respect.

I eat a high fat, high protein diet (extra protein from 93% whey protein isolate - however if budget were no constraint I would switch to SunWarrior raw-food vegan protein), and can maintain a 225lb frame with a RHR of 58, a VO2Max of 46 and "1.3x BW for 10 bench" strength (think "Mike Mahler, but prettier" - MM is the 'Aggressive Strength' vegan kettlebell guy)... and I just turned 48, yo.

(Yes, 225 is too fat at 6'1": I've re-started IF to get my lard ratio back down to where it was when I was a teen - LeanGains style ["train fasted, train hard, no mercy SIR"]).

Anyhow... basic point: trotting out some vegan or vegetarian straw-man is really irritating to us non-religiotard type vegetarians - particularly those of us who are veggie for reasons other than health (our household is veggie for reasons of animal welfare - the health benefits are secondary - and we both have strong research backgrounds so we have refined our diet to be varied, healthy, nutritionally complete and delicious).

I am always amused by folks who think they're onto something good while getting their protein from some piece of rotting carcase at 25-35% protein [max] - i.e., lower than Parmesan or Reggiano - and BV of about 80 and PDCAAS of 92... compared to my 93% WPI with BV of 104 and PDCAAS of 100, bitchez!

Not all vegetarians are weak and skinny - and The Lovely (also vegetarian) is slim but not weak.

How many of y'all have been with the same Lovely for 20 years... and she's still the same size now as when you met her? For the record: she's 5'7", 108lb, RHR 52 and Vo2Max 48... and a barrister (which has nothing to do with coffee: outside the US it's a type of legal Jedi-Ninja).

February 15, 2013
2:28 am
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Kratoklastes:

"That I respect" is the key phrase here. 

I've had (vegetarian) authors of published reference books tell me with a straight face "Nothing can be burned for energy without first being converted to carbs."  Dr. Oz still repeats the "Meat rots in your colon" myth on Oprah's website, last I checked (which was, admittedly, a while ago).  Then there's "[Glucose can be stored, converted, or burned,] but WITH FAT however, only ONE outcome is possible – fat storage"...which I just responded to earlier today in another thread!

It sounds like you have a more realistic understanding of nutrition.  

However, I'm seeing some fanaticism creeping into your language, e.g. "some piece of rotting carcase at 25-35% protein"

First, as I've pointed out before, all living foods start rotting once you kill them in order to transport them to where they'll be eaten.  Vegetables and fruits rot, too, but that's certainly not a reason to stop eating them!  In fact, I view it as a positive: anything that bacteria won't eat probably isn't food, and we shouldn't eat it either.

Second, the 25-35% protein in meat is because of water content.  Water is found in real foods.  Add some water or milk to that whey protein in order to actually consume it (I know you're not eating it dry, as it turns to glue in the mouth), and suddenly it's much less "protein-dense" than the meat.  It's also much less nutrition-dense, as fatty meat contains a host of essential fat-soluble vitamins and cofactors not found in purified ingredients like whey protein.

I'm not against vegetarianism per se: it's possible, though difficult, to eat a nourishing vegetarian diet.  (Veganism is a different matter: it's evolutionarily incompatible and inherently malnourishing.)  So I'm sorry you were offended...but I'm frequently stuck dealing with bunk nutritional claims, and that spills over into my articles sometimes.

JS

February 15, 2013
4:31 am
Indiana
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Kratoklastes said:

How many of y'all have been with the same Lovely for 20 years

18 years.  He and I are very happy together=)

February 19, 2013
4:38 am
Thomas
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Hi,

thanks for that still great note. I undersant the ketosis state I call now "the bear diet" (meat, fish and berries). But i am wondering about reducing carb for stillness of mood and energy level for an average active thinking and training guy.

I am confused by the words : If we have excess glucose in our bloodstream, our muscles will burn it first, because it’s toxic. But eventually we run out of glucose, and that’s when our bodies need to switch over to beta-oxidation—burning fat. The ability to switch back and forth between the two processes is called “metabolic flexibility” in the scientific literature.
Because the word "switch" make me thin that beta_ox of fat and glycolis won't occur in the same time. this would induce that as your brain require glucose, if you couldn't have beta_ox while glucose in blood from carbs then you have to use gluconeogenesis to feed your brain.

I want to burn Fat from food as a first source of energy when possible and feed my brain from carbs from food not from gluconeogenesis. Indeed i guess that gluconeogenes is expensive in terme of energy to get glucose. you confirm it is possible?

February 19, 2013
5:50 am
Madison, WI, USA
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Thomas,

 

As far as I understand it, your brain ONLY requires glucose IF it's used to burning carbs.  The brain's glucose requirement is ONLY conditional.  The brain can run on ketones just fine.

 

Jen

"Often we forget . . . the sky reaches to the ground . . . with each step . . . we fly."  ~We Fly, The House Jacks

February 19, 2013
4:34 pm
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Thomas:

An individual cell will generally be using either fat or glucose for energy, because oxidation of one inhibits oxidation of the other.  However, your body is comprised of trillions of individual cells, so it's quite possible for some of them to be running on fat while some run on glucose.

For instance, some of your muscles might be running on glucose (from stored glycogen) because they're putting out max effort, whereas others are running on fat because they're not putting out max effort.  And your brain runs on glucose (including products of glucose metabolism, like lactate), or ketones, no matter what you do, because fats don't seem to cross the BBB.  

Furthermore, your muscles don't have to be running on glucose to absorb it.  If they're low on glycogen and insulin is present, they'll suck up blood glucose so they can synthesize more glycogen and build up their reserves.

Result:

For a metabolically flexible person, fat is your source of energy whenever you don't have high blood sugar (from having eaten a bunch of carbohydrate).  So it's probably better to eat your carbs once a day, as opposed to snacking on them throughout the day (which will also make you hungry)...and they seem to help people sleep better when they're eaten at dinner.  

Your individual need for carb will vary depending on your activity level and metabolism...some people do fine with lots, some people find that anything over ketosis levels makes them gain weight.  So experiment and find out what works best for you.

JS

February 22, 2013
9:04 am
Thomas
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Thanks a lot for your answer that explains things well.

As I won't go to a kestose adapted body, i have to experiment around the carbs doses i request as you suggest.

Once i found the good path i would come and report here!

thomas

March 11, 2013
7:25 am
M. Schmidt
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Very enlightening ! Weigth loss is my main goal for now and I am still researching this whole healthy lifestyle deal (having eaten practically exclusively trash since 2005 and paying for it now). This has put me substantially closer to favoring paleo over vegan or any other lifestyle. I am deliberately using the phrase "lifestyle" here, because I don't want a fix or a short-term solution. I want to redefine my body and my self (however cliche that sounds ;]).

I have only one question though : How exactly would I measure my current RER level ? Is there an easy way ? I couldn't find anything on this topic here and google also didn't prove to be of use.

March 12, 2013
12:49 am
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M. Schmidt:

You have the right mental model.  When evaluating possible life changes, it's best to ask "Is this something I can sustain, and enjoy, for the rest of my life?"  

RER is not a test that any health practitioner can prescribe or perform, to my knowledge.  AFAIK, it's typically performed in sports physiology labs at universities.

JS

May 4, 2013
4:05 am
Danny J Albers
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Very good read J. Thank you

This is surprisingly the first time i have seen this article from you.. not sure how I missed it.

At Primal North we have coined at term "Low Carb Limbo" which describes the person eating to few carbs to support their daily activities, but to many carbs and protein to obligate the neccessary blood ketone level that will have your muscles using ketones preferentially over glycogen.

This misguided approach will eventually cause all sorts of issues and it is why a blood keto meter is not optional but essential for anyone practicing athletics along with a ketogenic diet. It is a perpetual "low carb flu" as your energy demands are not met with carbs, and not met but having high enough blood ketones.

You are also about the only person I have seen outside of Phinney and Volek who correctly makes a distinction between fatty acid oxidation and keto adaptation. We continually see the term "fat adapted" and people assume that means they are keto adapted. Of course they are not and this assumption hurts them as they simply shut off all carbs, up fat, and continue to exercise without adapation period.

I submit in my "Low Carb Limbo vs Keto Adaptation" article that all humans are already "fat adapted" and able to oxidize fat when carbs are unavailable. That what we mean by "Fat adapted" is that we have actually worked on the ability of that system to ramp up as needed to much greater amounts than the average high carb eating member of the sedentary general masses.

Anyway your article has me rambling, it was a worthy read. Thanks.

May 13, 2013
1:36 am
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Danny:

"Low Carb Limbo" is exactly the state I'm talking about, and is absolutely to be avoided. As you mention, many people are not eating enough carbs to fuel a glycolytic activity state, but too many to ever keto-adapt.

And I've also been puzzled by the ongoing confusion between "fat adapted" and ketosis: "fat adaptation" is metabolic flexibility, whereas ketosis is...ketosis.  Met flex is a simple concept and key to understanding metabolic dysfunction -- but with the exception of Mike T. Nelson (who is also presenting at the 2013 AHS), no one else seems to be familiar with the concept, let alone applying it to the observed reality that low-carb dieters face, whether paleo or otherwise.

Note to readers: here's the Primal North page on Low Carb Limbo, which is definitely worth reading if you are physically active and want to stay on the ketosis side of the fence.

JS

July 18, 2013
3:30 pm
Dana
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Glucose is an anaerobic fuel, not aerobic. Its use as a cellular fuel predates the existence of multicellular organisms. (Insulin, in fact, is one of the oldest hormones on the evolutionary timeline, and can be found even in simple worms.) There are two types of fuel-burning that can be done by cells in the absence of oxygen: anaerobic respiration, and fermentation. I'm not a cell expert but from what I can tell from a cursory search, eukaryotic cells (cells with nuclei) tend to use fermentation when burning glucose. Glycolysis can happen in the presence of oxygen, but never *uses* oxygen. Cancer cells tend to favor glycolysis, in fact, because they tend to be unusually sensitive to free radicals and oxidative stress, so they do what they can to minimize contact with oxygen.

This is a really useful post for me, though. One more piece of my personal puzzle because there is a hell of a lot of type 2 on my mother's side and I had trouble with obesity early in my adult life. It seemed to be in response to hormonal changes, but still, certain dietary choices seem to have a better track record with reducing it.

July 25, 2013
11:44 pm
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Dana: 

Strictly speaking, glycolysis is the first step in both aerobic and anaerobic respiration for humans: it produces pyruvate.  

The second step for aerobic respiration is converting the pyruvate into acetyl-CoA and feeding it into the TCA cycle (aka the citric acid cycle or the Krebs cycle, depending on how long ago you took your biology course).  This happens in the mitochondria.

The second step for anaerobic respiration is fermentation, in which the pyruvate is converted to lactate.

Yes, it's complicated!  I've added an (optional) explanation to the article, which might help.  And I'll be covering this subject in more detail in my 2013 AHS presentation.

JS

August 17, 2013
6:47 am
Lake Ingle
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Very informative. I'm assuming you suggest eating the required carbs with complete fats and proteins because of fats sugar spike dampening properties?

August 24, 2013
12:22 am
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Lake Ingle:

Yes, the fats help slow down the spike, but it's also important to eat carbs with protein.  Insulin drives all nutrients into cells, not just carbs, so you'll at least do some good while you're shutting off lipolysis.

JS

November 19, 2013
12:16 pm
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Hello! I enjoy your articles a great deal! A couple of questions about this one, maybe you could offer your opinions:

Doesn't moderate-to-intense exercise always burn sugar, due to the requirements of moving fast-twitch muscle fibers quickly? Can this type of exercise also stimulate beta-oxidation of fats during or after exercise?

Will intense exercise (e.g. HIIT, CrossFit, etc) impair fat metabolism in any way?

Thanks!

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