I'm bringing this here because I've just been reading Jimmy Moore's latest book Keto Clarity. The book contains tons of information and discussion. However, to my way of thinking, it is put together haphazardly, and I'm left more puzzled than enlightened about the process of achieving ketosis, how to measure or assess ketosis accurately, and whether or not ketosis (and only ketosis) is the true key to weight management in low-carbohydrate eating.

Also, the book seems to insist that effective ketosis is achieved only through "moderate protein" combined with high fat.

Calories? Jimmy says this:

I don't believe that ANY aspect of personal nutrition is "naturally managed" in the cases of most people.

The thrust of most of Jimmy's experts seems to indicate that you have to use a calculator for everything and be quite picky about it.

I want low-carb eating to be effective and simple. I think "satiety" and perhaps "hunger" too are often psychological. I want to lose a pound week. These things are just not coming together for me.

So why am I in the war zone? Guess I'm just angry that some advocates of low-carb are making it sound like a miracle cure for everything--and also very complicated to achieve.

Ketosis is achieved when it's achieved. Sometimes I think moderation is a dirty word. Maybe tolerance would be a better word--protein to tolerance, the way low carbers commonly use the word with carbohydrates.

Maybe protein tolerance could be found like this. Keep carbs very low--and protein lower than you'd be comfortable with long term. Say, 40 grams of protein a day, for a week. Plus enough fat to keep hunger at bay. See where your ketones are, blood ketones would obviously be best for this. Then do a week at fifty, a week at sixty, a week at seventy, see at what point ketones plummet. For extra credit, I guess you could try different types of protein, cheese, beef, fish. Anyways, my point is--how much protein keeps a person out of ketosis is highly personal, a methodical approach couldn't hurt. For people who actually need or want to be in ketosis on their low carb diet. I really don't think everybody needs to be.

Somehow Jimmy determined that he needed his protein somewhere between 80 and a 100 grams a day to be consistently in ketosis. I agree it might have been nice if he'd included just how he got there in the book.

With the whole calorie counting thing... even back reading Good Calories Bad Calories... there were a lot of diet trials in the book where people were put on six or eight hundred calorie diets that were low carbohydrate. Taubes asked the question--if a high carbohydrate diet of say 1600 calories leaves people fantasizing about food, constantly hungry, in obvious discomfort, etc.--how come these very low calorie, low carbohydrate diets, don't?

Dr. Atkins didn't toss anything out of the toolbox. Jimmy Moore has sort of softly criticized Dr. Atkins--saying that he missed the importance of restriction of protein for ketosis. He really didn't. In DANDR, on the section on induction, he says to remember that two-thirds of protein can be made into glucose, and only ten percent--the glycerol fraction--of fat. Induction=benign ketosis=nutritional ketosis. I find it hard not to come to that conclusion reading that chapter of the book. He says that some people may need to be very close to induction levels, or even at them--I read this as in nutritional ketosis. And some he advised to go even further--a week of fat fast, at 1000 calories 90 percent fat a day, followed by a week of induction, rinse and repeat until goal, for the very resistant.

He also suggested (I forget in which book), for stalled dieters--the option of switching diets for a brief period. He even suggested a low fat diet as a possibility, although he advised choosing a particular plan and following it to the letter--I think it was either Ornish or Pritikin's plan he mentioned specifically. Potato Hack, anyone? Nothing new under the sun. I don't think he was suggesting jumping ship, just talking about shaking things up.

A low carb diet, disregarding proportions of fat to protein, just avoiding carbs--seems to put me around 170 pounds. To get leaner, I've always had to restrict my eating to some degree. This does usually involve some hunger, but I try to minimize that, try to find ways to hit my calorie goal with minimal hunger. With mixed success. I've done intermittent fasting, a multi-course version of the Warrior Diet including courses of sugar-free jello and broth to extend the apparent eating window, Volumetrics (lots of stewish type meals), high protein, low variety (last fall it was eggs and protein powder. Protein pancakes, protein pudding--four eggs and two scoops of protein freezes pretty well).

I generally drift back up after returning to eating to appetite--but it's a gradual, long term process. I've managed to hold on to about eight pounds of a sixteen pound weight loss from the fall and winter. I think ketosis helped, but it was hard to be as strict as I wanted to be. I've been working building a friend's cottage since the spring. They keep graciously offering me low carb meals. If I was trying to ward off seizures or something, I guess it might have been worth re-educating them. They'll be gone to Indonesia in a few days (they're going to snowbird, six months in Indonesia, six months in Canada, living in that cottage), so I'm going to try and drop a few more pounds again.

I think Jimmy makes the mistake of saying that we're all unique snowflakes , sorry I like Jimmy, but that sure sounds smarmy , and then not applying that idea. Just because intermittent fasting for him only seems to work when it's sort of organic--he's not hungry, so he skips a meal--doesn't mean that a more structured form of intermittent fasting won't work for someone else. And just because just eating to satiety worked for him, without counting calories--doesn't mean that this is the only way to approach this whole eating to satiety thing. Calorie counting can be a good tool. For instance--it allows me to know that if I pour myself a cup of heavy cream, about 800 calories, and drink it straight--it will be pretty filling. Eight hundred calories of peanuts, nuts, sunflower seeds--not so much. Restriction of food isn't the only use for counting calories--it's also a decent measure of just how satiating that food is. I suppose it could take more of a food to satisfy you, without the food actually being fattening for you--maybe I'll "overeat" those nuts one day, and be less hungry the next. That does seem to be the case, actually--unless I still have some nuts left.

Incidentally, ketosis seems to allow me to nibble on nuts, instead of gorging on them. I think maybe ketosis is conditionally necessary to weightloss, there are obvious ways that it might help with binging and especially sugar addiction, and since this isn't the only road to obesity, this particular benefit of ketosis might not be needed by everybody. I don't see it as "is ketosis necessary to weight loss on a low carbohydrate diet?" so much as "under what conditions is ketosis necessary (or at least strongly advantageous) on a low carbohydrate diet?"

THANK YOU, Teaser. Your long discussion is just what I was hoping for, and I appreciate your taking the time.

Since my original post, I've spent more time rummaging around in Jimmy's book. There's certainly a lot of information there, but the bottom line is still the old familiar YMMV.

Ultimately, what works for me will be some dietary design I can live with that keeps the Weight Creep in check. I can cherry-pick the research and the anecdotes. But the main point is: pay attention.

I'm not going to go so far as Jimmy with the hourly blood samples. As long as the trend is steady or downward, I'm doing fine.

Thanks again for the pep talk.

I agree - eating to 'satiety' never worked for me. Apparently I eat for other reasons than to quell physical hunger. Ha.

I'm not a big fan of Jimmy but I will come to his defense on one thing. It's really not his fault that the science behind ketogenic diets is so patchy. It's just the nature of the beast. In an ideal world Dr's would do a bit of researching into each patient's history, have a list of questions answered, do some blood tests and then prescribe changes to a keto diet which was individually tailored. I don't think they can even begin to do that because, I think, they really aren't sure why keto diets work when they do and possibly stop working before a goal is met.

Hi, gonwt (your new nickname). You are not alone in wondering what "satiety" actually means. Many, if not most of us, eat for other reasons, at least occasionally. I could nibble on mixed nuts all day.

I've at least learned to quit eating before the plate is empty. And to load on appropriate portions to begin with. But I've always sat down to eat more because it's "mealtime" than because I feel hungry. These days I find it's rather uncomfortable to feel "full."

All a part of the learning process. Takes a lifetime--and I only have about forty years left (optimistically speaking!)

Eating to satiety isn't my greatest strength either. However, learning how to NOT eat until truly hungry (rather than until some number on a clock says so) is something a ketogenic diet helps me with tremendously.

I've read Keto Clarity (and a ton of other books on low carb over the years) and I'm just not convinced of the "moderate protein" thing.

For one, I believe he misinterprets (or over-interprets) some of his own experts on this point (Bill Lagaos, Thomas Seyfried).

I've also spent a good amount of time in the past few months going back to biochemistry trying to understand protein metabolism and gluconeogenesis.

Here's my (layman's view) of what I think is going on :

On any and all low carb diets our bodies use the process of gluconeogenesis to make the carbohydrates that are truly essential for our bodies functioning. Apparently it's around 130g per day once you're keto-adapted. So if you're eating 20g per day, it's around 110.

And that carbohydrate will be created by your liver from amino acids (primarily, although I read that fat can also be used in extreme cases of starvation). If you have a low protein intake (from following the "moderate protein" advice, for example) then your body will just dip into its stores to find that protein and proceed with the same amount of gluconeogenesis. Those protein stores are your organs, bones & muscles - your lean body mass.

If the protein is available in the blood from dietary intake, it will simply take it from there, because your body of course doesn't want to cannabilize lean tissue unless it must.

Maybe I have it wrong, in which case I'd love to be corrected (and pointed to links/books where I can dig deeper, please!)

But the low carb mainstream authors that have been saying this for a long time are the Eades of course (Protein Power). And there are others, including Volek & Phinney who seem to lean this way too. Perhaps it's the vagueness of the term "moderate" protein that annoys me? Bodybuilding sites recommend amounts of protein that are staggering to maintain lean mass, let alone build more of it, and there is a real order of magnitude difference from what Jimmy recommends in his book.

And for the record, I appreciate a lot of what Jimmy does - I listen to a lot of his podcasts (depends on the guests, I skip over most of the chiropractors and such) and I really liked the great transparency he shared with the first year of his n=1 on his blog. And I do think he's shown that he's open to expanding his viewpoint (early on he was rather anti-paleo, today he considers himself fringe of paleo).

It's a lot lower than 130 a day, I think... that number's suspiciously close to the 120 grams of carb a day mainstream nutritionists are always trying to convince us is the minimum daily carbohydrate we need to fuel our brains. According to Jeff Volek, when ketones go above 1.0 millimolar, we can get more than half of our brain's nutrition from ketones. That drops that 120 grams down to 60. In an intense ketotic state, such as a prolonged fast, that number can go as low as 24 grams of glucose a day, according to earlier studies by George Cahill, one of the the granddaddies of ketones as brain fuel research.

Outside of the brain, cells that require glucose metabolism can get it largely through glucose cycling, where energy is provided by glucose through glycolysis, but instead of being ultimately oxidize, the glucose carbon is broken down into pyruvate and lactate to provide energy, and then recycled into glucose through gluconeogenesis and re-stored as glycogen. Energy from fat is used to fuel that process--so while this adds to the total for gluconeogenesis for the day, it doesn't provide any net glucose to the system.

On a personal note--if a ketogenic diet with insufficient protein and fat to produce 130 net grams of glucose a day constitutes a wasting disease, where lean body mass withers away to make up the gap, that doesn't seem to have manifested yet in my case. Of course, at some point, inadequate protein would be consumed to support lean mass at existing levels, I just doubt that it takes enough dietary protein to support net daily glucose oxidation of 130 grams a day to avoid that point. Can I prove it? Don't know. But has anything been done to prove the opposite, that 130 grams of glucose must be available to the metabolism per day to support lean mass (excluding glycogen)? I think the only real answer we have to this question is eat and see what happens.

That isn't to say some people won't do better on a somewhat less ketogenic low-carb diet.

I do disagree on one point with Jimmy--that low carb diets that are less ketogenic, where enough protein to provide the brain to run mostly on glucose are categorically "wrong." Dr. Atkins advocated both approaches, after all. Induction was "benign ketosis," remember that protein produces more glucose than fat does, etc. After induction, for most people, ketosis was optional--as long as a person was losing pounds or inches.


For the metabolically challenged, he advocated the fat fast. Repeated fat fasts for extreme cases. A week of 1000 calories, 90 percent fat--hard to get more ketogenic than that, and still eat anything. A week of induction--something that would throw the non-metabolically challenged people into ketosis. Rinse and repeat. A sort of intermittent fast, with weekly periods instead of daily. Atkins absolutely includes a form of nutritional ketosis, he just didn't advocate it for everybody, all the time.

A couple of other points.

1- on low carb, the need for glucose goes down due to glucose sparing. check out Alan Couzens's work with triathletes. The more fat-adapted one is, the more glucose is "spared'.

2 - glucose can also be made from fats, the backbone that holds together the triglycerides. But you need A LOT of fat because the backbone doesn't provide that much glucose. So the moderate protein advice must also always come with high fat.

3- Some moderate protein plans, like mine from Dr. Kwasniewski, are low carb but not full ketogenic. So maybe the "moderate protein" is being mixed up between regular low carb, and low carb ketogenic. you can get get some of the glucose from plain old dietary starch (gasp!).

The 130g figure came from Dr Eades's blog (but I found other sources that said the same when I was researching this) - in fact it's a need for 200g that is reduced when keto adapted

http://www.proteinpower.com/drmike/...eans-our-cells/

I guess what bugs me in the "moderate protein" dogma being thrown around in high fat low carb & keto worlds is that they make it sound like gluconeogenesis will happen because you eat too much protein, when in fact gluconeogenesis will happen regardless of if you eat any protein at all ... And at least how I've understood it, while some of the glucose need can be met by fat metabolism (ketosis), some must be made from exogenous or endogenous protein. I kinda felt like I was trying to "avoid" gluconeogenesis by keeping protein low when I was following that approach, and I now know that gluconeogenesis is a normal process, in particular during severe carb restriction, and it's not dependent on the amount of protein consumed.

So it seems to me more prudent to be sure to consume enough dietary protein to cover that need than to be severely restricting protein.

I've really enjoyed Bill Lagakos' PhD in nutritional biochemistry) book & blog - he believes excess protein doesn't drive gluconeogenesis, rather that if gng is happening anyway the dietary protein will be used for it

http://caloriesproper.com/dietary-p...trol/#more-4022

But I definitely feel that all the experts who say that protein is the most "satiating" of the 3 macronutrients are not right for everyone. I definitely feel more hunger with higher protein and somewhat lower fats (carbs the same) than I did with higher fat and low protein (calories roughly equivalent as well).

Normally the goal with "moderate" protein intake is to only eat as much protein as needed, since restricting protein below that level will cause your body to consume its muscles. We moderates are only "restricting" protein compared to those who eat as much as they want or more (to theoretically be more satiating).

When I was eating extra protein and less fat, I was very thirsty all the time and it left me dehydrated and shaky even though I drank tons of water (and was probably excreting a lot of electrolytes). I find moderate protein and higher fat more satiating as long as I don't eat my pig-out triggers: dairy, grains, sugar & soy

Truth. It is almost the most simple dietary math there is. The more nitrogen in the form of urea, ammonia and other nitrogen containing substances our kidneys eliminate, the more protein we need to eat.

Unfortunately though I don't think the guidelines are very good. Moreover they vary greatly with the activity level. It is a very YMMV kind of thing. The keto calculator says I should get about 100g a day. I hardly ever do. Fortunately I find I have two thermostats (proteinstats?) to guide when I need more protein. One is when I crave a protein shake and sometimes I really, really crave a protein shake. It happens maybe once a month and I can eat as much other food as I want and it will not be enough until I get a ~50g shake which is the lowest calorie thing to have when I need more protein. The other thermostat is when my right calf muscle starts twitching a lot. I find generally that when it twitches, 25g will make it go away.

Whether protein in "excess" leads to an increase in gluconeogenesis might be up for debate. The fact that protein, next to carbohydrate, is the second most anti-ketogenic macronutrient really isn't.

Lowering protein intake can definitely lower blood glucose. I don't really have what I would call a blood glucose problem, at least on a low carb diet, ketogenic or not. I've never eaten high carb long enough to adapt and check how my blood sugar reacts to that. But lowering my protein consistently puts my fasting blood sugar down into the 70's and 80's instead of the 80's and 90's. Of course, that doesn't mean for sure that I'm not just literally eating my own liver or something, but it does seem like my body is defending a lower blood glucose level if I lower protein intake.

Bill at CaloriesProper offers the idea that amino acids might decrease ketones by providing an alternative fuel for the liver vs. fatty acids--so the liver doesn't produce as many ketones. That raises as many question as it answers, like, where does that leave the brain?

I suspect Dr. Eades was speaking with certainty in an area that hasn't been properly explored.

Thanks for the reply, teaser

Yes, I would agree that protein may be anti-ketogenic, at least my limited testing (Ketonix & ketostix) seems to point that way - I'm just not sure it matters very much, but maybe it does.

I also agree that this topic is something that is not as solidly understood and scientifically clear (in particular in the context of a keto-adapted person) as many of the keto/HFLC people state it to be. The science seems very thin, in particular there seem to be indicators that there is a period of adaptation to higher protein levels etc so that the transition period could show different effects than a longer-term stabilization. I don't have the desire to to blood testing (glucose or Bhb) on myself, so I guess I'll just keep toying around with this and see where it leads me... It does keep my head in the low-carb game to be tweaking these details of low carb.