Nutritional ketosis is a high fat, moderate protein, and low carb way of eating that shifts the body from a glucose (sugar) burning state into a fat burning state, thus utilizing healthful ketones that are produced by fat stores and fats from food. This is a therapeutic and/or long-term diet that is best chosen first and foremost for health reasons. Those with type 2 (and some type 1) diabetics, obesity, PCOS, epilepsy, and insulin resistance may best be suited to this approach though it truly comes down to one’s choice to experiment with it, beliefs, enjoyment, and one’s unique bio-individual response.
Nutritional ketosis was discovered therapeutically in the 1920’s for effective treatment of epilepsy, years later for the treatment of diabetes, and eventually declined as a nutritional prescription once medications were developed. Throughout history it has been prevalent in the culture of the Inuit whereby ketones provides slow burning energy in an extremely cold environment that lacks edible plant growth. It is also a unintentionally apart of many people’s dietary patterns now (and throughout history) as they cycle in and out of ketosis in times of lower carbohydrate to then moderate carbohydrate consumption. An unintentional or intentional state of ketosis is prevalent in people who are physiologically ‘starving’, for example in anorexia bulimia and fasting.
Carbohydrate intake is as low as 5 – 10% of one’s calories (30 grams or less net carbs) in the beginning phase where goals are to achieve a steady state of ketone production between 0.5 – 3 mmol/L. Blood glucose and insulin levels fall and glucose energy is swapped for ketone energy. It generally takes 1 – 3 weeks depending on one’s metabolic speed to physiologically shift the body’s enzyme and substrate functioning from sugar burning to a true fat adapted state. ‘Keto flu’ is common during this transition as the body lets go of sugar and water weight – signs and symptoms ranging from extreme fatigue, to headaches and dizziness, nausea and bowel movement changes. These symptoms are remedied with increased water and salt intake, and minerals such as magnesium and potassium. Once the body physiologically adapts to using fat for energy, known as ‘fat adaptation’ and nutritional ketosis, the individual can experiment with increasing carbohydrates to one’s threshold — being the total amount of carbohydrates the body can consume before it is kicked out of ketosis. This can be highly variable depending on one’s unique physiology, activity levels, stress levels, protein intake, metabolic history, and food sensitivity’s. Quality food journaling along with testing with a glucometer and blood ketone strips can give the best direction.
Cardiovascular and Ketoacidosis Clarity
Some of you who are not familiar with the benefits of a high fat diet may be wondering how it can benefit those with cardiovascular disease. In brief, it’s not fat’s fault. An excess of refined sugars that get converted into triglycerides, artificial trans fats, heated polyunsaturated fats, one’s overall quality of diet, lifestyle, and genetics contribute to the cause of cardiovascular disease — not solely fat. Those in nutritional ketosis most often see their labs improve, including an increase in HDL (good) cholesterol, a decrease in triglycerides, an increase in the large benign fluffy LDL particles and a decrease in the small dense oxidation prone LDL particles (through a NMR lipoProfile test that assesses LDL particle breakdown), a decrease in insulin and blood levels, and decreased C-Reactive protein (an inflammatory marker). Despite positive lab results those with familial hypercholesterolemia may see little to no improvement — I would not recommend ketosis in this case. Lastly, it is not to be confused with diabetic ketoacidosis, where both blood sugar and insulin levels rise to life-threatening levels in type 1 diabetics. Nutritional ketosis on the other hand involves both low blood sugar and insulin levels.
Nutritional Ketosis and Hormone Health
Hormones are highly interconnected; meaning when there is an imbalance of one there is most always an imbalance of another. A therapeutic diet such as nutritional ketosis can tip one’s synchronicity of hormone balance for one’s benefit, or loss.
When it works:
Some women with amenorrhea have a long history of a very low fat diet with over-exercising, sugar addiction, and the development of leptin resistance. If this is the case, a high fat low carb (less than 15% of calories from carbohydrate foods.), or real food nutritional ketosis diet (less than 10% carb) with moderate protein and low carbohydrate intake can help build the hormones they need through fat. It can also work for those with epilepsy, type 2 diabetes, insulin-resistant type PCOS, and overweight and obese women who have chronic sugar addiction alongside insulin and leptin resistance.
When it doesn’t work:
Conversely, those with hormone deficiencies due to chronic life stress, trauma, chronic illness, and carbohydrate restriction may not feel right with nutritional ketosis or a high fat low carb diet. Here hormones will benefit from increasing healing real foods from a variety of healing carbohydrates (20 – 30 (+) % carb.) alongside quality proteins and fats.
With pre-pregnancy, pregnancy, lactation, and in postpartum nutrition, the body needs energy through increased carbohydrate consumption and the nutrition they contain. Women with non-insulin resistant infertility will not benefit from ketosis.
Many women in perimenopause, menopause, or post-menopause states benefit from increased carbohydrate intake.
Non insulin-resistant PCOS women will benefit from a balanced real food diet.
Lastly, women generally benefit from increased carbohyrdate intake from days 14 – 28 of their menstrual cycle.
In a fat adapted state the thyroid and liver require adequate blood sugar and insulin to convert the thyroid hormones inactive T4 into active T3 for thyroid health. It also requires the right amount of cortisol to transform protein in the liver into glucose (for physiological homeostasis) through gluconeogenesis. When blood glucose, insulin, thyroid hormones, and cortisol naturally decrease in a fat adapted state over time, the resulting metabolic insufficiency can result in various unwell symptoms. Further yet, before true fat adaptation takes place the body may think it’s literally ‘starving’ as it physiologically transforms to using fat instead of glucose as its primary source of fuel. This process (especially with increased life demands) can be stressful, resulting in increasingly taxed hormone levels. It is thought that over time nutritional ketosis can even lead to insulin and leptin resistance in some people.
Some women (with hormone deficient states) who thrive in ketosis defend their liver’s ability to metabolize the glucose needed for the thyroid conversion through gluconeogenesis, delight in the induced lowered hormone state which may promote longevity, and believe that once keto adaptation takes place the body lifts out of thyroid and adrenal fatigue symptoms (despite low lab values). In fact, some women feel best eating this way during perimenopause and menopause. These women may thrive because at the root of their deficiencies may have been causes such as being genetically carb sensitive and fat burners, and/or because all along sugar was at the root of it all (for their unique metabolism). If your liver is in good health (the liver performs ketogenesis through fat), and if you’re looking for specific therapeutic effects in conjunction to a well-balanced lifestyle, ketosis may work for you despite low adrenal and thyroid hormones.
Keto and Your Body
There needs to be more research in regards to hormone health and the benefits of nutritional ketosis, however, you are your own experiment in your own genetically unique body.
Generally, I believe that most women do require at least 50 grams (low carb) of carbohydrate and/or carbohydrate cycling to maintain optimal long-term hormone health. A low carb high fat diet rather than strict keto may be all that is needed.
Carbohydrates in their real food form give the brain and body the energy to provide hormone health. Yes, we need fat to build hormones, however I personally believe that gram for gram an extreme high fat diet doesn’t provide the nutrient density and bacterial substrate that the body-mind desires, long-term.
Notes + Reflections:
– Dig deep. Depending on what induced hormone imbalance will reveal what is required for healing.
– Pregnant and lactating women are advised not to go lower than 30% of calories from carbohydrate and no higher than 25% calories from protein. Pregnant women with type 2 diabetes will want to slightly decrease their carbohydrate intake.
-Nutritional ketosis and low carb high fat diets are especially challenging for those who are advised to eat foods that may be uniquely inflammatory — such as eggs, certain nuts and seeds, low carb FODMAP rich vegetables, nightshades, histamine-rich foods, and dairy. If those wishing to be in ketosis continue to eat these foods the therapeutic effects will be suppressed.
– Nutritional ketosis works best when it focuses on REAL FOODS. Nutrient dense foods must be included, such as dark leafy greens, a variety of low carb vegetables, quality proteins and fats, bone broth, sea salt, and fermented vegetables.
– Every extreme turns to the opposite. Now that fat phobia is fading we’re seeing a mindset pattern in low carb diets that can lead to negative feelings in regards to carbs, cravings, insulin, and blood sugar. These limiting beliefs often develop alongside a desire for weight loss. Once one’s whole health state is relatively balanced weight will regulate itself.
– It’s important to exchange unhealthy food beliefs for understanding the benefits of a variety of real foods that work synergistically together, with compassion for one’s body, and the messages that cravings bring – whether they arise for the desire of cellular (physical), emotional, or mental nourishment. Oh, and cravings can be tamed by much more than fat! Think protein, fiber, and non-food treats.
– Choose a diet that you enjoy and believe in and choose it. This will help facilitate the production of enzymes necessary to digest your food.
I hope my post has given you insight today. If you’re interested in nutritional ketosis or blood sugar balancing I’d be happy to guide you along. Check out my services to learn more and feel free to email or call me (for a free 10 minute visit) to see how I could help you.
I’d like to know, have you tried nutritional ketosis? How do you nourish your hormones through food?
Wishing you love and vitality,
Moore, Jimmy and Westman, Eric MD. Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet. Las Vegas: Victory Belt Publishing, 2014.
Ballantyne, Sarah PhD. The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body. Las Vegas: Victory Belt Publishing INC., 2013.
Asprey, Dave. Bulletproof: The Cookbook. Toronto, ON: HarperCollins Pulishers Ltd, 2015.
Kresser, Chris. Your Personal Paleo Code: The 3-Step Plan to Lose Weight, Reverse Disease, and Stay Fit and Healthy for Life. New York, NY: Little, Brown and Company, 2013.