In almost every study in overweight people lasting 3 months or longer that compares a ketogenic diet with a low-fat diet, weight loss is slightly or significantly greater on the low-carbohydrate diet (Sachner-Bernstein 2015). Most of the weight lost on a well-formulated ketogenic diet that lasts a few weeks or longer comes from body fat.
The relationship between nutritional ketosis and weight loss
1. Does having nutritional ketosis necessarily cause weight loss?
Yes, in a person who is relatively insulin sensitive, so that when that person reaches their new stable (“maintenance”) weight, they can eat a wider range of total daily carbohydrates and still maintain their weight. (The carbohydrates should not contain sugar, wheat products or processed foods.)
2. Can a person remain in nutritional ketosis and not lose weight?
We must first understand the science of ketosis. Especially ketones ((beta-hydroxybutyrate [BOHB]) are the preferred fuel for the brain and to some extent the heart. Ketones allow these important organs to function as well or better when dietary carbohydrates are severely restricted compared to when dietary carbohydrates are high.
Switching from carbs to ketones doesn’t happen overnight – it takes weeks of consistently restricting carbs before this process of keto-adaptation can fully occur. But once this process is complete, the body can burn fat more than twice as fast as when carbohydrates were a major part of the diet (Phinney 1983, Volek 2016).
Once keto-adapted, people consistently report that the intensity of their hunger and cravings decreases; (Boden 2005, Mckenzie 2017) and that the daily fluctuations in energy and mood that they experience with high carbohydrate intake are reduced, if not eliminated. These problems are usually replaced by a consistent feeling of energy and mental alertness, as long as a well-formulated ketogenic lifestyle is followed (Volek & Phinney 2012).
Ketones activate your body’s defenses.
In addition to being the preferred fuel for the brain and heart, we recently recognized that BOHB also functions as a hormone that signals multiple changes in gene expression (referred to as “epi-genetic effects”). Among other effects, BOHB activates the body’s innate defenses against oxidative stress and inflammation (Schimazu 2013, Youm 2014), and it also works to reduce insulin resistance at its source (Newman 2014).
Ketones (beta-hydroxybutyrate [BOHB] and acetoacetate [AcAc]) are produced by the liver when both serum insulin and liver glycogen levels are low (McGarry 1973). BOHB protects us against oxidative stress, inflammation, diabetes and probably also Alzheimer’s disease and aging (Roberts, 2017). All we need to do to get these benefits is limit carbs so that the keto adaptation process can take place.
Can a person remain in nutritional ketosis and not lose weight?
Yes, when someone embarks on a ketogenic lifestyle with some extra body fat, it may be the increased ability to burn these stores, coupled with the reduction in appetite and fat cravings, that facilitates the initial weight loss.
In this scenario, keto adaptation facilitates weight loss, but only as long as the reduced hunger and cravings allow you to comfortably eat fewer calories per day than you burn.
Over time, most people who follow a ketogenic lifestyle stop losing weight and find a new stable weight (Hallberg 2018). This is achieved when their natural instincts of hunger and satiety lead to an increase in dietary fat intake to balance daily expenses. But as long as dietary protein remains moderate and carbohydrates low, this dietary fat is used instead of body fat to produce ketones. Thus, it is clear that nutritional ketosis can be maintained without further weight loss (Phinney 1983).
People ask if they can speed up the process without cutting back on carbohydrates.
Here’s a problem that many people experience. They have been told that increasing blood ketones will accelerate their weight loss. But instead of cutting back on carbs and avoiding extra protein to boost ketone levels, they are led to believe they can achieve the same effects by adding extra MCT oil, coconut oil, or exogenous BOHB to boost blood ketone levels. But this does not improve their body’s ability to burn fat. It just gives them a type of fat to be burned (some of it as ketones) instead of body fat. No wonder they are usually disappointed when their weight loss remains far above the goal they want to achieve.
What this means for weight loss and weight maintenance with a ketogenic diet
In summary, When you are in nutritional ketosis, you increase the rate at which the body burns fat. If the extra fat burned is offset by an increase in dietary fat, there will be no loss of body fat (but there will still be other benefits). However, most people with excess adipose tissue who achieve nutritional ketosis by eating natural low-carb foods initially feel more satiated, which allows them to eat less fat than they burn, resulting in net fat loss. But ultimately, even when one is in sustained nutritional ketosis, our natural instincts drive us to increase fat intake to meet our daily energy needs, resulting in stable weight and body composition.
In short: For those seeking additional weight loss rather than keeping their weight stable, the goal should be to reduce dietary fat intake to the satiety margin (just enough, but not too much) and to avoid or limit non-satiating energy sources such as alcohol.
This post was a summary of the Virta post https://blog.virtahealth.com/weight-loss-ketogenic-diet/ By Stephen Phinney, MD, PhD and Jeff Volek, PhD, RD. Copy and paste this link to read the original post.
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