I feel like I’ve been bombarded lately with questions about fad diets. They’ve always been around, but they just don’t seem to go away.
It just seems shiny and new to try a “new” diet instead of sticking to the fundamental principles of a healthy one.
I’ve been noticing this more and more, with the incredible popularity of “keto” which is pretty much paleo circa 2012, and with new books sent to me for my feedback like The Sirtfood Diet (Find it here).
I was able to read and review The Sirtfood Diet, a plan that claims to help you lose 7 pounds in 7 days, all with the power of what they call “Sirtfoods” which are essentially antioxidants, polyphenols, and other health supportive compounds.
What are the kinds of foods the Sirtfood diet wants you to eat? Things like buckwheat, soy, strawberries, turmeric, red onions, kale, dates, garlic, and olive oil, among others. Besides buckwheat (for some) and soy, I had a hard time figuring out how these foods were so lacking in typical healthy diets like the authors claim.
Most people who promote a paleo diet include ample amounts of these, and sometimes the dark chocolate and red wine pictured on the cover, as well-rounded parts of the diet.
Reservetrol, a healthful component the diet authors claim is often missing is available in fabulous multi-vitamin supplements like this one and in many foods like blueberries and cranberries, besides red wine.
Polyphenols are also common across the range of plant based foods and are even available as powders to mix with smoothies (like this one). Most paleo authors value and promote the inclusion of lots of plant based foods in the diet.
Here’s the truth as I see it. The reason you might lose 7 pounds in 7 days is because the first three days consist of 1000 calories of mostly green juice. This is a common trend among fad diet plans- starve you during the first week while you’re motivated (while also telling you that you aren’t starving but are instead “detoxing” which is why you feel like you’re starving) and then working calories up to more maintainable levels so you continue to lose weight but think you are eating much more.
You’re losing water that first week. A little fat is lost too, but its almost scientifically impossible to lose 7 pounds of pure body fat in one week for the average person. It requires a caloric deficit that not even 1000 calories a day can meet.
I have no issues with a diet that supports the inclusion of healthy ancient foods. My mind has changed over the years with regard to gluten-free grains and other dietary components, so long as they are healthy FOR YOU.
The key to lifelong weight loss is learning how to heed your internal cues. Learning your body, understanding its needs, and feeding it nutrient dense food. There doesn’t need to be a special superfood protocol. There just needs to be balance.
I’m never going to say its ok to eat mostly bacon and butter. They’re nice as inclusions, but they don’t have the nutrient density that vegetables do.
I’m never going to be cool with women fasting. Thankfully the Sirtfood diet and I agree on that one (though I still think 1000 calories a day for a woman is pushing it, even for 3 days). If the choice is between you eating or not eating, I’m always going to say, eat.
But eat what makes your body feel good. I know what that looks like for most people- vegetables, fruit, meat, fat. Eat those things, in balance with the other things. with a focus on quality. That’s all you really need. And that’s what Weight Loss Unlocked is all about.
If weight loss has become a struggle following that paradigm, then you should look into seeing a professional. A good functional nutritionist in your area can help you get to the bottom of what is going on and provide a structured plan that will help you reach your goals, along with the accountability and monitoring to help you truly maintain that weight loss.
Please, oh please, don’t just go looking for another crash diet. In the end, you’ll lose much more than some money and a few pounds.
One of the more esoteric but much beloved tools in the paleo dieter’s tool-kit is intermittent fasting.
What is intermittent fasting? I.F. is the practice of maintaining overall caloric intake while consuming those calories in fewer meals or in reduced time windows throughout the day. The goal is to create conditions of fasting in the body, but not for extreme lengths of time.
Some examples of intermittent fast strategies include 10, 8, or 5 hour eating windows throughout the day, or perhaps eating just two meals each day: one in the morning, and one at night. The evolutionary premise — the argument that proponents of intermittent fasting make — is that humans evolved to optimize their health under less-than-optimal conditions. Intermittent fasting, they say, is a natural and perhaps even necessary part of being human.
The modern-day scientific correlate appears promising, too:
Most people are nowadays aware that a calorie-restricted diet has the ability not just to decrease body weight but also to lengthen a human life. Emerging research is beginning to show, however, that intermittent fasting is just as effective as calorie restriction in ensuring these health benefits! Amazingly enough, this happens without any of the psychological crippling side effects of cravings and food obsession that practictioners of calorie-restriction often experience.
Intermittent fasting, proponents say, also may benefit the fight against cancer, diabetes, and autoimmunity. Here is an excellent, up-to-date review of the “benefits” of fasting. It is wholly understandable that fasting is all the rage these days.
Intermittent fasting women is a specific interest of mine because of what I have witnessed both in myself and in working with literally thousands of women in the PfW community.
Many women report to me (read more about that in this awesome book) that intermittent fasting causes sleeplessness, anxiety, and irregular periods, among many other symptoms hormone imbalance, such as cystic acne.
I have also personally experienced metabolic distress as a result of fasting, which is evidenced by my interest in hypocretin neurons. Hypocretin neurons have the ability to incite energetic wakefulness, and to prevent a person from falling asleep, in reaction to the body detecting a “starved” state. Hypocretin neurons are one way in which intermittent fasting may dysregulate a woman’s normal hormonal function.
After my own bad experience with IF, I decided to investigate intermittent fasting. I looked into both a) the fasting literature that paleo fasting advocates refer to, and b) the literature that exists out in the metabolic and reproductive research archives.
Intermittent Fasting Women: Problems in the Paleosphere
What I found is that the research articles cited by Mark’s Daily Apple (and others), focus on health benefits such as cancer-fighting properties, insulin sensitivity, and immune function.
However. I was struck by what seemed like an egregious sex-based oversight in that MDA post I linked to above. MDA cites this article as a “great overview” of the health benefits of intermittent fasting. This startled me because the article MDA cited was for me one of the strongest proponents of sex-specific differences in response to fasting.
Sex differences were relevant in two striking areas:
1) women in studies covered by the review did not experience increased insulin sensitivity with IF regimes and
2) intermittent fasting women actually experienced a decrease in glucose tolerance.
These two phenomena mean that women’s metabolisms suffered from IF. The men’s metabolisms on the other hand improved with IF across the board. Recall that the review was reported by MDA as “a great overview of benefits [of IF].”
Secondly, in another fasting post at MDA, of which there are many, the health benefits of fasting are listed and reviewed, but the sex-specific aspects of the hormonal response go unmentioned, and reproduction/fertility/menstrual health isn’t mentioned at all.
This is not to say that Mark is not attentive to who should and who should not be fasting. He knows very well and cautions people against the dangers of fasting while stressed. Still, the mere fact of being more sensitive to fasting simply by being a woman is, I would assert, pretty important for a woman who is contemplating or already practicing IF.
This goes nearly unmentioned in the blogosphere.
Intermittent Fasting Women: Problems in the Literature
Beyond reporting biases in the blogosphere, there remains an even greater problem of a significant testing bias in the fasting literature. Searching “men” + “intermittent fasting” in a Harvard article database yields 71 peer-reviewed articles. Searching “intermittent fasting women” yields 13, none of which are a) solely about women b) controlled studies or c) about more than body weight or cardiovascular benefits.
The animal studies are more equitable, but also a bit less applicable to human studies.
It is well-known in both the research and the nutritional communities that caloric restriction is horrible for female reproductive health. This is not news. There is an infertility condition – called hypothalamic amenorrhea – that millions of women suffer from due to being overly restrictive. But what of fasting?
Intermittent Fasting Women: Should we Fast?
The few studies that exist point towards no.
It is not definitive, since the literature is so sparse, and it necessarily differs for women who are overweight versus normal weight (and who have different genetic makeups), but when it comes to hormones, women of reproductive age may do well to err on the side of caution with fasting.
What follows first is a brief review of what can be gleaned in sex-specific responses to fasting in animal studies. Afterwards I talk about what has been concluded by the few relevant human studies.
Mice & Rats
First up is a study that demonstrates the hippocampal changes of calorie restriction and intermittent fasting for both male and female rats. In this study, they do alternate day fasting, which entails free eating on one day and a fast day on the next.
The study found that brain states while fasting were different for male and female rats. For male rats the change in hippocampus size, hippocampal gene expression, and ambulatory behavior was the same no matter what kind of restricted diet they were on – but for female rats, the degree of change in brain chemistry and in behavior was directly proportional to degree of calorie intake, demonstrating the unique sensitivity of female rats to the starvation response.
” The organization of the females’ response to the energy restricted diets is suggestive of some underlying mechanism that may allow for an organized, pre-programmed, response to enhance survival in times of food scarcity. Comparatively, the males’ genetic response was less specific, suggesting that the males respond to a general stressor but they seem to lack the ability to discriminate between a high energy and low energy stressor.”
Moreover, “IF down-regulated many gene pathways in males including those involved in protein degradation and apoptosis, but up-regulated many gene pathways in females including those involved in cellular energy metabolism (glycolysis, gluconeogenesis, pentose phosphate pathway, electron transport and PGC1-α), cell cycle regulation and protein deacetylation.” In this study, both male and female rats gained small amounts of weight on IF diets.
For female rats, even in the most innocuous form of restriction–intermittent fasting–significant physiological changes take place. Male rats do not experience as dramatic hippocampal and general brain chemistry change as female rats do, and their behaviors, specifically their cognition and their dirunal and nocturnal activity, do not change.
Female rats, on the other hand, “masculinize.” They stop ovulating and menstruating. They become hyper-alert, have better memories, and are more energetic during the periods in which they are supposed to be sleep. Theoretically, according to these researchers, this is an adaptive response to starvation. The more the female rats need calories– or at least the more their bodies detect a “starvation” state– the more they develop traits that will help them find food. They get smart, they get energetic, they get active, and they stop sleeping.
In a follow-up study conducted by the same researchers who explored the masculinzation of female rats, the researchers analyzed the gonadal transcription of male and female rats subjected to IF regimes.
This study found that male reproductivity up-regulates in response to metabolic stress. Female reproductivity down-regulates.
Completely opposite to the female rats becoming infertile while fasting, male rats become more fertile. In the researchers’ own words: “our data show that at the level of gonadal gene responses, the male rats on the IF regime adapt to their environment in a manner that is expected to increase the probability of eventual fertilization of females that the males predict are likely to be sub-fertile due to their perception of a food deficient environment.”
In the final relevant IF rat study I could find, researchers subjected rats to the same diets– to 20 and 40 percent Calorie-Restricted (CR) diets, as well as to alternate-day fasting diets, and monitored them over the long term for hormonal responses. The results were striking. Below is the abstract in full because it’s so powerful:
Females and males typically play different roles in survival of the species and would be expected to respond differently to food scarcity or excess. To elucidate the physiological basis of sex differences in responses to energy intake, we maintained groups of male and female rats for 6 months on diets with usual, reduced [20% and 40% caloric restriction (CR), and intermittent fasting (IF)], or elevated (high-fat/high-glucose) energy levels and measured multiple physiological variables related to reproduction, energy metabolism, and behavior.
In response to 40% CR, females became emaciated, ceased cycling, underwent endocrine masculinization, exhibited a heightened stress response, increased their spontaneous activity, improved their learning and memory, and maintained elevated levels of circulating brain-derived neurotrophic factor. In contrast, males on 40% CR maintained a higher body weight than the 40% CR females and did not change their activity levels as significantly as the 40% CR females. Additionally, there was no significant change in the cognitive ability of the males on the 40% CR diet.
Males and females exhibited similar responses of circulating lipids (cholesterols/triglycerides) and energy-regulating hormones (insulin, leptin, adiponectin, ghrelin) to energy restriction, with the changes being quantitatively greater in males. The high-fat/high-glucose diet had no significant effects on most variables measured but adversely affected the reproductive cycle in females. Heightened cognition and motor activity, combined with reproductive shutdown, in females may maximize the probability of their survival during periods of energy scarcity and may be an evolutionary basis for the vulnerability of women to anorexia nervosa.
They also found this:
The weight of the adrenal gland was similar in rats on all diets; however, when normalized to body weight CR and IF diets caused a relative increase in adrenal size, the magnitude of which was greater in females, compared with males.
The testicular weight was unaffected by any of the diets. In contrast, both CR diets and the IF diet caused a decrease in the size of the ovaries.
And this, bearing in mind that “daytime” for nocturnal rats is “nighttime” for humans:
The daytime activity of females was doubled in response to IF, whereas the IF diet did not affect the activity level of males. Nighttime activity levels of males and females were unaffected by dietary energy restriction.
Uterine activity was monitored daily with vaginal smear tests; cyclicity was scored as regular, irregular, or absent. The mild energy-restriction diets (20% CR and IF) significantly increased the proportion of animals displaying irregular cycling patterns, whereas the 40% CR animals displayed an almost complete loss of estrous cyclicity.
In males, corticosterone levels were elevated only in response to the 40% CR diet, whereas in females corticosterone levels were significantly elevated in response to all three energy-restriction diets, suggesting a relative hyperactivation in females of the adrenal stress response to reduced energy availability.
For lipids, all the rats did well: “Collectively, these data suggest that atherogenic profiles of both males and females are improved by dietary energy restriction.” Interestingly, too, as they pointed out in the abstract, human females also perform cognitively much “better” (memory and alertness) on CR and IF diets than on normal feeding schedules.
There are of course some caveats to this study: A) They are rats. B) They are somewhat “metabolically morbid” rats, which may make them more susceptible to disease. C) The rats were allowed to eat ad libitum on the IF days, but they simply did not meet their caloric requirements this way. So while it is a somewhat natural form of IF, it is still calorically reduced, such that that must be taken into account when gasping in horror at the hormonal responses of IF-ing female rats.
The Few Human Studies
I mentioned above that through the same review that MDA used as a “great overview” of IF benefits for all sexes, I found harmful metabolic effects for women subjected to alternate-day fasting regimes.
This is the study:
Heilbronn et al found that with IF, insulin sensitivity improved in men (21 participants) but not in women (20 participants): after three weeks of alternate day fasting, insulin response to a test meal was reduced in men. Women experienced no significant change. “It is interesting that this effect on insulin sensitivity occurred only in male subjects,” they report.
With respect to other health markers female health actually declined, specifically with respect to glucose tolerance:
“Another diabetes risk factor that has shown a sex-specific effect is glucose tolerance. After 3 weeks of ADF, women but not men had an increase in the area under the glucose curve. This unfavorable effect on glucose tolerance in women, accompanied by an apparent lack of an effect on insulin sensitivity, suggests that short-term ADF may be more beneficial in men than in women in reducing type 2 diabetes risk. ” The opening line of their discussion reads: “Alternate day fasting may adversely affect glucose tolerance in nonobese women but not in nonobese men.”
In a follow up study, Heibron et. al studied the effects of alternate-day fasting on cardiovascular risk. When human subjects fasted on alternate days for another three week period, circulating concentrations of HDL cholesterol increased, whereas triacylglycerol concentrations decreased. This is a good thing. However, the shifts in lipid concentrations were shown to be sex specific: ie, only the women had an increase in HDL-cholesterol concentrations, and only the men had a decrease in triacylglycerol concentrations.
The most recent review of IF agrees with my conclusion: sex-specific differences in metabolism exist and need to be studied further.
This study of alternate day fasting included 12 women and 4 men. In eight weeks, body weight decreased by about 10 pounds, and body fat percentage decreased from 45 to 42. Blood pressure decreased, total cholesterol, LDL cholesterol, and traicylglycerol decreased. These people were significantly obese, which limits the results of this study to an obese population. However, “perimenopausal women were excluded from the study, and postmenopausal women (absence of menses for >2 y) were required to maintain their current hormone replacement therapy regimen for the duration of the study.” (Their words, my emphasis)
The one, big study of intermittent fasting conducted on men and women looked at differences between isocaloric feeding schedules: 3 meals/day feeding versus 1 meal/day.
The study focused on body weight composition, blood pressure, and body temperature in subjects. Subjects were fed isocalorically either one meal each day or three meals each day. All subjects were between 40 and 50 years old (excluding women of reproductive age), and between BMIs of 18 and 25. They ate, so far as I can tell, a healthy diet with 35 percent fat, PUFA < MUFA < SFA. Only 15 of the original 69 completed the study (which goes to show just how fun everyone thought fasting was). As for the results,
“Systolic and diastolic blood pressures were significantly lowered by ≈6% during the period when subjects were consuming 3 meals/d than when they were consuming 1 meal/d. No significant differences in heart rate and body temperature were observed between the 2 diet regimens. Hunger was enormously larger in the one meal/day than in the three meals/day group. “The 1 meal/d diet was significantly higher for hunger (P = 0.003), desire to eat (P = 0.004), and prospective consumption (P = 0.006) than was the 3 meals/d diet. Feelings of fullness were significantly (P = 0.001) lower in the 1 meal/d than in the 3 meals/diet.” Body weight dropped only four pounds after several months. Cortisol dropped, but Total, LDL, and HDL cholesterol were 11.7%, 16.8%, and 8.4% higher, respectively, in subjects consuming 1 meal/d than in those consuming 3 meals/d.
In sum: patients on the one meal/day regiment were unhappy, hungry, lost a little bit of weight, increased cholesterol. This was a small sample, included somewhat menopausal women, and all people of normal body weight.
Intermittent Fasting Women: In Conclusion
All that being said, that’s it. That’s all that exists! Women don’t have much to go on.
There are a few rodent studies. They found that when alternate-day fasting,female rats and found significant negative hormonal changes occurring in the females.
There are even fewer human studies. Human studies on alternate day fasting have not been conducted on women of reproductive age at all, nor have any studies analyzed reproductive responses to fasting.
Moreover, the few studies that have been conducted on non-obese women have demonstrated that their metabolic responses are not nearly as robust as those of men, and may in fact be antagonistic to their health.
This post has focused on sex-specific responses to fasting, specifically intermittent fasting women. Another important distinction to make is between different body weights. Overweight and obese patients appear to experience significant improvements with IF regimes, but normal weight patients do not show the same across-the-board benefits. For women this may be a particularly sensitive issue. Overweight women may experience metabolic benefits, whereas normal weight women do not. I suspect that that may roughly be the case, but who knows. Honestly, no one at this point.
The practical solution, then, I believe, is to look at options, to be honest about priorities, and to listen to one’s body with awareness and love.
Is fasting worth trying if a woman is overweight and trying to improve her metabolic markers, and so far hasn’t had much success? Perhaps. Should it be undertaken if a woman is of normal weight? What if she is a light sleeper? What if her periods begin to dysregulate? Or stop? What if she starts getting acne, getting a stronger appetite, or losing her appetite altogether? These things happen, and I see them in women who fast and contact me time and time again.
We women (people!) should be honest with ourselves about our priorities, and act constantly with our mental and physical health foremost in our minds. All women are different. But the literature is so sparse in this area that we cannot make any real statements or predictions about the effects of fasting, other than that we just don’t know, and that we should continue to emphasize the centrality of awareness, caution, and loving nourishment in moving forward.
IF is one realm in which the female body has unique characteristics and needs that demand attention. There are boatloads of others. If you’re interested in reading about the collective set of them and learning how to optimize female skin, weight loss, and hormone balance, for a few examples, you could do worse than my best-selling book, Sexy by Nature, here.
And that’s a wrap! What do you think?
In recent months, there has been a resurgence of diets I had long thought were old, buried news.
I am speaking specifically of ketosis and of fasting. In ketosis, the goal is to eat so few carbohydrates that the body produces ketones as an alternative fuel source. In fasting, you simply stop eating.
Both of these dietary practices are aimed at reducing insulin and blood sugar levels as much as possible. This is supposed to predispose the body to “fat burning mode.”
These methods appear to actually be helpful to some people. There can be substantial health benefits to both ketosis and fasting for certain groups of the population. People who have very high body fat percentages and are insulin resistant may benefit—at least in terms of their body fat percentages–from fasting. Ketosis may also benefit people who have dysregulated insulin levels, but it also has the unique benefit of being able to help people with certain kinds of cancers and neurological conditions. I do not deny the potential potency of either of these diets, given the right clinical needs and application.
(You can read more about the physiology of ketosis in this post here.)
But I would here like to address the concept of freedom.
I have recently heard people call bboth fasting and ketosis “freedom.” You can read a post about it and fasting, here, or a whole book on ketosis and freedom, called Keto Freedom, here.
I do not mean to detract from the worthiness of each of these people and what potential they have to offer many people. But I do wish to shed some light on this whole “freedom” thing.
Two ways to define freedom
There are, so far as I can best tell from my philosophical training, two primary ways to define freedom. One is as freedom from something; the other is as freedom to do something.
Freedom from something is what we find most common in discourse about restrictive diets.
In talk about ketosis, fasting, and other kinds of dietary (including paleo) freedom, advocates walk around talking about how great their freedom is. People are sometimes confused. The word “freedom” is very appealing. Yet what kind of freedom are the gurus talking about? When pressed, they typically that their diets enable them to achieve freedom from some symptom. (Sometimes they say the diets provide freedom from negative body image or disordered eating, which while not impossible is also kind of ludicrous.)
Ketosis is “freedom from blood sugar swings.” Intermittent fasting is “freedom from obesity.” Paleo is “freedom from gut distress” or etc.
These are all important points. It is great to finally be liberated from health concerns that have dogged you your entire life. I know this quite well, as I have suffered from many chronic symptoms such as generalized anxiety disorder, insomnia, acne, PCOS, and migraines throughout the course of my life.
But this concept of freedom is actually not the most popular one. It’s not the one that makes immediate sense to people.
The most popular idea of freedom is the one in which we have degrees of freedom with which to act. For example, most people intuitively understand that people in the USA have more freedom than people in North Korea. People who are not incarcerated have more freedom than those who are. People who have so much money they don’t have to work are more free than those chained to minimum wage 9-5 jobs. This is because they have more options and abilities due to their circumstances. They are more free.
If we analyze diets in terms of this kind of freedom, we come up with a spectrum. On one end – the most free end – people eat whatever they want, whenever they want. On the other far end are highly restrictive diets, ones that require a lot of control and very few options.
I would argue that there is almost nothing less free than ceasing to eat for several days or periods at a time, as is what people do when they fast.
Perhaps worse, and more importantly, there is almost nothing less free than ketosis. There is almost nothing less free than having to pee on a stick to determine if your diet is “pure” enough.
Any time you go on a diet, and deliberately restrict the kinds of food you can eat, you limit your freedom.
If you give yourself a rule that you cannot break, you limit your freedom.
If you give yourself a set of acceptable foods and feel guilty if you eat outside of it, you limit your freedom.
If you struggle at all with your body image, your self love, your sense of self worth, or your love and forgiveness for yourself as a result of the diet you’re on, you limit your freedom.
Yes, I believe there are psychologically healthy ways to limit the food groups you eat. Yes, I think focusing on whole, natural foods is probably best for health. Yes, I do think certain health conditions such as leukemia and neurodegenerative disease (both possibly helped by ketosis) can call for severe measures. Yes, I do think weight loss is an acceptable goal given that it is done well on both physical and psychological levels (as I attempt to do here).
But I do not think we should ever make the mistake of calling a diet freedom – unless of course we are very clear from the outset that it is freedom from, not freedom for. To call a diet “freedom” is to do psychological health and real honest-to-god freedom a serious disservice.
If you seek any of these things:
Overcoming an obsession with food
Then I would never recommend a set of diet rules – and again, especially one where you can’t eat for days or one where you have to pee on a stick — to help you.
I would recommend instead doing the hard, psychological work of sitting down with a friend, a therapist, or a pen and paper and digging deep into your heart. I would recommend discovering and deconstructing the demons that haunt you. I would recommend learning to embrace body fat as a natural part of what it means to be a human being – of what it means to be an animal – of what it means to be you, in your skin, nourishing your body the best way you know how.
Ketosis and fasting may be many things. They may even liberate you from serious health conditions. But if we want to have an honest discussion about what these kinds of diets can do for us, we need to stop calling them “freedom.” They are pretty much anything but.
In 2012, when I began writing this blog, the paleosphere was what I am now thinking of as “old school paleo.”
Paleo bloggers then focused on leanness, fitness, biohacking, and generally being a hard guy (taking baths in ice water was a thing). We were told to never eat legumes or other carbohydrates. We were told that it was better to starve than to have a meal that wasn’t paleo. We were admonished to never snack. We were told that fasting was a lifesaver, and ketosis, a miracle.
But in the years since 2012, in small part due to my own advocacy and in large part due to the wisening up of the whole sphere, paleo leaders opened their eyes to the larger picture. They realized that women’s bodies might need some more calorie nourishment than men’s. They realized that carbohydrates can sometimes be helpful – and eventually appeared to embrace them entirely. They realized that fitness is different for everybody, and maybe some people should do less of it. They recognized that body fat percentage doesn’t dictate the quality of someone’s health. Major parts of the paleosphere relaxed into an atmosphere of love and encouragement and relaxation.
All of this means that I was very surprised rounding the corner into 2017 when all of the sudden everybody was talking about fasting and ketosis again. I will write about fasting in another post. Today, I will focus on the return to ketosis. I will talk about what’s bringing it back, and then re-examine what this can mean for your body and your mental health.
What is ketosis?
I am going to steer clear of giving you a long, technical definition of ketosis. I do however think it’s worth learning the biochemistry if you plan to experiment. In that case, I highly recommend Dr Peter Attia’s posts or Dr Chris Masterjohn’s.
In short, ketosis is a state the body enters when there is an excess of molecules called acetyl groups over oxaloacetate. This happens when there is a shortage of glucose supplied to the metabolic processes that create energy–ie, when you eat a very low carbohydrate diet. Yet interestingly enough the body will also produce ketones when medium-chain fatty acids enter the metabolic processes. Most people do not know this, but it’s very important, and I will return to it later.
So then, when there is this excess of acetyl groups relative to oxaloacetate, the body produces something called ketone bodies. Ketone bodies come from fatty acids that the body has liberated from fat tissue, which can be used as an alternative fuel to carbohydrates. This is important because the body (and specifically the brain and heart) literally need carbohydrates or ketone bodies in order to function. When carbs are gone, basically, ketone bodies step in to do their work.
People typically achieve ketosis by fasting or by eating diets very low in carbohydrate (high fat, moderate protein). This calls for at least fewer than 50, and maybe more like 20, grams of carbohydrate a day. This depends on your age, body type, activity level and the like.
You can verify how deeply your body has gone into ketosis by peeing on a stick, which reveals the level of ketone bodies being circulated in and used by your body.
Why do people do ketosis?
The supposed health gains of ketosis are different depending on who you ask. Some will call is a miracle that cures all ailments, some will be more circumspect.
In general, there are two many categories of benefits that people talk about: metabolic health and weight loss, and performance gains. There is some truth to each of these categories.
For metabolic health and weight loss, ketosis can be helpful for people who struggle with insulin resistance. Now, to be clear, ketosis does not cure the underlying problems that cause insulin resistance such as poor gut health and inflammation.
But ketosis can provide a way to circumvent the issue. If insulin levels are chronically high and you eat a moderate carbohydrate diet, you may find that you never lose weight, because the body always has a surplus of sugar to burn instead of dipping into its fat stores, which it really only does once the body’s glucose and glycogen stores have been burned through. If however you keep your body’s carbohydrate intake to an absolute minimum, it will more consistently be able to reach into fat stores to burn fat (and make ketones to burn), given that there is a caloric deficit. This is something everybody, and especially ketosis aficionados, should keep in mind; calorie deficits need to be present in order to lose weight.
This being said, there is debate about whether or not there is a “metabolic advantage” to being in a state of ketosis. It is possible that, given how much energy it takes to create ketone bodies, the body actually burns slightly more calories in ketosis than otherwise. Unfortunately this matter is not altogether settled. Though it is worth noting that even if this is the case, the difference is relatively small. For the most thorough discussion I’ve seen of this issue in a blog, see Dr Attia’s write up here.
Ketosis may provide metabolic benefits. They include:
-Regulation of blood sugar levels for people who are sensitive to blood sugar swings (as the body produces its own blood sugar in a state of ketosis so there are fewer fluctuations)
-A reduction in circulating insulin levels for those who were previously insulin resistant; an increase in insulin sensitivity
-Potential weight loss due to increased insulin sensitivity and ability to burn fat
-Potential weight loss due to decreased caloric intake from eliminating an entire food group
The other main category of improvements people discuss have to do with performance. Many people say they think more clearly or have more mental or physical energy while on ketosis. This does not seem an altogether unreasonable claim since the brain burns ketones efficiently, and ketosis can help keep blood sugar levels stable.
Importantly, however, I would like to draw attention to the fact that the adrenal glands can get involved in ketosis – as they play a role in regulating blood sugar, among many other things. When the adrenal glands are active, typically cortisol, adrenaline, or norepinephrine (or any myriad of other stimulatory chemicals) are released into the bloodstream. Norepinephrine, notably, is released in a state of fasting at 2x the rate of regular body metabolism. This can create great feelings of energy. And it can help preserve muscle mass. But it is important to note that it can also lead to disruptions to circadian rhythm, or a feeling of being over-wired.
Specific Health Conditions
Finally, there are also specific health conditions for which ketosis appears to be therapeutic. Certain neurological- and degenerative diseases such as Alzheimer’s, dementia or Parkinson’s may be helped by ketosis, as may seizures and chronic migraines. Ketosis can also starve tumors which thrive on glucose as a fuel source, and therefore be helpful for cancer, specifically that of the brain or blood.
Importantly – we should be clear about which types of benefits we are chasing
So you may decide that ketosis seems like a good idea, something worth trying. But it is important to note something that often goes neglected in conversations about ketosis: there is more than one way to achieve the presence of ketone bodies in the blood. In fact, there are two main ways, and they correlate to the two different types of benefits discussed above: the metabolic, and the performative.
The traditional way of achieving ketosis is to eat a low carbohydrate diet. This has two types of benefits: 1) it can increase insulin sensitivity and can therefore help remediate insulin insensitivity and diabetes. It can also help stabilize blood sugar, and, importantly, if one is eating fewer caloriess since one’s diet is almost 100% fat, then one will be in a calorie deficit and may lose weight. 2) Ketosis can increase mental performance given that ketone bodies are produced as a result of carbohydrate restriction.
But there is another way to achieve ketosis. You can get ketone bodies into your bloodstream simply by consuming MCT oil. Chris Masterjohn addresses this masterfully in this podcast (linked to transcript). I stated earlier in this post that ketosis is widely misunderstood as a result of low carb dieting. While low carb dieting does lead to the acetyl group excess over oxaloacetate in the fuel burning process that leads to ketosis, so do medium chain fatty acids. So if you cook with or add MCT oil to your diet (coconut oil contains MCT’s but is far from 100% MCT, so if you’re looking for a ketosis effect it may be wise to purchase an MCT oil such as this one), you can achieve the performance-enhancing effects of having ketone bodies in your bloodstream without subjecting your body to the rigors of a low carbohydrate diet.
You can also get ketone bodies into your bloodstream by consuming exogenous ketones. This is a fancy way of saying “eating ketones.”
In fact, exogenous ketones are I think a big part of why ketosis has made a come back in recent months. There has been an explosion in the market for selling ketone bodies, especially with MLM schemes. I can’t tell you how many facebook posts I see from paleo friends talking about how great their exogenous ketone supplements are. I am sure they really are. But it is also a part of an industry wide boom, so I’d step very carefully about choosing a brand and making sure you know what you’re buying into.
Importantly, if you take exogenous ketones, a) know that you are taking exogenous calories as ketones are calories, and b) know that you will be getting the performance enhancing effects of ketosis but not the insulin sensitizing effects of a very low carbohydrate diet. I do not caution you because I think this is a bad thing. In fact, this is a great option for many people, as I do not think the low-carb aspects of ketosis are important to strive for unless it is an experiment you choose to conduct for the sake of managing diabetes or etc.
How to achieve ketosis performance gains without sacrificing metabolic health
I talked at length before about how low carb ketosis poses potential metabolic gains. This is especially true for people who suffer from diabetes or insulin resistance and/or also have high body fat percentages.
But I would be remiss if I did not also point out – especially as Paleo for Women – the many different groups of people who may be hurt by ketosis.
Women of reproductive age who are attempting to conceive or are pregnant should probably not undergo low-carb ketosis, as carbohydrates play an important role in A) pregnancy, and B) assuring the hypothalamus that the body has been properly fed. In fact, insulin is actually an important satiation hormone. For women who want to conceive, it may be best to err on the side of caution and make sure you get bountiful carbs.
Women with sensitive reproductive systems may want to step carefully. If you have a history of low hormone levels, hypothalamic amenorrhea, dieting, or irregular menstrual cycles, the hormone changes invovled in low carb ketosis as well as the uptick in stress hormone levels may hinder your reproductive hormone production.
People (mostly women) with sensitive thyroid systems may also be in jeopardy from low carb ketosis. Ketosis is well known to downregulate thyroid production. T3 (the form of thyroid hormone that is actually active in cells) decreases, and reverse T3, a molecule that blocks the activity of T3, increases. Ketosis advocates may bend over backwards trying to make this phenomenon seem hunky dory, but I would advise anyone with thyroid issues to step carefully around ketosis. If you have clinical hypothyroidism I would consider consulting a doctor first.
People with adrenal issues or a lot of stress. Adrenal glands may become more active with low carb ketosis, which can exacerbate feelings of being wired, stress, and all the attending symptoms that come along with it.
People (especially women) with sleep issues. Low carb ketosis may up-regulate the production of stress hormones, which can have a negative impact on sleep.
In general, low carb ketosis is another stress on the body. For people who can handle that stress – it may go off without a hitch. But if your body is predisposed to adrenal, thyroid, or hormone issues, you may wish to at least step carefully.
What about my psychological health?
I will be publishing a post on the concept of “ketosis freedom” next week. In the meantime, it stands to note that this is obviously a highly restrictive diet. If you have a history of punishing yourself for falling off the wagon, feeling guilty about food, engaging in cycles of over- and under- eating, or confining yourself to strict dietary rules, I would not recommend ketosis. In order for someone to truly achieve wellness, then psychological health must be prioritized, perhaps above whatever ketosis-based goals you may have (and of course this varies by the individual. If you have brain cancer then please feel free to try ketosis regardless of how much you love your body).
All of which is to say that…
Ketosis is very complicated. It has a common practice of very low carb dieting that has been shown to benefit some people, but it certainly does not benefit everybody. It is different for every person – so if you decide to try it, please simply be aware of potential pitfalls that may result and adjust your diet accordingly.
You can also achieve ketosis a less well-known way, which is by consuming a tablespoon or two a day of MCT oil. If you are seeking simple psychological and physiological performance gains, and are not trying to starve your body of carbohydrates, then this may be a much more safe route with which to experiment. (It would also be compatible with recommendations I make in my program for weight loss – in which you can choose to be low carb or low fat – Weight Loss Unlocked.)
In the end, however, ketosis may be good for some conditions, but is not good for everybody. Every time a new fad roles around, it is best to step around it with caution, as hype (at least in my experience of observing the health world) typically vastly overemphasizes actual results. The only way to truly know if a diet works for you is to try it – but also to do so armed with as much healthy skepticism and and self-awareness as possible.
If you know me, you know I’m not big on the calorie-counting and tracking mania of the rest of the diet world. I prefer to let people figure out their health intuitively, eating whole, healthful foods that make them feel good.
But in some circumstances I actually think tracking may be a good idea.
There’s no one size fits all way to know if tracking might be a good choice for you. You know yourself best.
But here are 3 reasons you might consider tracking food intake.
Even if you’re eating paleo, you may not be getting ALL the nutrients required for health.
Ever monitored how much potassium you’re taking in? I can almost guarantee it doesn’t meet the recommended daily allowance.
Now, I’m not about perfectionism and strict rule following.
But micronutrients are just as important, if not more important than macros.
Instead of worrying about what exact percentage or gram amount of carbs you’re eating in a day, how’s about worrying if you’ve got your daily allotment of vitamin C, or the B vitamins, or (gasp!) fiber!
You might be surprised. In fact, I’m pretty sure you will be.
Because if you’re not downing tons of non-starchy veggies and leafy greens you’re not getting as much as you could. And if you’re not going to make it a priority, it might be time to start thinking about the dreaded multivitamin to help prevent nutrient deficiencies.
I recommend this one in my post on multivitamins which you can find here.
#2 You’re having trouble losing weight
I’m a huge proponent of eating a naturally healthy diet and being moderate about the crazy counting calories stuff.
My program Weight Loss Unlocked works for a lot of people by helping them make healthful food choices without really having to count anything. But some people just have trouble with this method.
Did you know the average person underestimated their caloric intake by about 30%?
That number can rise even more if the person isn’t tracking calories.
And while I agree that calories are not the end all be all of weight loss, and certainly not of health, you can’t eat 3000 of them as a fairly sedentary person a day and expect to lose weight.
I don’t care if you’re eating cake or coconut oil, too many calories are going to derail your efforts.
This is where tracking can help.
Take a week and see where you’re at. That can give you a better idea of where you’re eating too much and where you’re just right.
Then try tracking a week at a more appropriate calorie count for weight loss and be mindful of how it feels. Then, when you stop tracking, you’ll have a better idea of what the right amount of food should feel like.
#3 You’re gaining weight or aren’t feeling well
Weight gain can be caused by a number of factors- hormones, water retention, medications, etc.
But if you have been gaining weight inexplicably, you haven’t done anything differently, or don’t feel you have, tracking your food intake may be helpful.
Perhaps you’re eating the same number of calories but have increased your carbohydrate count. If you have insulin resistance, this could cause weight gain. If you don’t, it could be water retention.
Maybe you feel like you’ve been eating the same, but are forgetting about those dark chocolate squares you sneak in throughout the day, or that new post-workout drink, or those new fat bombs.
Excess calories could be causing sneaky pounds to build up.
Maybe it’s just the second half of your cycle, maybe it’s constipation, it could be anything, but sometimes excessive weight gain can indicate an underlying problem.
If you track your intake and nothing is outside of normal, and the weight keeps packing on, it could be a thyroid problem or a side effect of a medication, or any number of issues.
You can use this information when you see your doctor, and you’ll be one step ahead of the curve.
Likewise, if you aren’t feeling well or are having increased anxiety, depression, or blood sugar crashes, tracking food intake alongside your mood after eating can help you pinpoint possible issues or trigger food/times.
Same thing goes for having digestive issues. If you know what you ate and at what time, it’s much easier to figure out intolerance.
Mindful eating is a skill. And it’s best learned in the context of normal hunger and satiety cues.
If your insulin is out of whack or you’re carrying a lot of excess weight, or have any kind of health condition or medication that interferes with your hunger cues, mindful eating is going to be remarkably difficult and could lead to feelings of failure and lack of results.
Nutritionists and nerds alike love the website cronometer.com. It gives you WAY more detailed micronutrient values than other apps like My Fitness Pal, though that is a great choice for busy people because it has an app.
Whether you choose to track or not, I hope we can all learn to be respectful of what works for us as individuals.
If mindful eating isn’t right for someone right now, they certainly don’t need to be judged for that. And likewise if counting calories is mentally unhealthy for someone, they deserve respect and support as they follow the natural cues of their body.
Do you track food intake? Why or why not? What site do you like to use?
Does it get harder to lose weight the older you get?
For many women who have already reached this point in their lives, the answer is an obvious YES.
Yet the question still remains of why this is the case, and if it is absolutely necessary. What is the science behind it? Can you avoid weight gain? How much of a challenge is it to keep the same shape and weight as before?
As it turns out, the answer is a bit unfortunate. There are real biological events that happen in your body as you age – particularly as a woman – that naturally lead to weight gain. But, fortunately, the more we know about them, the more equipped we are to take counter measures.
Here are the 4 most important reasons women in menopause gain weight:
1. Estrogen regulates appetite and fat storage
Arguably the most important facet of weight gain in menopause is decreased estrogen levels.
Estrogen receptors are located all throughout a woman’s body. They are particularly concentrated in the brain. This is important, because studies have shown that one type of estrogen receptor–estrogen receptor alpha (the other type is estrogen receptor beta)–plays an important role in energy homeostasis. That is – estrogen regulates how much energy your body burns.
In 2007, in a series of animal experiments described at the 234th national meeting of the American Chemical Society, researchers demonstrated how important estrogen is to the regulation of food intake, energy expenditure, and body fat distribution.
Professor of Psychiatry Deborah H Clegg led a group of researchers investigating two ER-alpha rich portions of the brain. There is a part of the brain called the ventromedial nucleus. This area has been long recognized to play a role in energy regulation.
Clegg and her colleagues used a new laboratory technique called RNA interference. This enabled them to deactivate the ER-alpha receptors in the ventromedial nucleus (but not other parts of the brain) in rats. When they did so, the animal’s energy levels and metabolic rates plummeted. The animals also developed insulin regulation issues, an intolerance of glucose, and weight gain, even though their calorie intake remained the same.
This is so important it bears repeating:
Without estrogen in the ventromedial nucleus, rats ate the same amount of food as normal but developed severe weight gain, glucose issues, and low energy. Without estrogen, keeping everything else the same, they gained weight.
Plus, their weight was not evenly distributed. Instead, it went directly to the visceral, or abdominal area of the body. This area is linked to a much higher rate of inflammation and disease than fat in other locations.
Lowering estrogen activity in the brain throughout menopause and after has the same effect on women: the body natural starts to burn less fat, and to keep storing it in places like the abdomen.
2. Estrogen and progesterone combat insulin and cortisol
As I discuss at length in my program for weight loss, Weight Loss Unlocked: The Paleo Woman’s Solution (check it out here) – estrogen and progesterone play important roles in modulating insulin sensitivity.
Importantly, estrogen helps make you more insulin sensitive. As estrogen levels drop in menopause, this can be a big problem for keeping fat storage to a minimum, and especially around the abdomen, where it can be a health concern.
Importantly, estrogen and progesterone also help modulate cortisol levels. When estrogen and progesterone levels fall during menopause, it’s entirely likely that over time, the body shifts toward storing fat when calories are high (as opposed to building muscle), and reduces the amount of fat burned when calories are low (and burn muscle instead). This is an effect both of reduced cortisol suppression as well as reduced insulin sensitivity.
3. Muscle mass deteriorates more quickly than it used to
Oxidative stress, inflammation, and inactivity are important reasons that muscle mass decreases as women age.
Yet estrogen is also quite important. Estrogen helps move calcium into bones and therefore supports a strong skeleton.
Estorgen also helps build muscle.
Now, this might not make a lot of sense, since body builders are always talking about the importance of testosterone. Yet even male body builders recognize the importance of estrogen. The body needs a certain amount of estrogen to maintain androgen (male sex hormone, like testosterone) receptors, which then go on to stimulate muscle growth. Furthermore, estrogen receptor beta appears to encourage muscle growth itself. The process of muscle loss while aging – called sarcopenia – has been shown to be slowed by estrogen treatments (and estrogen receptor beta activity) in rats. Interestingly, these muscle-stimulating affects occur in both male and female mice.
4. When exercising the body doesn’t burn as much fat as it used to
Unfortunately, due to declining muscle mass and insulin sensitivity both, it becomes harder for the body to burn calories during workouts.
This is unfortunate, but also not without its solutions. Women who switch to high quality weight-bearing exercises (which you can find, or example, in Noelle’s amazing Strong from Home workout program) do maintain muscle mass, and therefore high quality, effective workouts. They just have to good about it. This is partly why I recommend Noelle’s program so highly – it helps you craft a fitness plan that is the perfect amount of cardio, weight training, and challenge for you.
You can be sure that the more you focus on maintaining muscle mass, the more intense and beneficial your workouts will be.
What to do about it
As I just mentioned above, you can help preserve the efficacy of your workouts by choosing ones that focus on lifting heavy weights. You can get an awesome program designed just for this purpose with Noelle’s wonderful Strong from Home.
You can also do everything you can to keep inflammation to a minimum. This will help keep your body from building up stress hormone levels and storing fat in your abdomen. This means eating a nutrient-rich, anti-inflammatory diet full of organic vegetables and fruits, organ meats (here’s a supplement in case you do not like to eat liver), eggs, fermented foods (on this page are my favorites) and the rockstar superfood cod liver oil can go a long way.
Finally, you can work on supporting your estrogen levels. I do not recommend hormone replacement therapy. Sometimes, a small dose for a short period of time can work great as an interim fix. But in the long term, it is probably best to focus on supporting estrogen with simple diet and lifestyle choices. You can do this getting plenty of high quality carbs (such as fruits and starches) and fats (such as olive oil and coconut oil) which can help boost estrogen production.
You may also be served by playing with your intake of phytoestrogens. Phytoestrogens are estrogens found in plants. They occur in high doses in soy and flax, and in lower but still sometimes effective doses in legumes such as black beans and chick peas. For some people they hurt estrogen production, but for many women in menopause it can actually help. Start with a small dose, such as a bowl of chickpeas or hummus, once a day to see if it helps make a change.
I talk in more depth about the effect of hormones on weight maintenance in my manual for permanent weight loss for women, Weight Loss Unlocked: The Paleo Woman’s Solution. If you’re looking to find a way to keep losing weight as you age, this may be a great resource for you. Plus, it’s 100% risk free – you can try the plans without any hassle or risk. Check it out here.
Importantly, I personally have not gone through menopause! Everything I’ve shared here I’ve learned through research. Please if you have any comments or ideas or experiences share them below!