Does A Ketogenic Diet Cause Weight Loss?
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In almost every human study of overweight patients lasting 3 months or longer comparing a ketogenic diet to a low fat diet, the weight loss with the low carb diet is somewhat or significantly greater (Sachner-Bernstein 2015). Most of the weight lost on a well-formulated ketogenic diet lasting a few weeks or longer comes from body fat.
Two Questions about the Relationship Between Nutritional Ketosis and Weight Loss
1. First, does being in nutritional ketosis necessarily cause weight loss? Yes in a person who is relatively insulin sensitive, so that when that individual gets to their new stable (‘maintenance’) weight, they could eat a wider range of total daily carbs and still remain weight stable. (The carbs should not include sugar, wheat products or processed food.)
2. This leads us to the second question: Can a human remain in nutritional ketosis and not lose weight?
The Science of Ketones
Ketones particularly ((beta-hydroxybutyrate [BOHB]) are the preferred fuel for the brain and to some degree the heart, allowing these key organs to function as well or even better when dietary carbs are severely restricted compared to when dietary carbohydrates are high.
Switching from carbs to ketones does not happen overnight – it takes weeks of consistently restricting carbs for this process of keto-adaptation to fully occur. But once this process is complete, the body can burn fat at over twice the rate compared to when carbs were a major component of the diet (Phinney 1983, Volek 2016).
Once keto-adapted, people consistently report that the intensity of their hunger and cravings is diminished; (Boden 2005, Mckenzie 2017) and that the daily swings in energy and mood they experienced on a high carb intake are reduced, if not banished. These problems tend to be replaced with a consistent sense of energy and mental alertness as long as a well-formulated ketogenic lifestyle is followed (Volek & Phinney 2012).
Besides being the preferred fuel for the brain and heart, we have recently recognized that BOHB also functions like a hormone that signals multiple changes in gene expression (aka ‘epi-genetic effects’). Among other effects, BOHB turns on the body’s innate defenses against oxidative stress and inflammation (Schimazu 2013, Youm 2014), and it also acts 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 from oxidative stress, inflammation, diabetes, and probably Alzheimer’s disease and aging as well (Roberts, 2017). All we need do to accrue these benefits is restrict carbs to allow the keto-adaptation process to occur.
Coming back to this question of ketones and weight loss, when someone with some extra body fat begins a ketogenic lifestyle, perhaps it is the increased ability to burn these stores, coupled with the reduction in appetite and cravings, that facilitates initial weight loss. In this scenario, keto-adaptation facilitates weight loss, but only as long as the reduced hunger and cravings allow one to comfortably eat fewer calories per day than one burns.
Over time, most people who sustain 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 out one’s daily expenditure. But as long as dietary protein is kept moderate and carbs low, this dietary fat is used in place of body fat to produce ketones, so clearly nutritional ketosis can be maintained without any further weight loss (Phinney 1983).
But here’s a problem that many people experience. They have been told that increasing blood ketones will speed their weight loss. However, rather than cutting back on carbs and avoiding extra protein to boost ketone levels, they are led to believe that they can get the same effects by adding extra MCT oil, coconut oil, or exogenous BOHB to push up blood ketone levels. But, this does not enhance their body’s ability to burn fat. It just gives them a type of fat that has to be burned (some of it as ketones) in place of body fat. No wonder they are usually disappointed when their weight loss stalls well above the goal they want to reach.
What This Means for Weight Loss and Weight Maintenance on a Ketogenic Diet
In summary, being in nutritional ketosis will accelerate the rate at which the body burns fat. If the extra fat that is burned is compensated by an increase in dietary fat, then no body fat loss will occur (but there still will be other benefits). However, most people carrying excess fat tissue who achieve nutritional ketosis by eating natural low-carbohydrate foods initially feel more satiated, allowing them to eat less fat than they burn, which results in net fat loss. But eventually, even when one is in sustained nutritional ketosis, our natural instincts prompt us to increase fat intake to meet our daily energy needs resulting in a stable weight and body composition.
Bottom line: For those wishing to lose weight additional rather than remain weight stable, one’s goal should be to reduce dietary fat intake down to the margin of satiety (just enough, but not too much) and avoid or limit non-satiating energy sources such as alcohol.
This Post had been condensed from the Virta post https://blog.virtahealth.com/weight-loss-ketogenic-diet/ By Stephen Phinney, MD, PhD and Jeff Volek, PhD, RD
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