Does "Nutritional Ketosis" Require 85% Fat?

For some if you bring calories into the discussion of low-carb diets, you're pontificating, unless of course you're not.

"...of course, if one eats too much fat during that low-carb diet, you're not going to lose weight; there are differences in metabolism, but calories count in the process of eating a low-carb diet."
-Steve Phinney
August 25, 2012, Ask the Low Carb Experts Podcast

I start with Dr. Phinney since he's co-author of The Art & Science of Low Carbohydrate Living, The Art & Science of Low Carbohydrate Performance, and The New Atkins For You.

A funny thing happens when you read all three books - you find they all explain the role of calories in a low-carb diet.  

Imagine that.

In The New Atkins for You we find, "Don't count calories, although we ask you to use common sense.  In the past, some individuals made the mistake of thinking they could stuff themselves with protein and fat and still lose weight.  If the pounds are falling off, forget about calories.  But if the scale won't budge or it seems to be taking you forever to lose, you might want to do a reality check, caloriewise."

In The Art & Science of Low Carbohydrate Living we find, "The definition of 'maintenance' is that your daily energy intake equals your daily expenditure"

Additionally there is, "In order to judge how best to formulate the mix of macro-nutrients in a low-carb diet, it is helpful to visualize how your total energy intake will change from induction to maintenance.  As indicated in the graph on the next page, a typical male with a BMI of 34 might start out eating 1600 kcal in induction while his body burns 3200 kcal per day (thus the weight loss).  But after losing 50 pounds to a BMI of 27, his daily energy intake will need to increase substantially to eventually maintain him stable at that reduced weight."

In The Art & Science of Low Carbohydrate Performance, calories aren't the focus per se; rather formulating a ketogenic macronutrient mix for performance is detailed with two key features - that initially carbohydrate intake, to keto-adapt, should be less than 50g carbohydrate each day, and that once adapted one may remain keto-adapted with up to with up to 100g of carbohydrate each day; and that protein intake should be between 0.6g and 1.0g per pound of lean body mass (LBM).  In the book, the authors refer back to The Art & Science of Low Carbohydrate Living for those who wish to lose weight.  

The salient point about calories however is that once you've determined protein and carbohydrate, your remaining calories come from fat to fuel your energy needs for performance, with this being especially true for those who do not have high levels of body fat.

In the podcast above, Dr. Phinney took pains to emphasize that a "well formulated" low-carb diet restricts carbohydrate, is moderate (not high) in protein and is high in fat.  Yet what that means wasn't well defined.  Details are found in the above books and the formulation is not based on percentage of calories from each macronutrient, but rather expressed as specific grams for carbohydrate and protein requirements based on height and gender (The New Atkins For You), based on kilograms of LBM (The Art & Science of Low Carbohydate Performance) or 1.5g to 2.5g of reference weight (The Art & Science of Low Carbohydrate Living).  

Interestingly, in the last one, detail was provided to show how initially on a calorie restricted low-carb diet, protein intake will appear to be high as a percentage of calories - yet when factoring total calories being expended through weight loss, it really is less a percent of the total calorie expenditure; and that once one refines calories for maintenance of body weight, percentage of protein usually falls within "...15% and 25% of your daily energy intake coming from protein."

So in each of the books, calories are not ignored, but fundamentally part of what you eat to lose or maintain weight. More importantly, each details why within context of a low-carb diet - which for weight loss reduces calories and stabilizes hormonal function, and in weight maintenance keeps body weight and hormones stable.  '

Over the years I've written quite a lot on how to do a low-carb diet that allows for weight loss while being nutrient-dense.  From my experience, three things are needed for long-term success - one is adequate calories because if you restrict calories too much, that is counter-productive to weight loss as the body makes adjustments when energy intake is too low to prevent additional weight loss; two, a nutrient-dense selection of foods each day, to provide adequate intake of essential nutrients from EFA, EAA, vitamins, minerals and trace elements; and three, a calorie deficit.  

As you lose weight, I've long recommended looking at protein intake and calories if you stall - you see, protein intake confounding weight loss is not a new concept - since 2005 I've been writing about the critical importance of protein and how much one needs to meet EAA based on their weight.  In August, I posted a chart, based on weight and the standard 0.8g/kg body weight minimum protein required daily and the range of 1.0-1.5g typically needed when one is in ketosis to fuel gluconeogenesis.  I noted in that post, that some individuals, due to higher activity levels, may need up to 1.5g/kg body weight to meet needs, and that for most, the 1.0g-1.2g/kg seemed to work nicely.  That chart is helpful to understand how protein needs change with weight loss and can help with adjusting protein intake as one loses weight.

So the question remains, is Jimmy Moore following a "well formulated ketogenic diet"?

While he is in ketosis ("nutritional ketosis"), he is not within the well detailed guidelines in the above books.  That's okay too - his body, his experiment - I'm writing this to provide accurate information to anyone out there whom may wish to attempt replicating what Jimmy is doing, me pointing to the areas that may be problematic if one duplicates exactly what Jimmy is doing based on the little information he's provided in the last six months.  

Jimmy has provided scant detail about what he is eating in grams or calories, instead sticking to percentages of calories and a few representations of meals that were indeed within those ranges.  The interesting thing though is that none of the above books specify a percentage of calories - they look at absolute grams for protein and carbohydrate and explain how these work out to ratios, highlighting how percentages changes from weight loss to maintenance; not percentages to define how you eat when losing weight.

A couple of examples:

In Chapter 6 of The Art & Science of Low Carbohydrate Living, the authors note "Second, when someone goes on the Atkins or another low-carb diet, they usually lose weight, right?   Much of the weight loss comes from body fat, which typically provides up to half its daily energy from "inside" (ie. endogenous stores) during the initial weight loss phase.  So if someone is eating 1400 kcal/day consisting of relatively lean "protein foods" that are helf protein (700 kcal) but burns 2800 kcal per day, his/her dietary protein intake is actually supplying about 25% of their total daily energy need, falling below the empiric 30% ceiling noted above.  But to the casual observer who is ignoring the contribution of body fat stores, the actual food being eaten appears to be high protein."

Chapter 16: "In order to judge how best to formulate the mix of macro-nutrients in a low-carb diet, it is helpful to vizualize how your total energy intake will change from induction to maintenance.  As indicated in the graph on the next page, a typical male with a BMI of 34 might start out eating 1600 kcal in induction while his body burns 3200 kcal per day (thus the weight loss).  But after losing 50 pounds to a BMI of 27, his daily energy intake will need to increase substantially to eventually maintain him stable at that reduced weight."   The example given considers that his energy requirements are 2800 kcal a day, with 150g of protein (600 kcal) and now 100g of carbohydrate (400 kcal), leaving 1800 kcal from fat.  That would represent 64% of his energy requirement each day.

So what is Jimmy doing?  Let's look first at protein intake.  Jimmy says he averages 80g a day and that represents 12% of his calories. 

Is that enough?

When he started at 306 pounds, no; at his last weight of 245.8, no.  

In fact, it appears Jimmy is eating below his protein requirements during this experiment - something that for long-term success I do not recommend.

• Using my chart online, at 306 his minimum requirement was 110g, good level for GNG 135g; at last weight minimum 90g, good level for GNG 115g. 
• Using The Art & Science of Low Carbohydrate Living, which references back to The New Atkins for You, it would be based on height and gender, 95g-199g
• Using The Art & Science of Low Carbohydrate Performance, with 155.92 pounds LBM in November, would be 92g-156g

Taking a look at carbohydrate, representing 3% of his calories, he's averaging 20g-25g a day.  He's been doing this now for six months and has not yet increased his carbohydrate intake, basically remaining within what is traditionally called "Induction" level carbohydrate.  

He may want to re-read The New Atkins for You, where they agree with Atkins' original concept to increase carbohydrates as you lose weight to broaden your horizons and variety.  

"Don't make the mistake of staying in Induction too long just because you love how the pounds are peeling off.  Eventually it's important to move through the phases to ensure that you have cured yourself of your old habits and can reintroduce foods without halting your weight loss or provoking cravings.  Losing weight fast is exhilarating, but it will likely be a temporary fix if you don't find your comfort zone for eating in the "real world".

Lastly, he details that his fat intake represents 85% of his calories each day.  It is interesting to note that none of the menus within the above books has that much fat - the range is between 68% and 74%, varying daily if one were to just follow those menus; that range falls within the range you'd find in the original Atkins' diet books published between 1972 and 2002, and the most recent The New Atkins For You.  Personally, I do like The New Atkins For You as it explains a lot more of the science behind why low-carbohydrate diets are effective for weight loss.

My recommendation to anyone looking to experiment with "nutritional ketosis" is to first read the books above to understand how to do it properly, they provide details about what your protein requirements are, how to increase carbohydrate and include a wider variety of foods as you lose weight, what level of fat is needed, and more importantly, how to transition to maintain your weight.  If you don't want to buy new books and have the older versions of Atkins' books, re-read them, the older version is very similar without need to buy a ketone meter and strips.  If that's you thing and you feel you need to, fine measure blood serum, but remember, you do not need to.

If you just want a quick refresher on following Atkins, here is my Review Time post from August.

Whatever you do, remember, calories do matter - in context; that context is nutrient-density and endocrine function.  

Jimmy Moore has spent incredible time repeating that his "well formulated" ketogenic diet is very high in fat, 85% of calories - before you leap to do the same, because ketosis does not require 85% of calories from fat, please educate yourself and understand how it's really done!