Keto Isn't About Ketosis: My December 2019 Reboot Live on Insulin, Protein and Realistic Pace

2019-12-01

On 2019-12-01, early in the morning and not yet dressed, I went live for an hour to start a six-month "reboot" for the group, running from December 1 to June 1. This was never on YouTube. It's the most complete statement I made of how I thought keto works: as an insulin-reduction diet that makes a calorie deficit easier to hold, not as a fat-burning trick (live JDDW2290).

In this recording

[0:52] The usual pattern: a few pounds of glycogen and water in week one, often nothing in weeks two and three (sometimes four), then it gets easier. People who celebrate week one and stall in week two get discouraged.
[1:30] Ketosis is a tool for cutting cravings later on, not a magic fat burner. My comparison: calling keto a "fat-burning machine" is like calling a Tesla an electricity-burning machine. It uses different fuel, not more of it.
[2:20] Reading a chicken-nugget label: the "protein" on a kid's plate has more grams of carbohydrate and fat than of protein.
[7:37] Protein is the most important macronutrient, in my opinion. With an aside on "rabbit starvation," which only happens in survival situations.
[10:46] Ketosis isn't the goal, and neither is weight loss. The goal is body recomposition. You can gain weight in ketosis.
[12:27] What drives weight loss is food choice and a calorie deficit. Ketosis makes the deficit easier to keep.
[13:27] I said the RDA is a survival amount, not an optimal one. In the food logs I'm sent, I almost never see enough protein and almost always see too much fat.
[17:30] Two reasons you want the cookie: something psychological (boredom, stress, habit), or hunger signals that are off.
[19:42] My understanding of the hunger path: leptin, ghrelin and insulin working together. I called it a theory that's still being tested.
[21:20] Keto is an insulin-reduction diet, not an insulin-elimination diet. Protein and trace carbs still produce insulin.
[24:43] For most people, cutting carbs means hungry less often and usually some weight loss. That's less true with age and for women, and the group was more than 90% women.
[28:21] Why loss slows as you shrink: carry a 40-pound bag of dog food around all day and tell me your activity level hasn't changed.
[31:12] Half a pound to a pound a week is a good pace. Half a pound is what I'd rather women have in mind. Don't measure yourself against social-media transformations.
[42:48] Where my own eating habits came from: a clean-plate upbringing, low-fat "diet" cookies, and the food pyramid's six to eleven servings of grains.
[47:13] On keto I don't overeat. When I bring carbs back, I'm hungry almost right away and snack and overeat.
[48:48] The reboot target: 10 to 20 pounds by June 1, with no cap if you want more.
[50:16] A low-carb day isn't a failed day just because you weren't in ketosis. Ketosis helps physical hunger. It does less for emotional or night-time eating.
[52:31] Track if you're new, stuck or off the rails. "I eat keto foods" tells me nothing without a log.
[55:20] Step one: drop the obvious starches (potatoes, rolls, rice, pasta) and raise protein. Leaner protein matters more from about weeks five to eight. Fat gets looked at around weeks three to six, when the deficit opens.
[1:01:16] Cut a piece of yarn to your waist, thigh, arm and neck, and hang the strings up. Scales drift, and I've seen people drop dress sizes at the same weight.

Drill-down: "ketosis is not what drives weight loss"

This was a pointed thing for someone called KetoDick to say. It's also the claim the evidence backs best.

In metabolic-ward studies, where every calorie is controlled, ketosis didn't come with a fat-loss advantage. When 19 adults had calories cut by removing either carbohydrate or fat, body-fat loss was 53 g a day on the carb cut and 89 g a day on the fat cut (Hall 2015). When 17 men switched to a ketogenic diet at the same calories, energy expenditure rose by about 57 kcal a day, and body-fat loss slowed after the switch (Hall 2016). Outside the lab, 609 adults on healthy low-fat or healthy low-carb diets for a year lost 5.3 kg and 6.0 kg, not significantly different (DIETFITS, Gardner 2018).

So when I said ketosis makes the deficit easier but doesn't replace it, that matches. What these trials can't test is the part I cared most about: whether people who aren't on a ward eat less without trying because they're less hungry. That's my hunger argument, and I said in this Live that the leptin-ghrelin-insulin pathway was a theory. None of the evidence pages for this site tests it directly, so it stays a theory here too. More in insulin and fat storage and the metabolic-ward studies.

Drill-down: is the protein RDA a "survival" number?

That's too strong, but it's pointing at something real. The US adult RDA is 0.80 g per kg of body weight a day (National Academies 2005). A nitrogen-balance meta-analysis put the median requirement at 0.65 g/kg and the 97.5th percentile at 0.83 (Rand 2003). So the RDA is set to cover nearly everyone's minimum need. It's a floor, not starvation rations. Reviews of dieting and training put useful intakes higher. One gives 1.8 to 2.0 g/kg during energy restriction, depending on the size of the deficit (Phillips & van Loon 2011). On hunger, raising protein from 15% to 30% of energy led people eating freely to eat 441 fewer calories a day (Weigle 2005). So "protein first" holds up, even though "survival" was the wrong word.

Then vs now

The week-one-drop-then-stall warning goes back to my day-three reply in July 2017 and my week-by-week timeline. By 2019 I'd added the reason people quit: they announce keto works in week one and feel betrayed in week two. The "adherence, not a trick" idea is from why keto works (2017). The yarn measurements and the +20 protein rules both appear in keto basics (2018).

Before you start a reboot

If you take medication for diabetes or blood pressure, cutting carbs can change your dose quickly. Talk to your doctor first (why doses change). If you have a history of an eating disorder, tracking and deadlines can do harm, so set this up with your care team (eating-disorder history).

Key points

Ketosis is a tool for appetite, not the source of fat loss. Controlled trials back that (live JDDW2290).
Get protein right first. The RDA is a floor, and dieting needs more.
Half a pound to a pound a week is a sound pace. Women and smaller people should expect the lower end.
A low-carb day counts even without ketosis.
Measure with string or a tape, not only the scale.

Guide: Chapter 1: Keto basics · Chapter 2: How fat loss works · Hunger and appetite · How much protein · Weight-loss timeline · Non-scale victories
Blog: Do you have to be in ketosis to lose weight? · Does insulin make you fat? · Realistic goals · Comparing yourself on social media
Videos: Why keto works · Week-by-week timeline · Keto basics for beginners · Day three on keto