Is It Safe To Stay In Ketosis Indefinitely?

How Long Can I Stay in Ketosis?
Are You Putting Too Much Attention on Ketosis?

There seems to be a lot of focus on the state of Ketosis these days, with many people asking the same questions:
  • Am I in ketosis?
  • How many carbs does it take to get thrown out of ketosis?
  • What should I do if the Ketostix aren't showing that I'm in ketosis anymore?
  • I'm only eating 20 carbs, why am I not in ketosis?
  • Is it safe to stay in ketosis indefinitely?
And while some of these questions are certainly important, like just how safe of a diet is the Atkins Diet long-term, overall it seems that the low-carb community is putting too much emphasis on the process of ketosis and not enough focus on nutrition.

With so many different versions of Atkins out there, and people still doing all of them, I don't see the questions going away anytime soon.

With that in mind, I thought I'd take a moment and do a post on my own personal views about ketosis and its long-term safety.

Thoughts on Ketone Testing Strips

In the 70s, the whole Atkins' diet was built up around the idea of ketosis being the revolutionary miracle to save you from obesity. Like everyone else, I rushed out to the drug store and bought myself a bottle of ketone testing strips -- Ketostix they called them back then.

These ketone testing strips were actually created for diabetics who needed to test for the presence of Ketoacidosis. Acetoacetate are the type of ketone you are actually looking for when you test your urine: the ketones that prove a diabetic is in trouble.

The sticks don't test for the state of ketosis because that is actually measured by ketones in the blood, but at the time, Dr. Atkins felt that ketone testing strips were an accurate enough test. Plus they gave dieters the motivation they needed to put his Revolution to the test.

Since then, we've discovered they aren't very accurate, even for urinary ketones.

When I went on Atkins for the very first time, I registered dark purple no matter how much water I drank.

When I went on Atkins again, a second time, the color was somewhat lighter, but still moderate.

Each time I returned to Atkins, the strips grew lighter and lighter, until today -- I don't register on the sticks at all, even when doing Induction.

You can be in ketosis without turning the ketone testing sticks any color at all. You can register dark purple on the sticks, yet still not be burning body fat. In fact, these variances occur despite the number of carbs you eat.

There's NO standard.

Everything is individualized. Everything depends on your own:
  • circumstances
  • goals
  • and metabolic damage
And here's the clincher:

You don't even have to be in ketosis to mobilize your fat stores!

Latest scientific research showed participants had absolutely no problem mobilizing fat stores in the presence of insulin. Caloric deficit is what led to fat loss. In fact, as they moved from a high carb diet to a low carb diet, fat loss slowed down tremendously.

Insulin Hypothesis

The original idea for ketosis mobilizing your fat stores was tied to ideas about insulin.

Lowering basal insulin levels back to normal was supposed to open the doors to your fat stores and help them to stay open. This is what all of the low-carb experts over the years have taught.

Dr. Eades went a bit further and suggested that ketosis helps you avoid all of the pitfalls and health consequences associated with Insulinemia (high insulin levels) and insulin resistance. Those benefits may, or may not, be true.

I honestly don't know.

What I do know is that somewhere along the way, things got tilted.

People started teaching that low carb meant some kind of high-fat free-for-all.

Stay in ketosis and you can eat all of the low-carb high-fat food you want, whenever you want, including lots of high-calorie, fatty foods and you'll still drop the weight and make it to goal.

Stay in ketosis, they told me, and your body fat stores, regardless of the amount of calories you eat, will just fall off you because carbs are the demon, not calories.

Stay in ketosis, and you'll experience Atkins Magic:
  • no hunger
  • easy fat loss
  • permanent weight loss
But these were false promises, suggestions that didn't live up to their claim because the Insulin hypothesis is just a hypothesis.

Extended Induction

The problem, as I see it, isn't with the Atkins diet. The problem is us. We read the book cover to cover, but we only saw and retained what we wanted to see and remember.

We didn't think about how the whole book was structured, the different phases and steps we were supposed to move in and out of because Dr. Atkins said if you have a lot of weight to lose, it was okay to do an extended Induction.

Okay. An extended Induction.

With extended being the key word here.

The low-carb community totally loved the idea of faster weight loss, faster fat loss, and we embraced the idea of doing a very low-carb diet for an extended period of time because we are totally into FAST.

What we failed to understand, and this happened in the latter 90s as well as it does today, is that an extended Induction does something to the metabolism. I don't know what that is exactly but the body adapts to what you're doing.

It could be a thyroid issue. It could be a total body metabolic issue, a metabolic adaption so-to-speak, but I watched people do it to themselves in 1999, and I've watched people do it to themselves in 2010 when this post was first written.

Likewise, I'm still seeing people do it to themselves today.

But here's the rock-bottom truth:

Whatever carb level you chose for the majority of your weight-loss phase is pretty much the carb level you've sealed yourself into living with for the rest of your lives.

Did you get that?

The original Atkins diet, and even all of his later versions were never designed to keep you in ketosis forever.

They really weren't.

They were designed to get you into ketosis to initiate weight loss and make it easier to eat at a caloric deficit because you aren't hungry.

Ketosis is a metabolic state where hunger and cravings can be controlled long enough to teach you how to add more carbs to your diet slowly, so you can learn your own personal tolerance for carbohydrate -- and learn how to stay within that tolerance.

What most people did instead?

They stuck to Induction level of carbs for faster weight loss, or just barely above that, and stayed there for so long that their bodies literally adapted to that carbohydrate level.

The body created a new set point for carbs, so now, when these people try to up their carbohydrate level, even after the week or so required to up-regulate the enzyme needed to process carbs, they can't do it without gaining.

In a very real sense, people who didn't NEED to stay at those reduced levels literally shut themselves out of a more moderate maintenance diet -- all in the name of faster fat loss.

Playing the Victim Never Works for Long

We really need to think about what we're doing to ourselves. Right Now. Before it's too late. Because the original idea wasn't to stay in ketosis forever.

Unfortunately, staying in ketosis long-term is what a lot of folks are going to have to do even though we do not know how safe long-term is.

I've seen some pretty wacky things happen to those who have been in ketosis for too long, myself included.

Are you using the state of ketosis as it was originally intended? A tool to help you learn your own personal tolerance for carbohydrates?

Or, are you using the state of ketosis as a crutch because you have convinced yourself that the demon in your life, the thing outside of yourself that made you fat, the one thing that is to blame for everything wrong in your life -- is carbohydrates?


  1. I tried the Atkins diet years ago and the induction phase was brutal and my mindset was "I can't wait until this is over!" I was not able to maintain the Atkins diet and slowly returned to my normal way of eating, gaining back every pound.

    Two years ago, I decided to take a slightly different approach. I developed a spreadsheet using values from USDA Standard Reference Database and started charting what I was eating. Since I eat pretty much the same breakfast and lunch every day, it was fairly easy. I also decided not to make any changes in my diet more than once every two weeks.

    A year and a half ago I decided to slowly move to a low-carb diet, still using the one change per two weeks rule. It took me a year to drop my carbs from 300g/day to under 100, at the same time slowly raising the fat I ate. I now average around 70g carbs/day, enough to stay out of ketosis constantly, but low enough to keep buring fat as my primary fuel source.

    I've also discovered that my tolerance for sweets has been greatly diminished. Anything sweeter than a blueberry or strawberry isn't pleasant. I also don't drink anything with artifical sweeteners. I also have an unpleasant physical reaction if I do try to eat a significant amount of refined carbs. The upside is that I no longer need willpower or virtue to avoid sweets.

    I also decided not to eat any processed low-carb foods, like protein bars, etc. and to focus instead on foods that have been subject to minimal processing. For example, I enjoy greek-strained yogurt and very dark chocolate, and will occasionally have a few nibbles (tip of the spoon) of Ben & Jerry's ice cream that my wife enjoys.

    Any eating plan where I can't eat foods I enjoy is doomed to failure. The trick is to slowly adapt to new foods that are healthier for me. I now walk past tables full of foods that I used to eat and have absolutely no desire for them. It's really wierd at times.

  2. Thanks for your comments ET,

    As that seems to be the place I'm finding myself in today. Unable to do anything even close to an Atkins' Induction. Or even general low carb (30 to 40 carbs per day) without my blood glucose level going pre-diabetic or diabetic on me.

    Although I haven't yet been able to get my hands on any of the Schwarzbein books, it's my understanding that her opinion is that low-carb is unhealthy for the adrenals.

    I don't particularly like black and white thinking though. So I wouldn't go so far as to say that's true for everyone. But I'm wondering if all of my health issues (like Celiac, and other autoimmune stuff) in connection with low carb is just too much stress.

    I like your idea of backing into things. I also like Big Daddy D's idea of a more moderate carb approach spread out evenly over the day, which is what you have now arrived at.

    72 carbs a day is what Schwarbein recommends for Insulin Resistant, Exhausted Adrenals.

    Thanks for stopping by.

  3. Irregardless is not a word.

  4. I really have to recommend you edit out the "irregardless"es because I cringed at each one. Other than that it's a good article

  5. Would it be possible for you to include your qualifications please?

    Your article is interesting but it would certainly be more credible if you demonstrated some basis for your opinions.


  6. I currently am on day 6 of very low carbs. Although dairy doesn't seem to affect me so I do not monitor it. My goal is to purge the craving for sweets and then keep white flour and sugar out of my diet. I have about 150 pounds so I have a long way to go. I have a book "The insulin Resistance diet" that works very well for me once I get my sweet tooth under control. I could not eat like this for ever but I can do it for a few weeks then slowly add fruits and limited whole wheat carbs back in.

  7. Anonymous,
    That is very similar to the way The South Beach Diet works. Many people have been quite successful eating that way. The beauty of low carb is that there are a wide variety of ways to implement it. There is no single right way to follow a low carb diet program. Creating something you can live with is always the best way to go. Thank you for your comments.

  8. Dear Vicki,

    Your article is very well written, and i have had the same thoughts...and i concur that a one size fits all approach doesn't work.

    i'm a diabetic, and i can safely consume approximately 60-70 carbs a day-of whole, unprocessed foods, such as greek yogurt, berries, tons of veggies, good fats, know...

    and i can taste the ketosis on my i may add 10 grams more here soon.

    Anyway, thank you for writing such a good those anonymous trolls who comment on a, they must have a lot of free time on their hands, lol!!!

    Take care and thank you again:)

  9. Thank you for the compliment and the encouragement. Eventually, when the body adapts to ketosis, the breath problem goes away.

    There are a couple of low carb doctors who have been saying lately that they believe ketosis is perfectly safe because they have been in ketosis for 10 years, but I'm still not one who believes we are all the same metabolically.

  10. Isn't ketosis recommened for kids with seizures? Is there any data on how long they have been in ketosis and how healthy they are?

  11. Yes children or kids with epilepsy are recommended by some doctors to continue a low carb ketogenic diet. It helps reduce the risk for seizures in most cases and does produce favorable results of what I've read. I am a Nursing Student and do follow a Paleo-Ketogenic diet.

  12. Anonymous,
    Thanks for sharing your knowledge. Kids with epilepsy are placed in ketosis long term.

  13. Replies
    1. Funny. I haven't read this one in a long time. Thanks for the laugh.


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