Is the Keto Diet and Nutritional Ketosis the Same Thing?

What is the difference between Keto,
Nutritional Ketosis, and the Atkins Diet?

Ketogenic diets come with various names:

• Keto
• Nutritional Ketosis
• LCHF
• Protein Power Life Plan
• Atkins Diet

These are just a few. Many individuals lump some or all of these plans together under the term "Keto," but that can be very misleading, and even confusing, because there are two different low-carb plans that call themselves Keto.

A reader asked me if a low-carb diet was just a Keto Diet. They were greatly confused about what a Keto Diet was and hoped I could clear up the confusion for them. 

Over the past couple of years, many of the thought-leaders within the low-carb community have latched onto the word Keto and are using it as a synonym or nickname for the state of ketosis or a ketogenic diet in general. 

Some bloggers use Keto to refer to Nutritional Ketosis specifically, and many call it LCHF, even though they are not doing Dr. Phinney's plan, but an altered version of it.

I'm not quite sure why they have all suddenly decided to do this. This is something new that's going on.

In my experience, the Keto Diet is completely different from Nutritional Ketosis, as taught by Dr. Phinney, even though those doing that plan often refer to themselves as LCHF.

The differences have caused a lot of confusion among low-carb dieters, especially since many health professionals have also begun using the terms keto and ketogenic diet to represent the more popular low-carb programs, such as the Atkins Diet, Nutritional Ketosis, and even the Protein Power Life Plan.

When speaking of Keto or ketogenic diets, these people are simply referring to the same low-carb high-fat plan they have always supported. They are not talking about anything new. 

But the switch in terms does cause confusion for those who don't understand what's going on.

While there is nothing wrong with what people within the low-carb community are doing now – a very low-carb diet by definition is ketogenic since it causes ketones to be created by the liver – the low-carb, high-fat diet (LCHF) that has been linked to the word keto recently is NOT the original Keto Diet. 

What is the Real Keto Diet?

There are two Keto Diets.

One originally came from the book, The Ketogenic Diet: A complete guide for the Dieter and Practitioner, written by Lyle McDonald around 1998, or so. [The above link is NOT an affiliate link. It simply goes to the book info on Lyle's website.] 

Lyle is a personal trainer, and the diet was the result of his personal experiences with a cyclical ketogenic diet, tons of research, and the scientific knowledge that was available at the time he wrote the book.

The book has not been updated, since it was written, so some of the information in it is obsolete, but its principles still work well. It's just the science that's a bit off today. 

The low-carb diet Lyle created has a huge, solid, long-term group of supporters that hang out over at the Reddit subforum called "Keto".

They call Lyle the Keto Guy, but Lyle doesn't really like being called that because he specializes in a wide variety of weight-loss approaches, which you'll discover at the above link. 

Keto is only one of the many approaches to choose from at his website.

Keto is a great low-carb program that comes with a very high success rate when followed appropriately, but there are some major differences between that Keto Diet and the tweaked Nutritional Ketosis program that has suddenly been renamed Keto.

What is Nutritional Ketosis?

Nutritional Ketosis is a phrase that was originally coined by Dr. Phinney. It was used to differentiate the difference between dietary ketosis and the ketoacidosis that is so dangerous for Type 1 Diabetics. 

Dr. Phinney is a medical doctor and scientific researcher who has extensive experience with obesity, trained athletes, and low-carb diets. He was one of the authors contracted by Atkins Nutritionals, Inc. to write A New Atkins for a New You.

In addition to numerous scientific papers and journal articles, he also co-authored a couple of his own books, along with Jeff Volek:

1. The Art and Science of Low-Carbohydrate Living
2. The Art and Science of Low-Carbohydrate Performance

These books outline the Nutritional Ketosis diet for physicians and endurance athletes.

Art and Science of Low Carbohydrate Living

(Available at Amazon)

Art and Science of Low Carbohydrate Performance

(Available at Amazon)

Nutritional Ketosis theory says that if you optimize the number of ketones the body makes, you can train your body to prefer burning fats for fuel instead of glucose. 

In essence, you can flip your metabolism completely around, so that when you do eat things that are broken down into glucose, the body will instantly go back to burning fats once those glucose calories have been used. 

You don't have to start all over at square one. 

The body will simply move back into ketosis without effort and get back to burning fats when fats are more available.

This is important from an athletic perspective, but also important for everyday people, as well, which is why there are TWO books instead of just one. 

The Art and Science of Low-Carbohydrate Performance was written for highly trained athletes who want to use a low-carb high-fat diet (LCHF) to fuel their intensive workouts and long-distance bicycling or running efforts. 

This is not a weight-loss book.

The Art and Science of Low-Carbohydrate Living, on the other hand, was written for medical professionals, but many dieters purchased the book to read more about the science behind low-carb weight loss, as well.  

To reach optimal ketosis, you have to balance the amount of carbs, fat, and protein you eat on a daily basis. 

While 0.5 mmol/L blood ketones is high enough to produce dietary ketosis, 1 to 2 mmol/L is thought to be optimal, with well-trained athletes having ketone levels as high as 3 mmol/L, or a little bit more. 

Jimmy Moore's version of Keto
contains 80 percent fats and is a bit lower in protein.

Even though the books are popular, most of today's ideas about Nutritional Ketosis came from Jimmy Moore, a popular blogger who read The Art and Science of Low-Carbohydrate Performance and then decided to do an n=1 experiment on himself. 

After testing his blood for ketones, using a blood-ketone monitor that had just hit the shelves, he announced on his blog that he was not in ketosis at all.

Because of that, he decided to take the maintenance diet presented in the book for well-trained athletes and apply those same dietary macro percentages to his weight-loss diet. 


He didn't leave any of his daily fat percentage for body-fat. Instead, he ate the entire 80 percent fat that the body needs at maintenance and drastically lowered his protein intake.

This odd diet -- which is NOT Dr. Phinney's Nutritional Ketosis diet for weight loss, by the way -- sent Jimmy's low ketone level soaring up above 3 mmol/L. At the same time, he started to drop some weight. 

With his new weight loss, Jimmy's ideas caught fire within the low-carb community. 

Many bought their own ketone meters, at Jimmy's recommendation, and discovered similar things about their ketone levels. Those not in the optimal ketone zone, as defined by Dr. Phinney, saw super-high ketones when protein was reduced severely and fat intake increased to extremely high levels.

As a result of Jimmy's n=1 experiment, Nutritional Ketosis -- as practiced within the low-carb community today -- was born. 

3 Keto Diets: What is Going On?

According to Dr. Phinney, carb restriction drives Nutritional Ketosis. 

If you restrict your carbohydrates, the body will increase its production of ketones to save muscle wasting and fuel the brain. Going too high in ketones (above 3 or 4 mmol/L) is a sign that you have crossed over the upper limit for optimal ketosis and have gone into Ketone Starvation.

Ketone Starvation is driven by protein deficiency.

To lower protein to the extent that those doing Nutritional Ketosis or "Keto/LCHF," as it is more often referred to today, are doing, dietary fats are substantially increased, sometimes as high as 80 percent of your calories. 

All of this extra dietary fat gives the body ample material to make those excess ketones, so there is no incentive for the liver to mobilize body fat for fuel. 

Please notice that the diet called Nutritional Ketosis or LCHF within the low-carb community is Jimmy Moore's version of Nutritional Ketosis, and not the actual Nutritional Ketosis diet created by, and used by, Dr. Phinney -- also called Keto. 

To see what the original plan consists of, check out our post on The Truth About LCHF Weight Loss for further details.

What is the Keto Diet?

The Keto Diet at Reddit doesn't measure ketones in the blood. Nor the urine for that matter. Because, if you're eating at 20 or 25 net carbs per day, you are in ketosis no matter what the testing sticks say. 

There's no way that you can't be in ketosis. 

If you're not eating enough glucose-foods to support the brain and the body doesn't make ketones to take up the slack, you'd die. 

Period.

For this reason, the folks at Reddit have no use for Ketostix or blood ketone meters, although a few of them do use the urine testing strips for a moral booster.

The brain cannot use fatty acids for fuel. This is why the body decides to adapt to glucose deprivation by going into ketosis.

According to Lyle McDonald's book, the brain needs about 100 grams of glucose per day. Dr. Eades claims it needs 120 to 130. However, whichever figure you want to use, the brain can derive up to 75 percent of its daily energy needs from ketones when carbohydrates are restricted. 

These figures are simply averages. Some people might need 120 grams of glucose per day, which is why the two experts don't agree. 

The important thing here is that the brain uses a major portion of your daily calories, and it can substitute a large part of those calories with ketones, but not all of them. 

If you're severely restricting your carbohydrates, the only way the body can make the ketones the brain needs to survive is to put you into the state of ketosis.

There is no other way.

Major Difference Between Nutritional Ketosis and Keto at Reddit

The major difference between these two diets is based on what each believes causes fat loss to occur. 

Followers of Jimmy Moore's version of Nutritional Ketosis believe fat loss happens when you have an excessive amount of ketones built up in the bloodstream and protein is severely restricted. 

The Keto Diet at Reddit teaches that the number of ketones hanging around in the blood doesn't matter because fat loss only occurs when you eat at a caloric deficit. 

If you eat all of the fat your body needs to function, it won't dip into your body's fat reserves, so Keto dieters keep a close watch on their fat calories.

This is totally in line with what Dr. Phinney actually teaches.

Dr. Phinney says that fat loss results due to a reduction in fat intake because you're using some of your body fat to make up your daily fat percentage. 

Dietary fat looks low and protein looks high in a tracker or on paper because most of the fat you're using is coming from your fat stores.

Phinney agrees that weight loss occurs due to calorie deficit, but Dr. Phinney also believes you will naturally gravitate toward doing that, so there is no need to keep track of your macros. 

He's banking on the idea that you're smart enough to figure out that you're on a diet and can't eat at your maintenance level for calories.

This is logical, but doesn't really hold up in the real world where low-carb dieters are looking for a miracle that will allow them to do exactly that: eat as much as they want to and still ditch the body fat.

As for protein, the Keto Diet focuses first and foremost on supplying enough protein through diet, so the body won't need to break down muscle tissue to get the amino acids it needs to sustain your life. 

Since gluconeogenesis is demand driven, most of the excess protein you eat is either burned directly for calories or stored in the form of glycogen. A bit might be laid down as muscle if you are brand new to strength training, but this rarely occurs when you are in weight-loss mode. 

Ordinarily, to lay down new muscle tissue, you need to eat more than your maintenance level of calories. You'll also need an insulin spike to get that protein into your body's cells. Neither of these occur on a typical low-carb diet.

Dietary Fats

Pumpkin Cheesecake with extra whipped cream
is low in protein and heavy on fats.

The point of Nutritional Ketosis seems to be to get the body into a more optimal state of ketosis than the Atkins Diet provides, where the body creates just enough extra ketones to support athletic performance.

However, human nature, such as it is, sees life in terms of extremes.

Where 1 to 2 mmol/L blood ketones might be optimal, sedentary dieters took that idea and twisted it into the ideal that more is better. The higher the ketones, the faster the weight loss will be. This is how they think.

To achieve those high numbers, reducing protein wasn't enough, so many of Jimmy's followers also raised their dietary fats to the level that supports athletic maintenance. 

This extra attention placed on fats results in low-carb weight-loss diets that contain up to 80 percent of their calories in fat.

The 80 percent doesn't leave much room for protein or even carbs, so most people reduced their protein intake to less than optimal levels, paving the way for super-high ketones in the blood that these ill-informed dieters could brag about.

Lower protein helps to balance some of the higher calorie intake you're suddenly getting from increasing your fats, but not always.

Right after the trend began, I received an increase of emails from readers who were gaining weight doing it Jimmy's way. 
These dieters wanted me to know that I wasn't the only one gaining weight.

Dietary fats help to blunt some of the insulin response you get from eating protein, if you happen to be severely insulin resistant or sensitive to protein. This is especially true for dairy products, which come with the highest insulin response. It's also effective because fat doesn't trigger an insulin response. 

Because of this fact, dieters who already believed in the Insulin Hypothesis, found the theories Jimmy presented about his version of a LCHF diet completely logical. Eat more fat and your insulin levels will stay super low, causing you to lose more body fat.

Only, it didn't play out that way.

I lost muscle, due to the lack of protein in the diet, and gained a lot of belly fat because the fat content of the diet was much too high.

Protein

Nutritional Ketosis advocates state that the program is a moderate protein diet. If you take Dr. Phinney's advice to eat 15 to 25 percent of your maintenance calories in protein, that's true. 

But, many women using the tweaked program told me that they were only eating about 50 grams of protein per day and encouraged me to do the same. 

50 grams of protein is NOT a moderate protein intake, especially for those on a low-carb diet. 

According to Dr. Phinney, high ketones are starvation, which is why many of these dieters are running around bragging about their high ketone levels. If you don't eat enough protein, he says, your ketone levels will go sky high, well over the optimal range.

When ketones go too high, the body secretes insulin to put future ketone production on hold. This gives the body time to use the ketones that have build up in the bloodstream before manufacturing more. 

It's also why a person with a normal insulin response doesn't get ketoacidosis on a low-carb diet. The body will simply secrete insulin and bring your ketone level back down into a safer zone.

Even though Dr. Phinney recommends you eat about 15 to 25 percent of your calories in protein, depending on your body structure and activity level, percentages are often relative. They don't work as well as exact protein grams do, especially if your short.

Low carb requires the body to make several adaptions in the way that macronutrients are handled, low carbers need greater amounts of protein than those on a standard diet. Recommended daily allowances for protein on a balanced diet, optimized for protein intake, is 60 grams a day.

Those 60 grams are for someone who is eating a moderate amount of carbs!

When I was doing Weight Watchers as a young mother, the protein content of that low-calorie, well-balanced, exchange diet was a little over 80 grams per day. Carbs came to 120 to 150, depending on your fruit choices. This was moderate protein and moderate carbs.

In contrast, the Keto Diet recommends you eat a minimum of 0.8 grams of protein per pound of lean body mass if you're basically sedentary and not following a heavy lifting regimen. 

Those lifting heavy need 1 to 1.5 grams of protein per pound of lean body mass.

For me, the 0.8 recommendation would be about 80 to 90 grams of protein per day, or more. While I'm very short, I also have a large body frame.

Interestingly, when I was doing Atkins in 2007 and 2008, the recommendation made to low carbers then was to eat a minimum of 1 gram of protein per pound of lean body mass and about 60 to 65 percent of your calories in fat. This was thought to give the brain all of the glucose it needed to function at an optimal level.

Current scientific studies have also shown that gluconeogenesis is demand driven and, therefore, nothing to be afraid of. The body prefers to use other sources of glucose, such as:

• lactate and pyruvate
• the glycerol backbone on triglycerides
• the carbs in the vegetables and low-carb foods you eat
• non-essential amino acids

Dietary protein is used as a last resort, but mostly goes to refill glycogen stores, so if you're eating a very low-carb diet -- say 10 grams or less -- then, you'll need even more dietary protein than 0.8 grams to supply the glucogenic amino acids needed for a little more gluconeogenesis.

At lower levels of protein, you're not stopping gluconeogenesis from happening.

Why?

Because the body will simply strip your muscles to get the amino acids it needs. 

At higher levels of protein, the body will use those protein calories instead of body fat, so protein is a target on the Reddit Keto Diet instead of a goal. However, it's always better to eat a little too much protein than not enough.

What About Calories and Dietary Fats?

Where Nutritional Ketosis leaves it to the dieter to
control their food intake, Keto has you track your calories.

Nutritional Ketosis leaves it up to you to restrict your food intake, where the Keto Diet recommends you track what you eat. For those who don't track anything but carbohydrates, the Reddit version of Keto calls that Lazy Keto. 

Rather than lowering protein, the Keto Diet uses dietary fats to control calories. Fat is encouraged, but it cannot be eaten in unlimited quantities, or your weight loss will stall.

After first setting your protein calories and your carbs, everything left goes to dietary fats. For that reason, there are no percentages to hit on Keto; just calorie targets. 

As the weight comes off and your calorie level goes down, so does the fat content of your diet. 

In contrast, the real authors of Nutritional Ketosis believe that your fat calories go up as you move closer to goal weight. This might be true for athletes or younger folks, but not for the average low-carb dieter that I've seen hit maintenance.

People at maintenance who've published what they eat are eating between 900 and 1200 calories a day in order to maintain their newer weight. They are not eating anywhere near the 2,800 calories that Dr. Phinney uses in his Nutritional Ketosis diet example.

The Major Flaw in Nutritional Ketosis and the Atkins Diet

Since protein and carbohydrates are both set amounts on the Keto Diet, the only macronutrient left to play with is dietary fat. This aspect of the diet seems to be why Keto has such a huge success rate when compared to other low-carb diets. 

Keto dieters are encouraged to carefully monitor their calorie intake, as well as their carbohydrates, protein, and fats, and recalculate those macros as their weight comes down.

Where other low-carb diet programs, such as Nutritional Ketosis and the Atkins Diet only focus on limiting carbohydrates, the Keto Diet limits all the macronutrients, so they fit snugly within your personalized set of macros and keep you eating at a caloric deficit.

Mindful eating is not the name of the game when it comes to Keto, although some people on Keto do choose to follow a more lazy way of eating, which resembles Atkins.

Lazy Keto is when you just focus on keeping your carbohydrates restricted to 20-net carbs per day. This lack of mindful eating is at the heart of both Nutritional Ketosis and Atkins. It seems to work well for most people when they have a lot of weight to lose.

However, eventually, those following a lazy Keto protocol, and many on the Atkins Diet, reach a lengthy plateau similar to those on Nutritional Ketosis. At this point of equilibrium, where energy coming in equals energy being used, people on lazy Keto are encouraged to begin tracking their macros and move to a standard Keto Diet.

Those on Nutritional Ketosis or Atkins often believe that calories and portion sizes don't play a serious role in what's happening. Instead, they would rather receive a lengthy list of possible reasons why they might be stalled in their weight-loss progress instead of addressing the real issues. 

While some of those reasons are valid, such as medications, food intolerance, health issues, stress, or unrealistic expectations, other suggestions are ways to trick yourself into eating less. 

This is what drives other popular eating methods, such as Intermittent Fasting and Water Fasting.

The mindset of general low-carb programs is that carbohydrates are the enemy, rather than overeating. This seems to be the major flaw in almost all low-carb diet plans. 

People don't want to hear that they have to eat less to reach their weight-loss goals, and even fewer are willing to listen to what you have to do to maintain those losses.

How the Keto Diet Overcomes that Major Flaw

Juicy sirloin steak and simple lettuce salad
is a standard Atkins Induction meal.

Unlike the Atkins Diet that tells people they can return some of their favorite carbs to the diet once they hit goal weight, thereby upping their calories to maintenance levels, the Keto Diet doesn't approach weight loss from a dieting mindset. 

It lets people know right up front that how you lose the weight – the low-carb foods you eat and the amount you're eating when you reach goal weight – is how you will have to eat the rest of your life if you want those pounds to stay gone.

For most people reaching maintenance on any low-carb diet, the metabolism and body's energy needs have diminished to the point where maintenance will only be a hundred to two-hundred calories more than what you're eating when that last pound melts away. 

You'll never be able to eat as much as non-dieters can, even those who weigh as much as you do.

While this might be different for an athlete, this is what I've seen in most maintainers at Low Carb Friends.

Maintenance isn't magic. 

In fact, it's much, much harder to maintain the weight once you get there than you realize. 

For that reason, the Keto Diet takes more of a lifestyle approach to dropping the pounds from day one because it don't restrict food choices. 

Unlike Atkins, Keto has no Induction, so any food that fits into your daily macros is allowed. Nothing is divided into low-carb and high-carb foods.

Stick with your protein, carb, and fat limits for the day, eat at a caloric deficit, and you're Keto.

There is no low-carb police watching over you, and no one telling you what you can and cannot eat. The responsibility for sticking to your macros is yours and yours alone.

In contrast, Nutritional Ketosis (which is also called Keto today) and the Atkins Diet have particular foods you are allowed to eat and other foods you must stay away from until you get closer to goal weight. 

For example, the newer Atkins Diets have a carbohydrate ladder that you climb, returning foods to the diet in a specific order and quantity.

This is because Dr. Atkins always believed that you could eventually eat at a higher carbohydrate level if you returned carbs to your diet slowly enough. 

While that holds true for some, including him, there is a lot of confusion over how to go about upping your carbohydrates when you reach the pre-maintenance stage.

Neither Nutritional Ketosis nor the Atkins Diet tells you that you have to stick to the amount of calories you're currently eating and that any carbohydrates you return to the diet have to be compensated for by either eliminating something or cutting down somewhere else.

Since protein is often already at a minimum for most folks, that means some of the fat you've grown so fond of has to go.

Otherwise, you'll start to gain the weight back.

In addition, most diet authors do not talk about how the body will literally fight to re-fill it's fat stores a little while down the road, and that force becomes stronger at higher carb levels. 

For this reason, most people on the Keto Diet stick with 20 to 25 net carbs for life. They continue to hit their protein goal, raise their fats up to a maintenance level of calories, and count those calories even after reaching goal weight.

In a very real sense, the Keto Diet never ends.

Some people do raise their carbs to 35 or so, leaving everything else right where it is. Others choose to up their fat calories by 100 to 200 per day and keep their carbohydrates super low. 

None of the success stories I've read so far have included returning to anything close to a well-balanced diet. Those who voice such dreams never seem to make it to ideal weight.

But that might be because few people know what a well-balanced diet looks like.

Atkins Diet maintainers tell a similar story. 

Most people eventually find that keeping both calories and carbs low, activity up, and moving to a more moderate fat level is the key to success, especially for those who are severely insulin resistant. 

Only those on zero carb or nearly zero carb are actually eating at very high-fat levels on maintenance.

Which Low-Carb Program is Best?

The bottom line seems to be a reorganization of your mental attitude about food and how you plan to approach eating for the rest of your life. 

Ignoring thoughts of maintenance and how you plan to keep the weight off once you reach your goal is the kiss of death for most dieters. 

Weight management isn't something you can put off until you get there because mindless dieting quickly becomes mindless maintenance and, eventually, results in complete failure, especially if small regains are ignored or perceived to be insignificant.

Although the Keto Diet does have higher success numbers than those following Jimmy Moore's version of Nutritional Ketosis or even the Atkins Diet, those who make it to goal weight all seem to eventually arrive at the exact same mindset. 

The difference between succeeding and failing isn't so much about which low-carb diet plan you choose, but how you handle that lengthy plateau when you reach the point of equilibrium.

What you do at that point in your weight-loss journey can make the difference between success and failure. 

If you understand that maintenance is simply more of the same and that low carb never ends, you'll be more likely to pick a plan you can live with for the rest of your life. 

Success is as simple as that.