What does “Keto-Adapted” mean?

In which I explain that ketoadpation needs more specific, clinical definition and I define it as having steady fasting blood glucose under 85 and an A1C of under 5.  

Have you noticed that all the cultural niches in cyberspace have their own language? Their own abbreviations, their own memes, their own repetitive ad nauseam arguments. Paleo/keto-nutrition is no different. When you start hanging around “Keto World” on the internet, you see the word “keto-adapted” a lot. When people are talking about adaptation, they aren’t always sure what they mean. For some people it is just a time period. After eating low carb and making ketones for about four weeks…you’re adapted. For others, it means something slightly more specific. Others seem to use it as a value system, “Hey Bro, you might not get the same results. I’m highly adapted.”

I will tell you what I mean when I say keto-adapted. I mean fasting blood glucose of <85, an A1C under 5, and blood ketones between .5 and 6. It’s in the numbers, baby. Have I mentioned I love data? The reason I define it this way is simple and can be broken into two parts:

1) If nutritional ketosis doesn’t result in numbers like this, there isn’t really an advantage to it from a long term health perspective.

2) By definition if you are generating enough glucose in the liver to raise your BG you are not fully keto-adapted, that is to say, you have not completely switched to being a ketone burner, preferentially. You are, in fact, still alternating between ketosis and glycolysis. It isn’t adapted/not adapted. There is a range and you can measure that range by how low the average circulating blood glucose is.

I’m going to explain this in a bit, but let’s get to the bottom of where the term comes from. The term keto-adapted has been used in the scientific literature since around 1977, and perhaps earlier, but language is a living thing and its meaning changes with use. More recently, the use of the term “keto-adapted” comes from the fact that when low carb diets first began getting tested they came out poorly in several categories. The defenders of the dietary approach knew, from practice, that it takes a period of time for the body to get used to using fats optimally. Soon, people were cautioning that to test the effects of low carb diets, the subjects need to go through a period of adaptation before you can effectively evaluate the benefits (or the liabilities) of the nutritional approach. It’s a qualifying term. Because everyone knows that if you give an athlete a low carb diet, initially they “bonk,” or lose their performance edge. The idea is that after a period of adaptation, their performance comes back up to and even outshines its former glory.

At a biochemical level, this comes in the form of more cellular mitochondria, working at higher levels of efficiency. This is the reason that those interested in ketogenic diets and health (like the awe-inspiring Terry Wahls) are finding such intriguing effects from using ketogenic diets to treat diseases as wide-ranging as epilepsy, cancer, Alzheimer’s disease, and autoimmune disorders, like MS. All these diseases of metabolism are mitochondrial diseases. Greater mitochondrial function, less disease. While all the mechanisms at work in the therapeutic effects of the ketogenic diet are not fully understood, certainly mitochondrial biogenesis is one the top suspects.

It seems like a leap to some, but to me it is clear. If keto-adaptation doesn’t include greater mitochondrial biogenesis it is meaningless. Since the popular books on the subject are directed at a lay audience who aren’t likely to do more than pee on a stick or prick their finger as a measure of adaptation–simply producing blood ketones (not urine or breath–but that’s another post) is enough and they use the studies done on athletes to conclude that “keto-adaptation” is completed by around 3 weeks.

This causes people to presume, however, that the maximal effects of adapting just stop there. They clearly do not as therapeutically Dr. Wahls has recorded continued improvement and health rebound up to 3 years. You need time to grow better, stronger mitochondria. You need time to replace inflammatory, insulin-resistant tissue with anti-inflammatory insulin-sensitive tissue. The idea that it can be done in a few weeks is fairly absurd. Further, through studies on disease response we can learn that there are adaptations that are stronger and adaptations that are weaker. Dr. Seyfried, for example has found that blood glucose beween 55 mg/dL and 65 mg/dL, and ketone levels between 3 mmol and 5 mmol provide maximal therapeutic benefit for tumors. When you move out of that range it loses its therapeutic effect. One might well say, well, I don’t have cancer. Except that misses the point: if the therapeutic mechanism is derived from “transitioning metabolism from glucose to ketone utilization for energy” as it was discovered here, it means that, metabolically there is a RANGE of adaptation because the person who has a fasting BG of 75 and ketones of 2.6, is certainly in ketosis. There is simply another LEVEL to that process of adaptation, one that apparently brings well-nigh miraculous therapeutic results in certain cases.

Not to mention that what is therapeutic is usually preventative. Vitamin C cures scurvy. It doesn’t follow that we should only take vitamin C to prevent scurvy. To say, I don’t need to worry about BG and A1C because I don’t have diabetes/cancer/epilepsy, is like saying, I don’t need vitamin C, I don’t have scurvy.

And here it is–scurvy is a deficiency. One might very well say that metabolic disorders like the ones here are diseases of dietary deficiency that lower mitochondrial function and decrease methylation over time. The ketogenic diet is the vitamin C. You don’t have to wait for damage to be done in order to maximally prevent it.