Section 1: General issues for
ending a ketogenic dietWeight regain
Although this topic has been discussed several times already, it bears repeating.
Individuals who have been on a low-carbohydrate diet (of any type) will show a rapid increase in
bodyweight when carbohydrates are added to the diet (2,3). This weight gain, similar to what
occurs during the carb load phase of a CKD, can be anywhere from 5 to 11 pounds (2,3).
For dieters who focus only on the scale, this rapid weight gain can be disheartening,
pushing them straight back into a low-carbohydrate eating style. The inability to differentiate
between weight gain and fat gain tends to promote the belief in dieters that excess carbohydrates
(rather than excess calories) are the cause of their problems. This may make it difficult for these
individuals to ever wean themselves away from the ketogenic diet.
Once again, a distinction must be made between weight gain and true fat gain. Weight
gains of 3-5 pounds or more are not uncommon for individuals who eat even small amounts of
carbohydrates after being on a ketogenic diet for long periods of time. From an energy balance
standpoint, we can easily see that it is impossible to gain this much true fat in a short time
period.
To gain one pound of fat requires that 3,500 calories be consumed above the number of
calories burned. To gain a true three pounds of fat would require that 10,500 calories be
consumed above the number of calories burned that day. A five pound fat gain would require the
consumption of 17,500 calories above the number of calories burned per day. It should be
obvious that the weight gain from initial carbohydrate consumption reflects shifts in water
weight only.
To fully discuss proper nutritional strategies for either bodyfat maintenance or mass gains
would require another book. Simply keep in mind that maintenance of new bodyfat levels
requires that caloric expenditure match caloric intake, regardless of diet. By the same token,
gains in body mass (for bodybuilders or other strength athletes who wish to gain muscle mass)
require that more calories be consumed than are expended. This will come with the consequence
of some fat gain while lean body mass is being added.
Insulin resistance
As discussed in chapter 7, one effect of long term low-carbohydrate diets is an increase in
insulin resistance, sometimes called ‘starvation diabetes’, when carbohydrates are refed (4). This
effect is briefly discussed again here.
In brief, the initial physiological response to carbohydrate refeeding looks similar to what is
seen in Type II diabetics, including blood sugar swings and hyperinsulinemia. Several possible
hypotheses for this effect have been considered including a direct effect of ketones, but this is not
the case (5,6) and ketones may improve insulin binding (4). The change in insulin sensitivity is