In Categories: Science & Research

And why for some people, this is a delicate balance

Protein is a fascinating macronutrient. Of the three dietary macronutrients, protein must provide at least 9 essential components (amino acids), whereas dietary fats provide just 2, and carbohydrates none. To the uninitiated, it is tempting to think of proteins in the body as relatively stable (e.g., the structure of muscles, heart, liver, kidneys, brain) compared to the body’s use of ‘fuel’ (carbohydrate and fat). But in reality the body’s protein metabolism is incredibly dynamic, and limitations in either dietary protein or energy intakes from carbohydrate or fat can tip the balance between gain or loss of important tissues or functions.

When embarking on a well-formulated ketogenic diet and going through the process of keto-adaptation, there are necessary changes in how the body uses its incoming macronutrients to maintain (if not improve) health and function. To achieve this requires enough protein but not too much – balance is important. And as you might expect, this balance is achieved at different ‘recommended daily intake’ levels than our official government recommendations. But as you read this post, you will see that your need for dietary protein during a well-formulated ketogenic diet is not much different from what the average person in the developed world currently eats – i.e., moderate protein rather than high protein (Fulgoni 2008). What follows is our best attempt at a brief explanation of dietary protein requirements during nutritional ketosis.

The dynamics of protein turnover, and why this is important

Besides being a vital component of the body’s structure (e.g., muscle, tendon, ligament, bone, skin, hair), it is the stuff from which functional molecules like enzymes, antibodies, membrane receptors and transporters, and oxygen-carrying hemoglobin are made. Every step in your metabolism is accomplished with the help of proteins, which number in the thousands within any one cell. And while some of these last for months once they are made, others last for mere minutes before they are broken down and replaced. In other words, proteins in the body are in a constant dynamic state of being broken down and replaced.

Proteins are chemical chains made from 20 different molecules called amino acids, with these chains of amino acids varying in length from less than 10 to many hundreds. On average, the shorter the chain of amino acids, the more rapidly that protein is broken down and replaced. This is called ‘protein turnover’ and it is going on in every cell, tissue, and organ in the body every day. So in order to maintain your health and function, the body needs to be constantly making new proteins. This requires a consistent supply of amino acids and lots of energy, because making new proteins (aka protein synthesis) is a high-energy process.

The amino acids that the body uses for protein synthesis come from two sources. The most obvious is the dietary protein that we eat each day, but this is normally the lesser contributor of amino acids for protein synthesis. The major source is actually recycled amino acids from the breakdown of existing body protein. In a typical day when dietary protein and energy intakes are adequate to maintain lean body mass* (i.e., one is neither gaining nor losing lean tissue), more than two-thirds of the amino acids entering the bloodstream come from breakdown of existing body protein, while less than one-third come from digestion and absorption of dietary protein.

*Lean body mass. Body composition is commonly divided into 2 compartments – fat mass and lean body mass. While real life is not quite this simple (e.g., the fat cells in our adipose tissue actually contain about 15% ‘lean tissue’ and 85% stored triglyceride), most of the body’s physiological functions such as circulation, breathing, movement, energy metabolism, conscious and sub-conscious brain activity, digestion, absorption, excretion, and reproduction are performed by our lean (aka non-adipose) tissue. So that’s what most of the body’s protein is used for, right?

Wrong. All of these active things the body does make use about half of its protein, and most of that is inside of our cells. The other half of our protein is structural and is outside of our cells (e.g, tendons, ligaments, bone, skin, hair). But even these proteins are turning over on a regular basis. For example, you replace all of your hair every 2 years, and the outer layer of your skin gets replaced every 3 weeks.

All of these structures and functions are dependent upon having adequate amino acids so that they can rebuild themselves on an ongoing basis, and anything that impairs this rebuilding process over just a few weeks or a few months results in measurable losses of a broad range of functions.

Depending on multiple hormonal and environmental factors, a healthy adult will break down and restore between 300 and 600 grams of protein daily. To put this in perspective, if this were all muscle (which contains about 25% protein and 75% water), that would be the equivalent of replacing between 2.5 and 5 pounds of muscle per day.  Actually, much of the body’s protein turnover occurs in tissues other than muscle, but this calculation helps put the magnitude of this process in perspective. And in particular, it should be clear that any factor that gets in the way of protein synthesis (i.e., the ‘rebuilding’ side of this balance equation) can lead to rapid and significant lean tissue loss.

6.25 g protein = 1 g nitrogen. Thus 100 grams dietary protein produces 16 grams of nitrogen excretion when one is in ‘protein (aka nitrogen) balance.’

Factors affecting the balance between protein synthesis and breakdown

As shown in the diagram above, some of the amino acids we eat and some that come from protein breakdown are taken up by the liver, kidneys, and muscle where they are metabolized for energy and for purposes other than protein synthesis. In the process, they release the nitrogen molecules that characterize amino acids, and these are mostly excreted as waste nitrogen in the urine. In addition, some protein and protein breakdown products are lost each day from the skin and in feces, but this typically represents about 10% of daily protein losses.

In our dreams, most of us would like to be able to rapidly gain lots of muscle and lose lots of body fat. But in reality, if each morning we wake up with about the same amount of muscle as we had yesterday, we have been able keep protein synthesis and breakdown about in balance, and that’s a good result. When it comes to changes in our protein metabolism, good things happen slowly.

The most rapid changes in protein balance occur with infection, injury, stress, and starvation/fasting. Severe infection and trauma can result in 2-3 pounds of lean tissue loss per day, while up to a pound per day can be lost in the first week of the body’s adaptation to fasting.

On the positive of the protein balance equation, the most rapid gains in lean tissue are seen during recovery from prolonged wasting after illness or starvation, when up to a quarter pound of lean tissue can be added daily. But this rate of gain typically occurs in the context of a high energy (high calorie) diet, usually accompanied by gains in body fat as well. Sustained lean tissue gains are also seen during adolescent growth spurts and in pregnancy.  But in the latter case, if the pregnant mother produces a baby containing 3 pounds of lean tissue and adds 5 pounds of lean tissue to her own body over 9 months, that translates to 128 ounces of lean tissue over 180 days, or less than one ounce per day.  Additional factors influencing protein balance are listed in the table below, but alone or in combination they rarely result in average lean tissue gains of more than a quarter pound per day.

Factors known to stimulate or facilitate lean tissue gain:

  • Exercise (particularly resistance exercise)
  • Adequate dietary protein including adequate essential amino acids (usually only a concern with vegan diets)
  • Adequate dietary energy (but not necessarily carbohydrate) (Koopman 2007)
  • Increased serum insulin (in the presence of adequate amino acids) (Roy 1997, Borsheim 2004)
  • Branched chain amino acids
  • Adequate intra-cellular minerals (e.g., potassium, magnesium, phosphorus) (Dudrick 1972, WHO, 2005)
  • Creatine supplements
  • Illegal use of anabolic steroids and growth hormone

In summary, most positive changes in lean body mass occur slowly, whereas losses can occur rapidly with injury, illness, or inadequate dietary protein (including starvation/fasting).  In addition, proteins can only be produced when a number of factors are working together, including amino acid availability, associated minerals specific to that tissue, plus appropriate stimulus from hormonal and metabolic signals.

Nutritional ketosis and protein balance

We have known for many decades that lean body mass and physical well-being can be maintained with a ketogenic diet containing a moderate amount of protein. The 1928 Stefansson Bellevue Experiment demonstrated that 2 adult men could eat about 15% of their dietary energy as protein and maintain their weight and function for a year (McClellan 1930). In the modern era, we have done multiple shorter studies with more rigorous body composition analysis yielding similar results (Phinney 1983; Volek 2004). However when making the transition from a high carbohydrate diet to a high fat ketogenic diet, there is a 1-2 week modest lag in protein synthesis as the body switches its primary fuel sources (part of keto-adaptation).

While a precise analysis of dose-response to varying protein intakes during nutritional ketosis has not been done in humans, we have performed a number of studies indicating that most healthy humans maintain lean body mass and function during a ketogenic diet providing between 1.5 and 1.75 grams of protein per kg of ‘reference body weight’* (Phinney 1983, Davis 1990). Furthermore, there are no convincing human studies showing any benefit from dietary protein above 2.0 g/kg reference weight for adults following a ketogenic diet; and any potential benefit from a higher protein intake must be weighed against the reduction in blood ketone levels caused by excess dietary protein (more on this later in this piece).

*Reference body weight is an arbitrary value for men and women based upon the medium frame values from the 1959 Metropolitan Life Insurance ‘Ideal Body Weight’ tables. (Met Life, 1959) Using these values allows for protein intakes to be based roughly on normal lean body mass rather than total body weight. Note: ‘reference weight’ is an arbitrary value used to estimate daily protein needs – it is not a weight

In studies that measure urinary nitrogen excretion, both ketogenic diets and total starvation result in the greatest net protein breakdown in the first week of keto-adaptation. In the case of total starvation, these daily losses range from the equivalent to one half pound to one pound of lean body mass in women and men in the first week (Forbes 1979, Goschke 1975), and then taper towards a quarter pound loss after one month. In contrast, with a well formulated ketogenic diet, these losses average less than one fourth pound per day in the first week and rise to zero loss or even modest tissue gain after 2 weeks of adaptation (Phinney 1983, Davis 1990).

Once through the first few weeks of keto-adaptation, there does not appear to be any reason to change one’s dietary protein intake either with further time of adaptation or cumulative weight loss. The exception would be if blood ketones remain low (i.e., below 0.5 mM) despite tight carbohydrate restriction, in which case reducing protein from the 2.0 to 1.5 g/kg or even to 1.2 g/kg reference weight range might be reasonable.

In our experience, people on a ketogenic diet who think they are eating protein in moderation are often well above 2 g/kg due to fear of eating fat to satiety.

But in no case should dietary protein intake be reduced below 1.2 g/kg in the context of a well-formulated ketogenic diet. This range; 1.2 g/kg at the low end and 2.0 g/kg at the upper end, with a 1.5 g/kg mid-range moderate intake target, can be translated into daily consumption of protein-rich foods in ounces in the table below. Each ounce of protein-containing food contains about 7 grams of protein.

Why are our recommended protein intakes above the RDA of 0.8 g/kg-day?

The Recommended Dietary Allowance (RDA) for protein is defined by an expert committee as the average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy people (NIH).  This value for healthy adults who are maintaining at a stable weight is 0.8 grams of protein per kg daily. But it has been noted that this does not take into account illness, calorie restriction, stress, aging, or the minority who need more protein (Wolfe 2017), indicating the need for protein similar to our recommendations. This new perspective in combination with our research indicates that a somewhat higher range covers pretty much all of these added needs when people are following a well-formulated ketogenic diet. In addition, this range is well within the routine intakes of people in the developed world, and thus does not represent a high protein intake in any sense of the word.

Why we don’t use ‘macros’ or ‘percentages’ to guide your protein intake

It should be clear from the above explanation that an individual’s protein intake during a well-formulated ketogenic diet is pretty much independent of daily energy intake. For example, an otherwise healthy person beginning a ketogenic diet eaten to satiety usually starts out under-eating calories relative to daily energy needs, and thus loses weight. For example, let’s say that a 5’6” woman with a reference weight of 60 kg starts out at 82 kg (180 lbs) and eats 1300 kcal per day (about a 1000 kcal/day deficit). Her recommended daily protein intake would be 1.5 X 60 = 90 g/day, totaling 360 kcal. Expressed as a ‘macro’ of what’s on her plate, that’s 24% protein. But 6 months later when she weighs 63 kg (140 lbs) and is eating 2000 kcal per day at weight maintenance, that same protein dose (360 kcal out of 2000) represents a protein ‘macro’ of 16%.  The point is that in this situation where her weight is changing, her daily protein intake should be constant; whereas her ‘macros’ change as she transitions from weight loss to weight maintenance. This changing proportion of dietary protein to dietary energy as one proceeds through weight loss to weight maintenance is shown in diagram below.

Given the often large changes in body weight and fat mass that usually occur with a well-formulated ketogenic diet, but little if any change in protein requirements as long as one maintains lean body mass and remains in nutritional ketosis, it is better to calculate one’s daily protein need in grams of dietary protein or ‘ounces’ of protein-containing food per day.

Considerations favoring a moderate protein ketogenic diet

A moderate protein intake as part of a well-formulated ketogenic diet allows circulating ketones to reach levels of at least 0.5 mM. Too little or too much protein can negatively impact the many benefits of being in a state of nutritional ketosis. How to determine your protein needs can be a bit of an art and may take some time and expert coaching to get it right.

Too little protein in the diet may increase circulating ketones above 4.0 mM, but at the expense of nitrogen losses which can compromise lean tissue preservation and function. While still well-within the safe ketone range, if you are consistently achieving values above 3.0 mM that cannot be explained by something like exercise, consider modestly increasing your protein intake. In addition to not meeting the body’s needs, a low dietary protein intake can be far less enjoyable than one that is adequate in protein. Two of the many benefits of a well-formulated ketogenic diet are the satiety and satisfaction it provides.

On the other hand, too much dietary protein can drive down ketones for several reasons. Protein has a moderate insulin stimulating effect; and though less than the impact of a similar amount of carbohydrate consumption, high protein intakes can drive down ketone production in the liver (Marliss 1978). In fact, specific amino acids like alanine are potently anti-ketogenic. Additionally, when consumed to excess, protein can upset gastro-intestinal function and place a stress on the kidneys to remove the additional nitrogen.

Mineral considerations

Among the many factors that affect the body’s ability to build and maintain its lean body mass, maintaining an adequate balance of essential minerals is very important. In particular, there are complex inter-relationships among the mechanisms for handling sodium, potassium, and magnesium that can influence the body’s ability to maintain protein-containing tissue and function. (Dudrick 1972, WHO 2005). Without enough of the potassium and magnesium that are concentrated inside our cells, these tissues can’t be built up or even properly maintained. And because inadequate sodium intake causes increased potassium wasting by the kidneys, even salt intake can influence the efficiency with which dietary protein can be used.

In this context, it is also important to understand that our choice of dietary protein and how it is prepared can also influence our essential mineral status. Consuming one’s protein from minimally processed foods, whether from animal or plant sources, generally results in increased intakes of essential minerals. Thus 4 ounces of real chicken, fish, or meat typically contains more than twice the potassium and magnesium found in processed luncheon meats containing the same amount of protein. Boiled meat is leached of its essential minerals unless the broth is consumed, and protein powders such as whey and gelatin tend to be devoid of these important minerals. Ditto that for eggs compared to egg whites. Egg whites contain ‘high biologic value’ protein, but they are devoid of the essential minerals that are concentrated in the yolk. No need to pay more for those egg white omelets!

Conclusions

Achieving and maintaining a protein intake appropriate for a well-formulated ketogenic diet takes practice, and often considerable expert coaching. Individual needs and tolerances may vary, but in almost all cases they are found within the range of 1.2 to 2.0 grams per kg reference body weight. While this range is somewhat higher than the standard recommendations for minimum or average daily requirements, it includes enough of a buffer to allow for recovery after stress, exercise, and the occasional illness. This protein intake level is also consistent with usual protein intakes in developed countries, and matches the protein consumption of aboriginal cultures that consumed a hunter/herder diet for thousands of years. Thus there is no reason to be concerned about long-term consumption of protein in the context of a well-formulated ketogenic diet in someone with normal kidney function.

The information we provide at virtahealth.com and blog.virtahealth.com is not medical advice, nor is it intended to replace a consultation with a medical professional. Please inform your physician of any changes you make to your diet or lifestyle and discuss these changes with them. If you have questions or concerns about any medical conditions you may have, please contact your physician.

67 Comments

  1. Avatar

    For the average person to determine their own reference weight, should they just use their lean body mass in kg?

    Thanks, loved reading this article.

    Reply

    1. Virta Health

      Thanks for your comment! Dr. Phinney recommends using the height chart in the article to determine your reference weight and protein needs.

      Reply

      1. Avatar

        Something is wrong with this chart, possible unit conversion was made wrong.
        I weight 80kg – reference from chart is around 70kg, Proteins per day:
        1.2x70kg= 84gr
        1.5x70kg=105gr
        2.0x70kg=140gr
        In same time base on chart should consume 14oz (396.8gr) protein?!?

        Reply

        1. Virta Health

          Hi! 14 oz of protein would be the equivalent of 98 g protein and would fall between 1.2-1.5 grams per kg on the chart. 1 oz protein = 7 g protein.

          Reply

          1. Avatar

            So protein in oz is weight of protein food, whilst in grams is weight of actual protein in the food. A typical conversion factor of 0.25! Hardly true to say 1oz protein = 7g protein.!!!!!

          2. Virta Health

            True! That was a simplified statement to quantify that each ounce of protein-containing food contains about 7 grams of protein.

  2. Avatar

    I am hearing most people who adapt keto are eating 1-2 (maybe only 3) meals a day. I am quite active in the gym and the online calculators are suggesting I consume approx 112-120g of protein a day. Is it ok to consume 2 meals only a day where the protein intake is 50-60g? Am I wasting some of this high protein meals or could it be halting my keto benefits?

    Reply

    1. Virta Health

      We recommend you space out your protein and eat it with fat. Here are a few tips on protein consumption: https://blog.virtahealth.com/protein-on-low-carb-ketogenic-diet/

      Reply

  3. Avatar

    It’s difficult to be certain of my daily protein requirement at my age and activity level. Where can I get help.
    I’m 78. I bicyle 25 to 35 miles, 12mph, a week and do slow weights twice a week

    Reply

    1. Virta Health

      We can’t give personal medical advice in this forum, but we recommend that you refer to the chart listed and talk to your doctor if you have any questions!

      Reply

  4. Avatar

    I am on a keto diet and there is so much confusion around it. I work out almost daily, many of my workouts are high intensity (vertical jump training, high intensity intervals, etc). I train for power, speed, and muscle mass. I am trying to maintain or gain muscle but lose fat, how many grams of protien should I eat? In a video I watched with the doctor, he states that once in starvation the body will eat .25 lbs of muscle a day….that is scary as I work hard to gain or maintain muscle. I am 6′ 200lbs, roughly 22% fat, 57 years old.

    Reply

    1. Virta Health

      We can’t give personal medical advice in this forum, but we recommend that you refer to the chart listed and talk to your doctor if you have any questions!

      There is a lot of confusion around ketogenic approaches. We recommend this video series by Dr. Phinney for more insight: https://blog.virtahealth.com/dr-stephen-phinney-ketosis-ketogenic-diets/

      We also have an FAQ here: https://blog.virtahealth.com/nutritional-ketosis-faq/

      Reply

  5. Avatar

    Can you get all your days protein requirements in one meal or is it better to spread it out throughout the day?

    I prefer to eat less meals and I am very satiated from all the fat but also want to spare and gain muscle mass.

    Reply

    1. Virta Health

      We recommend you space out protein and eat it with fat. More on that here: https://blog.virtahealth.com/protein-on-low-carb-ketogenic-diet/

      Reply

  6. Avatar

    When calculating how many carbs you eat in a day does virta support the net carb idea. That is take the listed total carbs for a portion and subtract the amount of fiber in that portion to get the net carbs. Net carbs being the carbs we need to limit.

    thanks a bunch for your great work that really inspires me to beat my Big D (nickname for my diabetes.

    Reply

    1. Virta Health

      We usually use total carbs for our patients.

      Reply

  7. Avatar

    Is this for real?
    You reference g/kg of protein, yet the chart gives the body
    weight/protein intake in lbs/ounces… Can you please make up your mind and avoid confusion? The metric sysytem is fine, just keep it that way

    Reply

  8. Avatar

    I think I have a similar question as does Radu from today. Please help me understand this chart. I am a 6′ 1″ tall male who needs to lose a lot of weight.
    This chart says my “reference weight” is 160-174, but I don’t understand why I need to know this number. I am interested in understanding how much protein to eat daily. I understand not to eat too much or too little protein from this article. It looks like from the chart that there are three values per reference weight. Are the three values a daily range of minimum to maximum optimal protein consumption? If so, does the chart say that for me that I should be eating between thirteen and twenty-two ounces of protein daily?

    Also, can you explain why you use total carbs versus net carbs? Is Atkins wrong to use net carbs?

    Reply

    1. Virta Health

      Thanks for reading! The table shows ounces of protein-containing foods, so each ounce (an egg, and ounce of cheese, an ounce of meat, etc.) contains about 7 grams of protein.

      The three values are the range from minimum to maximum protein consumption.

      Reply

      1. Avatar

        The chart is terrible. Nobody who is bothering to track macros does so in “total weight of food consumed.” Who ever says “I had 4 Lbs of food today. 2 lbs of fat, a pound of protein, and a pound of carbs”? Nobody! So giving your recommendations in “weight of protein containing foods” is just a very, very poor way to communicate this information. Most food packaging or food tracking apps list protein content in grams. Please, at the very least, publish another table with target grams of protein per day.
        This is a great and very helpful article, and to have it so utterly fail to deliver the critical bit of information is a shame.

        Reply

        1. Virta Health

          We usually recommend thinking of it in ounces because three ounces of meat is roughly the size of your palm. This makes it easier if you’re cooking or eating at a restaurant to understand portion sizes of protein. If you’d like to think of it in grams, you can just multiply the ounces in the chart by 7.

          Reply

          1. Avatar

            I thought that 4 oz. of protein-containing food is about palm sized. I’ve seen that referenced in many sources. Thanks!

          2. Virta Health

            We usually count a palm-sized amount of meat as 3 ounces, but you’re right that the exact amount depends on the type of food!

  9. Avatar

    I find the table confusing as well – as a 191cm male reading across the table suggests I should be consuming between 13 and 22 ounces of protein per day. That is between 368grams and @624grams of protein.

    I currently weigh 110kg – there is no way I could consume that much protein. It should be a range of 132grams to 220grams.

    Unless I’m seriously misreading the table there is something wrong with those calculations.

    Reply

    1. Virta Health

      Thanks for reading! The table shows ounces of protein-containing foods, so each ounce (an egg, and ounce of cheese, an ounce of meat, etc.) contains about 7 grams of protein. 13 ounces of protein-containing foods would be about 91 grams of protein.

      Reply

  10. Avatar
    Yolanda Heuzen April 28, 2018 at 3:40 pm

    Excellent article doc, but could you please, please, please use metric instead of Mickey Mouse measurements? Or, include both for those who are still not hip to metric?

    Reply

  11. Avatar

    I feel that clarification is needed in regards to “reference weight” and which weight category correlates with the 0.8 g/kg of the RDA (lean body mass? reference weight? ideal weight?) How do you find your “reference” weight?

    My current weight is 226lbs and I would be around 200lbs if I could lose the fat that I want (without factoring in muscle gain), but my lean mass is more around 170ish. Which weight should I be using to calculate my protein intake at 1.2-2g/kg (current weight, ideal weight, reference weight or lean body mass?

    Reply

    1. Virta Health

      Reference weight is listed in the table above. Use the table to calculate your protein intake. Thanks!

      Reply

  12. Avatar

    I enjoyed the article … thanks. What does one do if they weigh more than 187 pounds, which I think would be a huge group given the goal of weight loss that make many Keto enthusiasts? Is there a ratio that may be used to figure out my protein recommendations as a guy at 226 lbs? Or are you simply trying to say that I should assume my reference weight is what’s listed at 6’1″ and go from there. Thanks. js

    Reply

    1. Virta Health

      You should assume your reference weight is what’s listed for your height and gender. Thanks!

      Reply

  13. Avatar

    Just wanted to say THANK YOU for all the work you are doing. Your work is very needed and you will surely (or hopefully I might say) rewarded accordingly.

    Reply

  14. Avatar

    Could you please extend the table up until at least 6’7” ?? :D.

    Thanks

    Reply

  15. Avatar

    Excellent Article!! Disregard the comments from posters who wish not to thoroughly read the contents of the article. One only has to reread a paragraph or two if they are not entirely clear on reference weight and associated protein consumption. It is clearly detailed in the article! Thank you Verta for providing such valuable information.

    Keep up the great work.

    Cheers!

    Reply

  16. Avatar

    According to the chart, as a woman who is 5’10” I should be eating 105 grams per day. I am finding that difficult because I get full. For example, to today I have had 3 eggs and 2 oz of Halloumi cheese with fresh greens and an olive oil dressing. I also had 1/2 of a keto roll (1 net carb). I beamce full and could not finish my salad. For dinner I am planning a filet mignon with a cauliflower casserole. By my calculations I will c ok nsu e 79 grams of protein today and most of my calories will be from fat and I will have about 15 net carbs. I am aiming to lose 80 more pounds (I have lost 20 since late April). On the urine strips it indicates I am in moderate to large ketosis. I did just order a blood test kit. Do I really need to up my protein? Thanks

    Reply

    1. Virta Health

      Every person is different, and these recommendations show that you should be consuming 84-140 grams of protein a day. You can try keeping your protein to the lower end of that.

      Reply

  17. Avatar

    Hi, I don’t really understand the whatabouts of counting calories. I read on virtahealth.com I should eat until I fell full. Now, testing a diet following the principles told here since a few weeks, I saw that if I am allowed to eat like I want my daily intake will be about 5,500 kcal – 2,000 kcal more than my need.
    So – counting calories is the solution nonetheless?

    Reply

    1. Virta Health

      We asked Dr. Phinney and here’s his answer:

      People differ one from another in how they respond to a well-formulated ketogenic diet; and for any one person, their experience will likely be very different when they are on a fairly low carbohydrate intake compared to actually being in nutritional ketosis. Getting into and then sustaining nutritional ketosis requires that carbs be very restricted and protein eaten in moderation. When this is done properly, dietary fat becomes surprisingly satisfying, and most people find that they can lose weight without counting calories. However this is predictably not the case if either too much carbohydrate or too much protein drives down blood ketones. This is why we have people test their blood ketones so we can coach them to this metabolic state where satiety kicks in as fat is added to the diet in moderation. As a point of distinction, this is not a feeling of being “full” or “stuffed”, but a sense of having eaten enough to be satisfied until the next meal. For some people, recognizing this takes some practice and maybe some guidance in mindfulness. And finally, the process of keto-adaptation typically takes a few weeks, for some perseverance may be required.

      Reply

  18. Avatar

    I’m curious after watching a lecture of Dr.Phinney’s in which he mentioned that Jason Fung had experienced markedly different results in regard to lean tissue loss during fasting. Just out of curiosity, were the subjects who were losing 1 pound + of lean tissue per day while fasting fat adapted? It seems to me the glide path for fat adaptation / lowered lean tissue loss on keto and the glide path for lowered lean tissue loss while fasting are quite similar, and ? possibly ? the same mechanism kicking in. Basically, I am fat adapted and I enjoy fasting for 3-4 days at a time, if I’m losing a pound of lean tissue a day I’m certainly not noticing that; loss of fat, water, food mass and lean tissue is closer to 1 pound a day total, with 3 of the 4 pounds coming back quickly when I resume eating.

    Reply

    1. Virta Health

      Thanks! Here’s a response from Dr. Phinney:

      “This is a great question, but one that needs more research done before it can be definitively answered. Unfortunately, Dr. Fung has not published any peer-reviewed research on this topic to support his assertion of minimal lean tissue losses with fasting beyond two days. In contrast, there are a number of classic human studies showing the prompt onset of lean tissue losses when either normal weight or overweight people who were not previously keto-adapted fast beyond 2 days. This rate of loss then tapers down to about a quarter pound of lean tissue loss after 3-4 weeks of continued fasting (https://blog.virtahealth.com/science-of-intermittent-fasting/).

      What has yet to be done is to carefully measure lean tissue losses when a fully keto-adapted person fasts for 2 days or longer. This is typically done by collecting all of one’s urine continuously for a number of days and measuring protein breakdown products leaving the body – obviously not an easy process, so it is usually done in a metabolic research ward. This kind of research is exacting and expensive, which probably explains why it has yet to be done and published.

      All that said, if I had to guess how a keto-adapted person would respond to total fasting, I’d put the lean tissue loss at one quarter pound per day starting on the second day and continuing for however long the total fast continues. Once back on adequate dietary protein, those losses would likely be recovered at the rate of two days’ recovery time for each day of fasting.”

      Reply

  19. Avatar
    Robin Sutcliffe August 14, 2018 at 9:57 pm

    Let’s say I eat a ribeye. Do I count the weight of the met before or after cooking?

    Reply

    1. Virta Health

      We recommend counting the weight of the meat before cooking!

      Reply

  20. Avatar

    So helpful! This is actually a bit more protein than I thought I needed on a ketogenic diet as a vegetarian.

    Reply

  21. Avatar

    Hi,
    Thank you for the info!, I usually take 25gr protein supplement with zero carbs as my first two meals and salmon, brocoli and sweet potatoe as my third, but every time I take a meal I have diarrhea, how much protein should I consume? Can I take 2 or 3 tbsp of coconut oil, salt, magnesium and potassium to avoid the side effect?

    I don’t want to decrease the amount of protein, actually I want to increase them to 170gr (my body weight, lbs) per day, since my main goal is gain muscle but I want the benefits of ketosis.

    Thank you very much.

    Reply

    1. Virta Health

      We have a post on diarrhea that might help! Eating too much protein can cause diarrhea. Learn more here: https://blog.virtahealth.com/fix-diarrhea-keto/

      Reply

  22. Avatar

    Love the height-weight chart for determining the amount of daily protein in ounces. Very practical.

    Reply

    1. Virta Health

      We are so glad you found it useful. Thanks for the feedback!

      Reply

  23. Avatar

    It is important to keep protein at about 10-20% of your daily energy needs. The amount of protein you need in Nutritional Ketosis varies among individuals.

    Reply

  24. Avatar

    I have a question to your Met-Life reference weights. I am a male 5″ 10′ and my reference weight is between 151 and 163 lbs. The fact is I am not trying to loose that much. I came from 245 lbs 5 months back, are now 220 lbs, and my goal is somewhere around 200 lbs. Should I still calculate my proteins from the lower reference weight?

    Great info all the way through. Really easy to comprehend. My Kcal calculator gives me gram of protein, fat and much more, thus I have focused on gram of proteins, and without knowing really kept me on track, maybe a little low.

    Reply

    1. Virta Health

      Hi Steve, thanks for your question. Protein needs are based on “ideal body weight” or your ideal weight for your height as you see in the reference chart. Severe illness or infection, injury, starvation and pregnancy can increase protein turnover and, in turn, protein needs but protein needs will not change with normal weight loss.

      Reply

  25. Avatar

    Interesting and useful article. Thanks.
    1. How, if at all, does age affect the recommended figures in the chart … e.g. for children, teenagers, and elderly people?
    2. What if people are a good bit under the recommended low end of the weight range for their height? Since their body mass obviously differs from the “norm” should they be taking in less protein than that recommended?
    3. The table shows a very consistent increase of weight range for every inch of height. I guess that makes it easy to calculate that figure for women who are over 6′. But the recommended daily intake of protein-containing food does not show the same consistent increase down the table. How, for e.g., is a woman who is 6’5″ supposed to calculate her daily intake of protein-containing food? Does she use the figures for males?
    4. Does the recommendation vary in any way depending on the amount of hard physical training (e.g. body building) a person does?

    thanks again for your articles, your videos, and your work.

    Reply

    1. Virta Health

      Monna, I’m going to summarize the answers to your questions using the format you asked them in order to keep it simple!
      1. The figures in the chart are based on adult patients. Children, teenagers and the elderly can have different protein requirements, however we currently only treat patients between the ages of 18-69.
      2. Protein needs are based on “ideal body weight” or the “ideal” weight for your height. In most circumstances, this is going to remain stable across a wide variety of weights (i.e. underweight to overweight). However, severe infection or illness, injury, starvation and pregnancy/breastfeeding will increase protein needs.
      3. It would be appropriate for a female with a height of 6’5″ to start with a protein goal of 14-22 oz per day.
      4. Yes, body building can increase protein needs, however it wouldn’t extend beyond 2 grams per kilogram of body weight or the upper range as displayed in the table.

      Reply

  26. Avatar

    The table especially in confusing, also the protein recommendation for “ideal body weight”. If I was at my “ideal body weight” then I wouldn’t need a diet, would I? Are there really NO MEN under 63ins tall and NO WOMEN over 6ft tall? Hmmm. Why not just make the statement that one should choose between P1.2g/Kg and P2g/Kg of lean mass.

    We are all different, and must experiment to find what is right for us. I went from 145lbs to 118lbs (slightly more of a reduction than my target of 125lbs), am 63 years old and 11% body fat (US Navy method). I am now looking to increase lean mass to get back to 125lbs without increasing body fat. Any recommendations?

    If one measures weight, load shifted during workout (since exercise is CRITICAL), then it becomes apparent, over the course of a month or two whether or not he/she is losing/gaining muscle mass.

    Reply

  27. Avatar

    Important oblivion…
    —————————
    Dear Dr Phinney,

    Too bad that Eric C. Westman, Stephen D. Phinney and Jeff S. Volek, the three co-authors, lack rigor in the drafting of their book, not even in the French translation, excellent otherwise,
    “New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great”.
    … nowhere appears a summary of the used utensils in the New Atkins Diet with their exact capacity because they forgot to consider that the usual size of these utensils may vary from one country to another.
    How much does it contain for them a small bowl, a half-small bowl, a large bowl?
    How much does it contain a medium plate, a soup plate?
    How much does a tablespoon contain? a tea spoon ? Domed or shaved? A.s.o….
    If one of them could enlighten readers in a future edition … it would be really nice!

    Reply

  28. Avatar

    I have been on a ketogenic diet for the last 10 years. I have never been diagnosed but believe that I was prediabetic when at 50 years old I weighed 230lbs with a host of ailments that had me feeling like I was 80yrs. I started with the Atkins diet where I never measured anything other than carbs. I responded well and lost 70lbs in 10 months. Over the years there have been times where I have wandered off plan (always weight gain and other symptoms come back) but for the most part have maintained. Now I am struggling with weight creep from the 150lb I had maintained for so long, I am 61, 5ft 6in. and 180lbs. I had quit smoking 4 years ago, then 2 years ago was injured so that my activity level has been severely impacted. And aging I guess. So in desperation I went from Keto to Carnivore 2 months ago. What I found was an improvement in hair, skin and nails. My eyebrows grew back ( yes I tested thyroid and Doc said normal) and my sleep improved from 5 hours to 7 per night, increased energy as well. I feel better. I think I was low on protein, perhaps I have caught up? I am going to go back to Keto and see how I feel. I looked at my protein consumption while Carnivore and typically I ate 1lb of either lean ground beef, pork tenderloin or steak sometimes split over 2 meals and breakfast typically 4 bacon and 3 egg with an ounce of cheese. Fat was butter, bacon fat or sour cream to fullness. Zero plants except for some seasonings. My protein was typically around 150gms per day?, if I mixed a bit of ground liver in with my ground beef I ate way less and felt full for a lot longer. I used to like chicken but actually on Carnivore I found it didn’t fill me up and I lost any craving for it. Beef or pork is my go to. Using your chart above I see at my height I could consume as much as 18oz of protein. At 7gm per ounce that is 126gms. So on Carnivore I was above that typically by 30gms. As I add back carbs that will drop I’m sure as I would not be able to eat that much. But my experiment did show me that I actually feel better at a higher end of protein. Now to see how I feel as I add back in my carbs and drop the protein level somewhat. There is a growing group of dedicated carnivores but without any real long term studies on it. I have not been able to find a doctor who understands Keto or would even be supportive. Thanks for all that you do at Virta Health, without groups like yours there would be no other opinion for me than a GP hell bent on putting me on statins and the vegetarian diet!

    Reply

  29. Avatar

    First off, I’d like to thank Stephen Phinney, Jeff Volek and the Virta team. I’ve read and seen so much articles and films about the WFKD and this works so well for me. I wasn’t diabetic but I wasn’t too happy with my weight. I’ve lost approximately 25 pounds and feel great now.
    But I do have a question regarding protein intake now I’ve watched Dr. Benjamin Bikman’s lecture “Insulin vs. Glucagon: The relevance of dietary protein”.(https://www.youtube.com/watch?v=z3fO5aTD6JU). He presents data that shows a different insulin respons to protein depending on the glycemic level of the individual.
    If you’re on a Standard American Diet you have an insulin response, but in a fasted state and ketosis you don’t. That would mean that if one is fat-adapted and in nutritional ketosis you wouldn’t need to worry about your protein intake. Can you comment on that?

    https://discourse-cdn-sjc1.com/ketogenicforums/uploads/default/original/3X/8/d/8d34495254e8a42f1fe4db33ccaf5168462e6850.jpg

    Reply

    1. Virta Health

      Hi Stefan, thanks for following along! In regards to your question, everyone will respond to protein in different ways but we have found, in our patients, that excessive protein consumption does drive down ketones. You can also find this paragraph in our post on protein where it discusses research looking at protein and ketosis: “Too much dietary protein can drive down ketones for several reasons. Protein has a moderate insulin stimulating effect; and though less than the impact of a similar amount of carbohydrate consumption, high protein intakes can drive down ketone production in the liver (Marliss 1978). In fact, specific amino acids like alanine are potently anti-ketogenic. Additionally, when consumed to excess, protein can upset gastro-intestinal function and place a stress on the kidneys to remove the additional nitrogen.”

      Reply

  30. Avatar

    what about Whey Protein in the context of weight training? Many people asks online if doing keto and incorporating heavy lifting to maintain/gain lean muscles, do they have to replenish protein above the normal recommended levels? Or do they simply pick a number of protein grams/oz on the higher end of the protein range given in the chart on this article? If they have to replenish protein after exercise, but happen to be doing fasting during OMAD fasting window, they prefer to take whey protein powder rather than consuming another meal. What happens to the whey protein powder after post-exercise ingestion? Does it turn into glucose or spike insulin? THank you in advance!

    Reply

    1. Virta Health

      Hi Amy! You may find this post helpful on whey protein: https://blog.virtahealth.com/whey-protein-keto/

      Reply

  31. Avatar
    Cheryl Knowles May 24, 2019 at 1:15 pm

    Wonderful article! I have read that foods high in the amino acid arginine will raise insulin without raising blood sugar and halt weight loss, and in some cases, even cause weight gain. “Foods high in arginine that need to be limited during weight loss are chicken, turkey, pork loin, crab, shrimp, oysters, lobster”. For someone with insulin resistance and trying to lose weight , what does VIRTA recommend for protein sources and would you agree to limit proteins noted above? If so, limit to what degree? For example, chicken breast – do you limit it to 2 oz portion versus 3oz or limit it to once a week meal versus 3 meals/wk with chicken?

    Reply

    1. Virta Health

      When it comes to protein sources, we do not recommend against those that are higher in arginine. For information on what we do recommend, you can read our tips, here: https://blog.virtahealth.com/protein-on-low-carb-ketogenic-diet/

      Reply

  32. Avatar
    Mishal Sequeira May 27, 2019 at 1:44 pm

    Hi,
    I am a marathon endurance athlete and on low carb for 3 years, and very low carb for 1 year. However, I am unable to sustain energy during race. My height is 5.4, women. I am currently consuming around 60 gms protein and around 60 gms fats. My weight currently is 60 kg but I want to come down to 55 kgs weight. I have a race coming up in September. Should I up my protein to 2 gm per kg which is 110 gm and also up fat to 121 gms or protein and fat to 1.5 gm per kg.

    Thanks
    Mishal

    Reply

    1. Virta Health

      Hi Mishal! We aren’t able to provide specific medical advice via this forum. Have you read http://www.artandscienceoflowcarb.com/the-art-and-science-of-low-carbohydrate-performance/? It may have more information to support your endurance journey.

      Reply

  33. Avatar
    David L. Donoho June 12, 2019 at 7:45 pm

    Help. I am 6′ 2″, 422#, 66 years old. In reasonable good health. Just over weight. I’m trying to figure my micros %. I want to stay around or below 50 gm of carbs. That figures around 15% carbs. Where should my protein and fat % be?

    Reply

    1. Virta Health

      Hi David! We don’t work with “macros” specifically but encourage our patients (who are insulin resistant) to start at 30 grams of carbs per day and eat enough fat to stay satisfied. Based on the chart on this post, your protein intake would be between 13-22 oz or 91-154 grams of protein per day.

      For information on what we consider to be a well formulated ketogenic diet, I’d recommend checking out this post: https://blog.virtahealth.com/well-formulated-ketogenic-diet/

      Reply

  34. Avatar

    Hi!
    In the article we see information about daily target protein intake in the range of 1.2 – 2.0 g / reference body weight.
    But in the book “The art and science of low carbohydrates performance” I can read, the protein intake should be
    between 0.6 – 1.0 g / pound of lean body mass (1.3 – 2.2 g / kg of lean body mass).
    For example:
    1) According to the article – Male 170cm – Reference weight 142 lbs (65 kg) – Target daily protein intake between 78 – 130 g
    2) According to the book – Male 170cm weighing 64 kg, body fat aproximately 20% – Target daily protein intake between 66 – 112 g

    Which option is correct ?

    Reply

    1. Virta Health

      Great question! Most people will not know their percent lean body mass, so the protein target of 1.2-2.0 grams per kg of reference weight is the simplest option. For those who are more knowledgeable of their body composition, using 1.3-2.2 g/kg of lean body mass will be more specific to their body type.

      Reply

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