I have tried that a few times now and both times I started to have health problems. It may very well not be what happens to you.

We are all individuals and you should work with your doctor if you can ( if your doc wont, look for a low carb friendly doc). Mine is open to anything that safely helps her patients lose that extra weight and improve their cholesterol and triglyceride numbers. My doc said that I was too deep into ketosis. So this time around I am going to eat at least 60g/day, and add exercise this time.

Symptoms to watch for (what happened to me):

Insomnia
Fatigue
Irritability (not so great at work)
Quite a bit of hair loss-(loss and breakage)
brittle nails

This may never happen to you, but I would recommend that you read some books on the subject. The two authors that were very imformative for me are Dr's Phinney and Volek.

You should keep track of your intake of salt (you need much more on this diet). Sodium, magnesium and potassium are important. I had to drink bullion cubes every day, otherwise my blood pressure got too low.

-Andrea

I am at 0 grams a day (more likely < 5 grams a day due to carbs from seafood, organ meats, eggs, and dairy) for well over a year. I plan on this for the rest of my life. And, I was at < 20 grams a day before that. I know people who have gone years at these levels, some have even gone decades. There were even entire cultures that consistently got less than 20 grams a day of carbs over the entire life of the people in it.

In short, there's no reason to expect it to be a problem. If you feel good at 20 grams, stay with it. The only reason most plans allow people to add carbs back in is because it's hard to get people to accept permanently giving them up. Most people can accept a temporary break from them, as long as they know they'll get to go back. It's a mental thing. Some people should likely never add carbs back, as almost any amount has negative returns for them.

Sorry in advance for the "book", but I have thought about this a lot. I HAVE to have a way of eating that I can do for the rest of my life, especially being closer to the end than the beginning. So, here's some thoughts:

I am currently at 20 grams total carbs or less and have been so since June 1st, and my weight loss has averaged around 2lbs per week, around 40 lbs down. With the great advice I've received here I have no keto flu, and other than some general tiredness occasionally (which I take care of by supplementing and a small protein increase), nutritional ketosis has been WONDERFUL as far as how I feel.

I am morbidly obese, and my hope is that I will have a success story like some of the kind folks in this group. I HATE BEING FAT! I want to LIVE, to MOVE without the restrictions that have been my life for so long.

I have a history of yo yo dieting the last 10-15 years. I am 58, so I don't have the time left to dink around with my health and with my eating.

All of that to say my mindset is 20 grams or less for as long as it takes. I am FIGHTING for a long term mindset, working every way I know how to develop that mindset. So far I don't miss the high carb "carbage" as some call it, although I haven't been to my favorite Caribbean island and had to drive by the best Gelato store in the universe yet!!

So, nearing my goal weight I will begin to do N=1 experiments and slowly and meticulously add back some healthy carbs (I really miss raspberries, I love nuts) and monitor my body's reaction. I will look for - 1) Cravings (I love not being hungry, being able to look at a plate of doughnuts and say no, etc. This was unheard of before, and if I let this return I'm doomed). 2) Energy, General "How I Feel". (The mental clarity and motivation I have being in nutritional ketosis is worth this way of eating all by itself. I am so much more in tune with my body in general - if things start changing I'll drop back.) 3) The Scale. I put this last not because it is unimportant, but because it is the least important. I currently weigh once a week, and any more drives me crazy. When I start increasing carbs I'll probably go back to daily or every two days to monitor myself more closely. As I lose weight I am starting to add light exercise in to help my body recover from carrying around an extra 150 lbs or so. Body fat percentage will become a far more important measure at that time than overall weight.

So, in answer to your question - YES! I will stay at 20 grams or less for life IF NECESSARY.

At my goal weight (which I haven't even set yet because I have so far to go) I will start going up 10 grams or so at a time, for maybe a week or two, monitor the results, and go from there. I would love to add in a few foods that I am saying no to currently, but that is not my goal, health is.

I am curious and would like to know what the upper end of my total carb consumption still being in nutritional ketosis is. I might even spring for the blood ketone testing apparatus then, because I think it is more critical when you are in maintenance than when you are in the weight loss process.

That upper end varies GREATLY between individuals, which is why there is no "one size fits all" low carb plan. There are general principles that if ignored will block success, thus the 20 gram mark.

I think it's important to have great clarity on "why am I doing this"? That changes over time, but honesty with yourself can prevent some very discouraging stuff down the road. Good luck!

nicintime wrote: »

How, and on what basis could the doctor even make that statement?

Unless you were above 10 millimolar and approaching ketoacidocis your ketosis would have little to do with those symptoms. There is a WIDE range of acceptable ketosis according to Phinney and Volek - did your doctor test your blood betahydroxibuterate levels? I'm not trying to be combative, just questioning the physician's statement about being "too deep into ketosis" (whatever that means) without some objective measure.

I'm a HUGE fan of Phinney and Volek. But they don't support their recommended level of ketosis very well. In fact, they really don't support it at all.

If you dig into it, their only justification for their "optimal" level is to feed the brain a maximum level of ketones. Even if that were a Good Thing, you can do it without targeting their "optimal" level.

Ketones are a mild acid. Ketoacidosis is a spectrum. I can easily imagine negative side effects from long-term high levels of blood ketones. Personally, I'd be concerned about mineral loss.

wabmester wrote: »

I can easily imagine negative side effects from long-term high levels of blood ketones. Personally, I'd be concerned about mineral loss.

Studies? Otherwise you are just "imagining".

So, I'm not an "expert", but I think it depends...

If you have 200lbs to lose, do it. Get well. Adjustments would then be made in maintenance which would not be as restricted carb wise..

Phinney himself has been in ketosis 7 years solid, and mostly for 11 years. And most of that in maintenance. His concern is LCHF long term... and I agree with that concern.

What's worse, the poison that bad carbs are to many of our systems, or monitoring and dealing with potential "mineral loss" or other condition? This is what drives my perspective.

People are different, very different and should find what they need to do to stay healthy.

But I see WAY more people quitting what could help them (LCHF) because of easily curable symptoms than I do people who have problems because they've been low carb for "too long".

There are long-term studies, but they're all from studies of epilepsy patients. It's easy to find other reasons to blame their particular ketogenic diets, but they documented bone issues, growth issues, kidney stones, and more. I can dig them up if you want, but there are no long-term studies of NK as Phinney and Volek prescribe it.

In any case, my own plan is for "intermittent ketosis." I don't see any need to be ketotic all the time, but there are clearly beneficial effects associated with ketones.

ajmurray1234 wrote: »

Hello,

I'm currently consuming 20 grams of carb and plan on doing so for another week as part of induction; however I wanted to see if anyone in this group has kept to 20 grams of carbs as a permanent lifestyle.

I've been at 20g carbs as my limit since January 2014. I'm not even considering changing that until I get to my goal weight. I did slip up for much of a couple months in the summer of 2015, so I haven't been on 20g/carbs a day straight through for the last 20 months, but I did go 15 months that way and once I got out of my slump in the summer I'm back to 20g carbs and staying there.

I've been doing about 20g of carbs for almost 3 months, but I can see doing it for years. My health improvements have been so large, and so noticeable, that I am reluctant to change anything since I have (finally) found something that works. Inflammation is down so I have less arthritic pain. My hair loss slowed and my skin improved. My postural hypotension has lessened. My blood glucose levels are basically normal unless I get a virus - I've had 4's for days now!

And the scariest improvement for me was a large leap in my cognitive abilities. I am much sharper than I was a few months ago, to the point where those who know and care for me have noticed. The fact that my old higher carb diet affected my intelligence and memory to that extent... That is very scary to me. I'm only 41, I shouldn't have any mental declines yet!

I've been reading about the link between IR (which I have) and dementia, which some call type 3 diabetes, and it is alarming. If I need to stay vLCHF for my entire life to ensure I am still mentally sharp in my senior years, or at least not dull, I'll do it.

That being said, once I am at my goal weight and am more active, I will probably add back a few more carbs. Spinach and mushrooms with my eggs, more celery mixed in with my tuna. Like someone else said, I will never eat white again... well, except maybe a small cinnamon bun of my Grandmother's recipe for my birthday treat... Maybe.

According to ketostix, I'm usually between 0.5 and 1.5; I'm only higher if I fast... That seems like a higher range than I would have thought prudent too. Then again, most people could not get into ketoacidosis if they tried, unless T1D.

dawlfin318 wrote: »

My worst symptom was not sleeping, or if I slept- not feeling refreshed by a night of good sleep. This could all be a hereditary brain chemistry issue. My older sister had some of the same issues as I did.

It's fairly common. My pet theory is that it's due to higher cortisol levels when you go below about 40g/d carbs. But it could also be due to reduced insulin levels and the effect that has on circadian control.

Personally, I sleep better than ever, but I don't restrict carbs that much.