In this video, we delve into a hotly debated topic: Does a ketogenic diet impact cortisol levels and adrenal health? While some claim that sustained ketosis could lead to adrenal fatigue or other long-term health issues, the scientific evidence is still limited.
Transcript:
Introduction: Is Ketosis Bad for Cortisol?
Is ketosis bad for cortisol? Could it lead to adrenal fatigue or does it cause sustained cortisol elevations potentially harming us long term? There are many online posts and videos about this many suggesting that, yes, sustained ketosis is harming our adrenal health. But is that true? This is one of those areas without much quality research to guide us. So we have to do the best that we can with what we’ve got as such much of the advice out there is based on opinion and best estimates stemming from potential mechanisms, but limited data. So what can we do about that? Well, one alternative approach is simply following the clinical concerns with cortisol rather than the mechanistic hypotheses. So let’s see if we can dig into this and make sense out of it all. This is by no means an end all, be all definitive discussion, but hopefully will provide a perspective to help us see things a little bit differently. Welcome to Metabolic Mind, a nonprofit initiative of Baszucki Group transforming the study and treatment of mental disorders by exploring the connection between metabolism and brain health. Thank you for joining us on this journey. Now, before we get into the details of ketosis and cortisol or adrenal fatigue, please remember our channel is for informational purposes only. We’re not providing individual or group medical or healthcare advice or establishing a provider patient relationship. Many of the interventions we discussed can have potentially dangerous effects if done without proper supervision. So consult your healthcare provider before changing your medications or your lifestyle. And in addition, please recognize that people may respond differently to ketosis and there isn’t one recognized universal response. You’ve probably seen the videos or read the blogs that long-term ketosis is dangerous because it’s stressful on the body and can raise cortisol. Now, as with many claims, this is partially based in data, but that doesn’t mean there’ll be negative clinical outcomes, which in the end is really what we care about, right?
Research Limitations on Cortisol and Ketosis
So let’s start by rewinding and talking about what data, clinical data exists on this topic. Well, one study, which unfortunately defined low carb as less than 35% of calories, which as we’ve discussed isn’t a true low carb diet and definitely isn’t ketogenic. But this study demonstrated that cortisol moderately increased in the first three weeks after reducing carbs, but then decreased after three weeks. And the larger meta-analysis actually kind of concurred with these findings showing an early rise and a later decline in cortisol. And another study investigated eight weeks of a low calorie, low carb diet. This time truly low carb at 50 grams of carbs per day and demonstrated reduced cortisol levels at eight weeks. But then there’s another study in athletes that demonstrated persistent increased post-exercise cortisol levels. And there remains concern about longer term effects, right? Not just three weeks or eight weeks, but longer than that. And does the lower amount of carbohydrates create a stress or the requirements of cortisol as part of gluconeogenesis, will that lead to increased cortisol and poor long-term health? The problem is that the data don’t exist to support the clinical claims. So when looking deeply at these data, I think we have to acknowledge we’re working with limited outcome data with inconsistent definitions and measurements. And that makes it very challenging to reach an evidence-based conclusion for ourselves or for our patients. And you know, it seems like there’s this time-based sensitivity about when we measure a diet’s impact on cortisol, short-term versus long-term findings. But I’d suggest a different approach entirely to this whole topic. I say worry less about the mechanisms, worry less about the cortisol measurement itself, and worry more about the concerns with high cortisol, namely insulin resistance, increased blood sugar or blood pressure, increased visceral fat, some of the main negative health outcomes from chronically elevated cortisol, right? And what’s the impact of one’s diet and lifestyle on these important clinical outcome measurements? Well, as it turns out, research and clinical experience demonstrate that ketogenic interventions have beneficial effects in these areas with improved blood sugar, improved blood pressure, resolution of insulin resistance, lowering of visceral fat. So I’d argue if someone is seeing these beneficial clinical effects with ketosis, it’s highly unlikely that they’re having an unhealthy cortisol response.
Study Insights on Low Carb Diets and Cortisol
And we’ll link to a blog post that goes into much more detail about these concepts. But I guess that’s my clinical bias, right? We can add mechanistic theories, animal data, or even very short term human data. But what really matters is how each individual progresses on their health journey. So again, this isn’t meant to be a definitive end all be all, but maybe a different perspective. So let me know your thoughts about that approach or if you have other approaches that work for you. And the same thing can be said for the concern about ketosis causing adrenal fatigue, although this one is probably even more controversial since mainstream medicine doesn’t even recognize adrenal fatigue as a true medical diagnosis, which really limits the diagnostic consistency in how we talk about it. But, but I want to start by quoting an article by Dr. Steven Phinney and Jeff Volek two of the most prominent pioneers of ketogenic therapy. Here’s what they said, quote, if you google ‘adrenal fatigue ketogenic’ at the time of this writing, which was 2017, you get 371,000 hits. However, a PubMed search of the same three words yields zero hits. Why? Well, the simple answer is that adrenal fatigue is not an objective medical diagnosis associated with a ketogenic diet, nor is it one that can be made based upon a physical exam or by lab testing. You can’t find its diagnosis and treatment described in medical textbooks or in peer reviewed research papers. The mere fact that adrenal fatigue does not appear in medical textbooks does not prove that it doesn’t exist. After all, nutritional ketosis and keto adaptation have yet to be adequately described in those hallowed publications. But where’s the science linking carbohydrate restriction and or nutritional ketosis to impaired adrenal function i.e. inadequate cortisol or adrenaline production? As usual, that’s pretty insightful wisdom from Doctors Phinney and Volek. I like how they laid out the issue that adrenal fatigue is not a recognized medical diagnosis, but that in itself isn’t evidence it doesn’t exist. And the same can be said about the lack of data between adrenal fatigue and keto diets. Again, not proving it isn’t related. So what do we do? How can we approach this issue? I think we need to ask why there’s such a disconnect between what mainstream medicine and the general population tend to think about adrenal fatigue and its relationship to ketosis. One issue is that there’s a wide range of ways people define or diagnose adrenal fatigue. And there aren’t agreed upon reliable tests, I guess you could say, and that complicates any discussion and may be part of the reason why there are no data demonstrating adrenal fatigue resulting from ketosis. So while people may talk about mechanistic theories of why our adrenals need dietary carbs or how ketosis is harmful, there’s no quality outcome data to support this. And as Dr. Phinney and Volak point out in their paper fatigue, anxiety, trouble sleeping symptoms often attributed to adrenal fatigue can result from multiple potential causes including keto flu or longer term sodium or electrolyte deficiency. In their experience, those symptoms are often solved with adequate electrolyte supplementation. Now that doesn’t mean salt will cure all forms of fatigue, I’m definitely not saying that, but it does often help when someone is in ketosis.
Clinical Outcomes vs. Mechanistic Theories
And it also highlights that symptoms of fatigue don’t automatically mean something’s wrong with the adrenals. Fatigue is non-specific and with multiple potential causes. So in an effort to remain open-minded, yet rooted in evidence, it seems correct to acknowledge that ketosis causing adrenal fatigue is a hypothesis or opinion without adequate supporting data, but one that can’t be completely dismissed. So let’s get back to what we can do about it. If someone has symptoms of fatigue while following nutritional ketosis, it’s worth experimenting with electrolyte supplementation, even investigating other potential causes. But if they want to experiment with adding carbs, that is certainly reasonable as long as exiting ketosis won’t undo other health benefits. And that’s the key I feel needs emphasizing. If someone’s using ketogenic therapy to treat a mental disorder or other brain-based disorder such as depression, bipolar disorder, schizophrenia, even anorexia, anxiety, then simply adding back carbs is not such a benign action. In those situations, it makes sense to exhaust all other diagnostic and treatment options before adding more carbs. So in summary, not all conditions have clear data. And when they don’t, I believe we need to fall back on clinical outcomes like blood sugar, blood pressure, visceral fat, metabolic dysfunction, and other beneficial health outcomes from ketosis.
Adrenal Fatigue: Real Diagnosis or Controversy?
I’m more interested in those outcomes than in isolated cortisol measurement. And when someone experiences clinical benefits from ketogenic therapy, it’s worth doing all we can to help them maintain those benefits. So again, this is not the end all, be all treatise see on cortisol, but hopefully it was helpful maybe to give you a different perspective on ketosis and cortisol. But please leave us a comment. I’d love to hear from you.
Key Takeaways on Cortisol and Ketosis
I know this is a controversial topic and I’d love to hear about your experiences. And if this was helpful, please like and subscribe so others can find and benefit from our content. Thank you so much for watching. I’m Dr. Bret Scher and we’ll see you here next time at Metabolic Mind, a nonprofit initiative of Baszucki Group
