When describing someone that has successfully made the transition to the Primal way of eating I often refer to them as “fat-adapted” or as “fat-burning beasts”. But what exactly does it mean to be “fat-adapted”? How can you tell if you’re fat-adapted or still a “sugar-burner”? I get these and related questions fairly often, so I thought I’d take the time today to attempt to provide some definitions and bring some clarification to all of this. I’ll try to keep today’s post short and sweet, and not too complicated. Hopefully, med students and well-meaning but inquisitive lay family members alike will be able to take something from it.
As I’ve mentioned before, fat-adaptation is the normal, preferred metabolic state of the human animal . It’s nothing special; it’s just how we’re meant to be. That’s actually why we have all this fat  on our bodies – turns out it’s a pretty reliable source of energy! To understand what it means to be normal, it’s useful examine what it means to be abnormal. And by that I mean, to understand what being a sugar-dependent person feels like.
A sugar-burner can’t effectively access stored fat for energy. What that means is an inability for skeletal muscle to oxidize fat. Ha, not so bad, right? I mean, you could always just burn glucose for energy. Yeah, as long as you’re walking around with an IV-glucose drip hooked up to your veins. What happens when a sugar-burner goes two, three, four hours without food, or – dare I say it – skips a whole entire meal  (without that mythical IV sugar drip)? They get ravenously hungry. Heck, a sugar-burner’s adipose tissue even releases a bunch of fatty acids 4-6 hours after eating and during fasting , because as far as it’s concerned, your muscles should be able to oxidize them (PDF ). After all, we evolved to rely on beta oxidation of fat for the bulk of our energy needs. But they can’t, so they don’t, and once the blood sugar is all used up (which happens really quickly), hunger sets in, and the hand reaches for yet another bag of chips.
A sugar-burner can’t even effectively access dietary fat for energy. As a result, more dietary fat is stored than burned. Unfortunately for them, they’re likely to end up gaining lots of body fat. As we know, a low ratio of fat to carbohydrate oxidation is a strong predictor of future weight gain .
A sugar-burner depends on a perpetually-fleeting source of energy. Glucose is nice to burn when you need it, but you can’t really store very much of it on your person (unless you count snacks in pockets, or chipmunkesque cheek-stuffing). Even a 160 pound person who’s visibly lean at 12% body fat still has 19.2 pounds of animal fat on hand for oxidation, while our ability to store glucose as muscle  and liver glycogen  are limited to about 500 grams  (depending on the size of the liver and amount of muscle you’re sporting). You require an exogenous source, and, if you’re unable to effectively beta oxidize fat (as sugar-burners often are), you’d better have some candy on hand.
A sugar-burner will burn through glycogen fairly quickly during exercise. Depending on the nature of the physical activity, glycogen burning could be perfectly desirable and expected, but it’s precious, valuable stuff. If you’re able to power your efforts with fat for as long as possible, that gives you more glycogen – more rocket fuel for later, intenser efforts (like climbing a hill or grabbing that fourth quarter offensive rebound or running from a predator). Sugar-burners waste their glycogen on efforts that fat should be able to power.
Being fat-adapted, then, looks and feels a little bit like the opposite of all that:
A fat-burning beast can effectively burn stored fat for energy throughout the day. If you can handle missing meals and are able to go hours without getting ravenous and cranky (or craving carbs), you’re likely fat-adapted.
A fat-burning beast is able to effectively oxidize dietary fat for energy. If you’re adapted, your post-prandial fat oxidation will be increased, and less dietary fat will be stored in adipose tissue.
A fat-burning beast has plenty of accessible energy on hand, even if he or she is lean. If you’re adapted, the genes associated with lipid metabolism will be upregulated  in your skeletal muscles. You will essentially reprogram your body .
A fat-burning beast can rely more on fat for energy during exercise, sparing glycogen for when he or she really needs it. As I’ve discussed before , being able to mobilize and oxidize stored fat during exercise can reduce an athlete’s reliance on glycogen. This is the classic “train low, race high” phenomenon, and it can improve performance, save the glycogen for the truly intense segments of a session, and burn more body fat . If you can handle exercising without having to carb-load, you’re probably fat-adapted. If you can workout effectively in a fasted state, you’re definitely fat-adapted.
Furthermore, a fat-burning beast will be able to burn glucose when necessary and/or available, whereas the opposite cannot be said for a sugar-burner. Ultimately, fat-adaption means metabolic flexibility. It means that a fat-burning beast will be able to handle some carbs along with some fat. A fat-burning beast will be able to empty glycogen stores through intense exercise, refill those stores, burn whatever dietary fat isn’t stored, and then easily access and oxidize the fat that is stored when it’s needed. It’s not that the fat-burning beast can’t burn glucose – because glucose is toxic in the blood, we’ll always preferentially burn it, store it, or otherwise “handle” it – it’s that he doesn’t depend on it. I’d even suggest that true fat-adaptation will allow someone to eat a higher carb meal  or day without derailing the train. Once the fat-burning machinery has been established and programmed, you should be able to effortlessly switch between fuel sources as needed.
There’s really no “fat-adaptation home test kit.” I suppose you could test your respiratory quotient, which is the ratio of carbon dioxide you produce to oxygen you consume. An RQ of 1+ indicates full glucose-burning; an RQ of 0.7 indicates full fat-burning . Somewhere around 0.8 would probably mean you’re fairly well fat-adapted, while something closer to 1 probably means you’re closer to a sugar-burner. The obese have higher RQs. Diabetics have higher RQs . Nighttime eaters have higher RQs  (and lower lipid oxidation). What do these groups all have in common? Lower satiety, insistent hunger, impaired beta-oxidation of fat, increased carb cravings and intake – all hallmarks of the sugar-burner.
It’d be great if you could monitor the efficiency of your mitochondria , including the waste products produced by their ATP  manufacturing, perhaps with a really, really powerful microscope, but you’d have to know what you were looking for. And besides, although I like to think our “cellular power plants” resemble the power plant from the Simpsons, I’m pretty sure I’d be disappointed by reality.
No, there’s no test to take, no simple thing to measure, no one number to track, no lab to order from your doctor. To find out if you’re fat-adapted, the most effective way is to ask yourself a few basic questions:
- Can you go three hours without eating? Is skipping a meal an exercise in futility and misery?
- Do you enjoy steady, even energy throughout the day? Are midday naps  pleasurable indulgences, rather than necessary staples?
- Can you exercise without carb-loading?
- Have the headaches and brain fuzziness  passed?
Yes? Then you’re probably fat-adapted. Welcome to normal human metabolism!
A quick note about ketosis:
Fat-adaption does not necessarily mean ketosis. Ketosis is ketosis. Fat-adaption describes the ability to burn both fat directly via beta-oxidation and glucose via glycolysis, while ketosis describes the use of fat-derived ketone bodies by tissues (like parts of the brain) that normally use glucose. A ketogenic diet “tells” your body that no or very little glucose is available in the environment. The result? “Impaired” glucose tolerance  and “physiological” insulin resistance , which sound like negatives but are actually necessary to spare what little glucose exists for use in the brain . On the other hand, a well-constructed, lower-carb (but not full-blown ketogenic) Primal way of eating that leads to weight loss generally improves insulin sensitivity .
That’s it for today, folks. Send along any questions or comments that you have. I’d love to hear from you guys.