Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...Tell Me More
The low-carb flu is real and it’s terrible. While it doesn’t kill as many as the Spanish flu of 1918 did or inspire the amount of panic seen during the 2009 swine flu epidemic, low-carb flu has dissuaded millions of people from pursuing and sticking to a healthy diet. You can laugh now that you’re fat-adapted and humming along on stored body fat, but you’ve forgotten just how terrible the transition from sugar-burning to fat-burning can be. Do any of the following symptoms sound familiar?
Brain fog so thick you almost welcome the headaches for cutting through it.
Malaise, fatigue, listlessness, and other synonyms for “exhaustion.”
Lightheadness and dizziness.
A sense of impending doom that you suspect would give way to bliss if only you’d have some ice cream.
At some point, you’ll just have to accept the reality of the situation: you’re shifting from a sugar-burning metabolism to a fat-burning metabolism. You’re building the metabolic machinery necessary to burn fat. You’re updating your body’s firmware, and it’s a big update (coincidentally, this is why I recommend plugging into a power source for the duration). That takes time. If the results of one study are representative, it takes about five days on a low-carb, high-fat diet to increase AMPK and start building new fat-burning mitochondria. And sure enough, most people report that the low-carb flu lasts from 4-7 days—right on target.
But that doesn’t mean we have to like it. So, what can you do to speed up the transition and/or reduce the pain and suffering?
One theory is that low-carb flu is caused by the release of stored arachidonic acid from adipose tissue. Since AA is the precursor to inflammatory molecules implicated in headaches, a sudden rush of AA into the blood—as happens in obese and overweight people during initial weight-loss—could be responsible. If this is true, taking extra fish oil or eating fatty fish like sardines or salmon should counter the omega-6-induced inflammatory response triggering the headaches. If this isn’t true, eating fish is still a good idea.
Going low-carb increases salt requirements on multiple levels. First, when your body dumps glycogen, it doesn’t just dump the water that accompanies it. You’re also losing tons of sodium. Second, a byproduct of low insulin is reduced sodium retention, so you’re both losing and failing to hold on to it. Third, going on a Primal eating plan inevitably entails eating more fresh food and less unprocessed food. Unprocessed food is usually low-salt; processed food often comes with added salt. Nothing a little extra salt can’t fix.
Add salt to taste. Drink salty bone broth (Peter Attia likes bouillon dissolved in hot water, but I prefer the real stuff). Sprinkle a little salt in your water.
You also lose potassium when you go low-carb and dump all that water weight. To replenish your stores, Use Lite-Salt (a potassium salt) along with your regular salt, and eat lots of non-starchy green vegetation, like spinach. Other great potassium sources include avocados and yogurt (if you get real yogurt, the bacteria have consumed most of the sugar).
Although losing water doesn’t really flush out magnesium like it does other electrolytes, we do need extra magnesium to regulate sodium and potassium levels in the body. Leafy greens like spinach (again) are great sources of magnesium, as are most nuts and seeds. I just found a sack of sprouted watermelon seeds at Costco that give you 35% of the RDI for magnesium per ounce. Even though low-carb and sweeteners don’t usually mix, I’d say the huge amount of magnesium in blackstrap molasses makes a tablespoon worth adding.
You may have to dip into the supplement bin for this one. Any magnesium ending in “-ate” will do: glycinate, citrate, malate, etc. And once again, it’s one of those cases where almost everyone can probably use extra magnesium regardless of their current diet. It’s simply a good nutrient to have.
People tend to focus on the electrolytes you lose with water loss, but there’s also the water. If you’ve ever been dehydrated, you know the symptoms—dizziness, fatigue, mental confusion—match those of the low-carb flu. Pay attention to your thirst and get yourself a good source of mineral water with a TDS of at least 500 mg/L (or make your own using Trace Mineral drops), like Gerolsteiner, to boost your intake of minerals that may be lost to water shedding. Don’t drink healthy-sounding things like reverse osmosis water without remineralizing it.
The study I cited earlier in which a low-carb, high-fat diet increased AMPK had another experimental group who also experienced AMPK upregulation: lean adults given a bunch of fat to eat. It turns out that both carbohydrate restriction and fat feeding can increase AMPK activity. In both instances, the amount of fat available for burning increases. By supplementing your endogenous fatty acids (the stuff coming off your body fat) with exogenous fatty acids (fat you eat), you can maximize the AMPK activation and, hopefully, speed up the adaptation process. You may not lose as much body fat this way, but you’ll be happier, less fatigued, and more likely to stick with the diet.
MCTs are treated differently than other fats. Rather than store them in the body fat or use them in cell membranes, the body sends them directly to the liver for burning or conversion into ketones. So a good percentage of the MCTs we eat become ketones, which provide some additional fuel to glucose-deprived bodies that haven’t quite adapted to a fat-based metabolism. Coconut fat is the natural source of MCTs, though only about 14-15% of the fatty acids in coconut oil are MCTs. If that’s not giving you the boost you need, MCT oil is an isolated source of the ketogenic fatty acids. You can go even further and get just caprylic acid-based MCT oil, which isolates the specific fatty acid with the most ketogenic potential.
Part of the low-carb flu comes down to poor energy availability: when you take away the energy source you’ve been relying on all your life, it takes awhile to feel normal. Similar to MCTs but more so, ketone esters “force” ketone availability. And while I’m skeptical of taking large amounts of supplemental ketones on top of a high-carb diet (so are others), I can imagine them helping the newly low-carb speed up the adaptation process and overcome the low-carb flu.
If you haven’t read Primal Endurance, consider grabbing a copy. It really fleshes all this out. But long story short? Hold off on the extended sugar-burning training—long CrossFit WODs, long hard endurance efforts, 30 minute interval workouts, P90X—until you’re fat-adapted. Do some intense stuff, but keep it really intense and brief. Short 2-5 rep sets of full body lifts, brief 5-10 second sprints (with plenty of rest in between), things like that. The bulk of your training should consist of easy movement keeping your heart rate in the fat-burning zone (180 minus your age) until you’re adapted and the low-carb flu has abated. Hikes, walks, light jogs, cycling, swimming are all great depending on your level of fitness, and they’ll jumpstart the creation of new fat-burning mitochondria to speed that process up.
The vocal ones, the people who post on message boards and leave comments and submit success stories, are generally going to be more extreme. They’re going from 400 grams of carbs a day to 40 grams. They’re going all in. They’re going cold turkey (literally: they’re eating entire meals consisting entirely of cold turkey to avoid carbs). That doesn’t work for everyone.
Another option, and one that might work even better for most people, is to gradually reduce carbs. By reducing carbs more gradually you reduce the shock to your system and give your body the chance to find its sustainable sweet spot. You might do best on 150 grams a day (that’s about where I am, in fact). You might like 120, or 130, or 70. The point is going gradually allows you to take a journey through all the possible permutations of carb/fat/protein intake. It’s quite possible that 140 grams a day works best for you, but because you immediately launched into a very low-carb 20g/day diet and failed miserably, you’re turned off from the idea altogether.
That’s what I’ve got, folks. Those are the tips that work best for me and mine. Those are the tips that science suggests actually work. What about you? How have you gotten over the low-carb flu?
Thanks for reading, everyone. Take care.
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