Monday, February 1, 2010

Induction Flu

Those of us who have done low-carb for years are happy to sing the praises of the low-carb lifestyle--decreased weight and increased energy, plus improvements in blood pressure, triglycerides, HDL and blood glucose numbers. But in much the same way that the joy of having a new baby diminishes our memory of the pain of childbirth, we find it easy to forget that one of the aspects of low-carbing is very hard. It's called Induction flu, or Atkins flu.

On the Standard American Diet (very aptly named the SAD diet) we are used to eating low fat, moderate protein and high carbohydrate. Our body's primary source of energy comes from the burning of hundreds of grams of carbohydrates we consume every day. When we change from a SAD diet to a low-carb diet, we abruptly remove the macronutrient that has provided most of our energy. Eventually our energy will come from the fat we eat, but in the meantime our bodies have a huge transition to make.

Every nucleated cell in our body contains 46 chromosomes with over 3 billion base pairs of DNA. In that DNA is the information needed to make the enzymes required for us to metabolize both carbohydrates and fats into energy. Although the information is there, it is not translated into enzymes unless those enzymes are actually needed. A person eating a SAD diet will have all the enzymes he or she needs to convert carbohydrates into energy, but very few of the enzymes needed to convert fat into energy.

Typically a low-carb diet is begun at a level of 20 to 30 grams of carbohydrate a day. Suddenly the carbohydrate conversion enzymes no longer have a substrate. They initiate Plan B, which is to utilize the glycogen stored in the liver and muscle tissue. Glycogen is converted to glucose, which is converted to energy. After about a day, glycogen is depleted, and the body moves to Plan C. It notices that fat is available in abundance, and it upregulates the machinery to transcribe the necessary codes from the DNA into RNA, and then to translate that into the enzymes that are required to metabolize the fat into energy. Unfortunately this takes a day or two, and in the meantime the new low-carb dieter starts to experience Induction flu.

The symptoms of Induction flu are not those that are normally associated with dieting. Instead of ravening hunger and cravings, there is a headache and nausea. The dieter may be irritable and lack energy and concentration. Chills and fever are not typical symptoms, but other than that, it feels like the flu and will last for about two days.

What to do? First of all, recognize that this is a transitional state and that it will end. Second, pamper yourself. This does not mean that you dive headfirst back into the carbs, but drink plenty of water, sleep, take a hot bath, take NSAIDs or acetaminophen, watch a good video or read a good book. One of the best strategies is to find a supportive friend either on the low-carb boards or in real life to commiserate with. Simply knowing that this stage is coming and planning for it is one of the keys to getting through it.

Sometimes new low-carbers try to change everything all at once. If you're a caffeine addict, you might want to wait until Induction is over before you give up the caffeine. If you are resolved to start an exercise regime along with the low-carb diet, it might be better to wait until you have recovered from the Atkins flu before you hit the pavement or go to the gym. If you are lightheaded or start having muscle cramps, consider taking a potassium supplement or using Lite Salt or a KCl salt supplement on your food. Low-carb diets have a diuretic effect and tend to make the kidneys excrete potassium.

It takes several weeks for the body to become fully keto-adapted, that is, to complete the conversion from from carb utilization to fat utilization for energy. However, the worst of the process should be over by the end of Day 3. At that point the benefits of low-carbing (increased energy, decreased appetite and a sense of freedom from the enslavement to rising and falling insulin) should start to predominate. Low-carbing is a continuous learning process, but once the Induction flu is over, it's a worthwhile journey into good health.


Helen88 said...

Thank you for an excellent blog. I have followed it for some time but not commented before. In this post tou infer that committed low-carbers cease caffeine. I am aware that in a previous post you have advised that in some people caffeine can thwart weight loss efforts. What is your advice with regard to caffeine in those who are doing low carb for weight loss? How does caffeine impact on weight?
Thank you

Stargazey said...

As far as the effect of caffeine on weight loss, I haven't done a review of the scientific literature, but I will try to do one as the topic of another blogpost. Thanks for the suggestion!

In the meantime, all I have is anecdotal evidence. Dr. Atkins recommended giving up caffeine, but many low-carbers continue to use it and lose weight successfully. Others note that it hinders their weight loss. You might do a personal experiment where you use caffeine for a couple of weeks and drop it for a couple of weeks. Keep a journal and see what effect it has on your own weight loss progress.

If a new low-carber decides to follow Dr. Atkins' advice, the reason I suggested that they wait to drop the caffeine is that abruptly stopping caffeine can cause severe headaches. I don't see a good reason to add more misery to an already-difficult process.

Another consideration is that, even if caffeine hinders the weight loss of a particular person, its effects probably won't be seen until a fair amount of weight is dropped and the person begins to encounter the stall phenomenon. That's when low-carbers start looking for foods that may slow their own personal weight loss--foods such as dairy, nuts, and the so-called Frankenfoods (low-carb equivalents of high-carb foods). During a stall, the low-carber could see if caffeine might be the culprit for him or her.

Ellen said...

Love your blog.. I would add magnesium supplementation as well, as you also lose magnesium. Dr. Eades talks at length about this in Protein Power Life Plan.

Anne H said...

I like the way you think, Stargazey!
Another great post.

Stargazey said...

Thanks, ellenwyo! Dr. Eades seems to be quite a fan of magnesium supplementation. Here he says, "...if we just had one supplement to recommend, and no other, it would be magnesium." It's an interesting article, if you have the time to read it.

Stargazey said...

Thanks, anne h! :-)

Lauralei said...

I have been on the low carb for 9 days - i felt okay for the first 4-5 and then the induction flu hit - i am so ready to start feeling better

Stargazey said...

Hi, Lauralei Properties! I see from your blog that you've done Atkins before, and Induction flu probably isn't new for you. I'm a biochemist, not a physician, so I don't give medical advice here. But if your symptoms persist, you might want to visit your doctor, just to make sure that something else isn't going on. Best wishes on your diet!

Helen88 said...

Would you consider doing a post on fats - please see the comment which I have recently added to your post of 22 May 2008.
Thank you
PS In order to leave a comment I find I can't just'sign in'as the system won't recognise my password. I have to go through the whole registration process every time - do you know why this is?

Stargazey said...

Hi, Helen88. Thanks for coming back. After I approved your comment on fats, I couldn't find it, even with Google. Blogger does not tell blog owners which post is being commented on, just that there is a comment. Usually I can guess where the comment is, but I couldn't with yours. Anyway, not your fault. And yes, I'll try to do a post on fats. It's a big topic and it may take me a while to work my way through the literature.

Stargazey said...

As far as needing to register every time, are you signed in with Google or Yahoo? I have to sign in with my Google account or it doesn't work. It signs me out after about two weeks, but then all I need is my Google e-mail and password. If your problem is more complicated than that, perhaps you could ask Blogger for suggestions.

Helen88 said...

Thank you for your response. With regard to fats, I am interested in fats in relation to our diet as there is a lot of conflicting information out there and it would be nice to have advice backed up by science, e.g. a summary of sat fats, unsat fats etc and how they should be used [or not used!] in our diet. You have commented previously that coconut oil is the best fat for us, but this is not available in supermarkets here in the UK where I live. What do you consider to be the place of low fat versions of food? e.g. low fat dairy products?
I look forward to your sound advice whenver you have time to do a 'fat' post.
Thank you.

Reamz said...

Awesome blog, but i've been wondering something for a while...
Say, you are fully ketoadapted - i.e have been eating a very low carb (some days zero carb) diet for months and feel great on it.
What happens if one day you eat a bunch of carbs (eg 100g in one go). How does your body react? Is it the same as someone who eats carbs every day (over 200g) and if not how does the body response differ? Will you continue to be keto adapted the next day, when you go back to ultra low carb?

And what if you don't just have one load of carbs, but raise your carbs for a couple of days, eating them throughout the day. Will you become glucose adapted, and then have to go through the couple of weeks it takes to be keto adapted all over again?

I've been dying to understand all this, and would appreciate any help!!

Stargazey said...

It's a matter of enzymes, Reamz. When you're keto-adapted, you have induced the proper enzymes to utilize fats for energy and you are able to obtain required glucose by gluconeogenesis from glucogenic amino acids and glycerol. If you are doing zero-carb or something close to it, you will have down-regulated the enzymes required to process carbohydrate.

For that reason, if a very-low-carber has a glucose tolerance test, the results will be skewed. He/she simply will not have the enzymes available to process the glucose properly. That's why the doctor will recommend eating 100 carbs per day for about three days prior to a glucose tolerance test. It takes about that long to get the carb-processing enzymes back and functioning efficiently in the gut.

Just one day of eating 100 grams of carbs shouldn't have much effect. Because of the extra insulin requirement and a carb-induced boost in your glycogen stores, you can expect a temporary gain in water weight. Eating extra carbs long-term will switch you back to the extra insulin release leads to insulin resistance leads to fat storage mode. Which is why you can't lose weight on low-carb and maintain the weight loss on low-fat/low-calorie.

If you then go back to low-carbing, the transition to keto-adaptation should be much quicker. The body has a memory for things it has experienced before. However, because of that, you will not experience the high degree of metabolic advantage that newbie low-carbers enjoy. That may be why people say that with low-carbing you get "One Golden Shot." Low-carb still works, but after the first time it works more slowly and it's much less common to see rapid, huge weight losses.

Reamz said...

cool, thanks for the clear response! totally makes sense now.
It's weird...after eating near to zero carb most days, every once in a while i may have a bunch of carbs (between 50 and 100g) at once, and i don't actually feel terrible! I feel absolutely fine/normal, no tiredness, lethargy, etc, and i don't get hungry soon after.. perhap this is a sign of a "normal" metabolism that can handle stuff like that?

Stargazey said...

You probably do have a normal metabolism, Reamz. From your Blogger profile, you're only 19, which means it is likely that you haven't started to develop insulin resistance following years of high-carb eating. If you can keep following a low-carb path, you should be able to maintain a good metabolism into old age. (No guarantees, on that, of course.)

As long as it doesn't set off cravings, it's probably a good idea for you to eat more carbs every so often. Our paleolithic ancestors (and the early 20th century Inuit) actively sought out plant foods, even when fatty meat alone would have met their caloric needs. There was probably a good reason for that, although we can't be sure exactly what it was.

Right now I have only anecdotal data to go by, but it appears that in some people, strict zero carbing eventually causes higher-than-expected blood sugars through gluconeogenesis. This is most often true in people over 50, but I've had a report of it from a woman in her 20's. Anyway, if you choose to zero carb, it's a good idea to purchase a blood glucose meter and strips (the Accu-Chek Aviva seems to be quite accurate in my experience) and to monitor both your fasting blood glucose and your glucose one and two hours after meals. There's no need to be obsessive about it, but checking every week or two will keep you aware if a problem is starting to develop. If you're interested, you can also see how your body reacts when you eat a bunch of carbs.

jkim said...


I have a question similar to Reamz. If a long-time low-carber (30-40 g per day) has an OGTT without upping their carb intake beforehand, how are the test results skewed? Are the numbers artificially higher or artificially lower?

I had a 100g OGTT some time ago and was not told to eat more carbs in advance. I didn't hit the 200 BG mark, but now I wonder if the number would have been higher had I eaten more carbs to prepare.

Stargazey said...

The numbers are artificially higher. You're more likely to get a false positive with an oral glucose tolerance test if you are a low-carber and have not done carb adaptation for three days.

When low-carbers eat a bolus of carbs for the OGTT, their pancreas is not used to shooting out lots of insulin in response to a meal. Consequently their peak blood glucose is likely to go higher and it may take longer than normal for them to secrete enough insulin to bring the blood glucose back to baseline. Hence the recommendation for three days of carbs to give the pancreas some practice.

In your case, if you didn't do the adaptation beforehand and your blood glucose still stayed under 200, that's a good thing and you wouldn't need to repeat the test until your doctor feels that it's time for another one.

PRIVATE said...

Hi, very interesting blog. I was wondering if you could clarify something though, you said that "if you're keto-adapted you have induced the proper enzymes to utilize fats for energy and you are able to obtain required glucose by gluconeogenesis from glucogenic amino acids and glycerol." So that means that if one did OGTT and an Insulin Challenge test then your numbers would be much lower ? I have alot of the symptoms of diabetes and I was following a low carb, (actually not eating alot of food in general either) and my test results did not show that I'm diabetic.

Stargazey said...

Hi and welcome, Private!

Usually if you're low-carb adapted, a glucose tolerance test will register higher than normal. The reason is that your carb-processing enzymes have been down-regulated, so when they're presented with a high carb load, they have a hard time dealing with it. When low-carbers get an OGTT, they are advised to eat 100 grams of carbs per day for three days before the test so that the enzymes that deal with carbs can be re-induced.

I can't find information on an insulin challenge test. Is it a way of measuring insulin resistance?

You may be in a pre-diabetic state, and you're wise to start taking preventive measures now, before diabetes begins to damage your body. You might want to purchase a blood glucose meter and some test strips. If you measure your fasting blood glucose, plus the glucose level one and two hours after meals, you should get a good idea of whether your blood sugars are in a normal range.

I'd recommend Jenny's Blood Sugar 101 blog if you need more information. She's much more of an expert in this sort of thing than I am.

Heather Kay said...

thank you thank you thank you for this blog!! I just started a modified fast through my local hospital dieticians and its atkins science at its core. yesterday i was home sick from work, threw up once in the morning, had headache for two days and felt generally like crap. I seriously thought about eating carbs lol
Today though I am already feeling better, today is day 4.
I needed to find this blog though cause i thought maybe this change wasnt good for me.

Stargazey said...

You're very welcome Heatluv88. It will take a while for your body to make the metabolic switch, but once it does, your food will taste better, you'll stay full longer, and your lab values will improve. You may even lose some weight! It's all based on good science, so be sure to look around and read the various blogposts here. It's good to have you along on the low-carb journey to good health.

Unknown said...

Nice article, interesting read.

I do a CKD diet and if I go too long without a carb up.......well, you guessed it.....induction flu....yuck, happened to me today.

Incessant Chatter said...

THANK YOU for your blog! I started the Ketogenic Mediterranian Diet 4 days ago and felt absolutely miserable yesterday. Muscle and joint pain. I searched everywhere and found a suggestion regarding the biochemical conversion process taking place at the microscopic level in my body. But before that - I ate about 6 ounces of nuts!!! Read the label - carbs. That's why only 1 ounce a day. Thank you, I'm following. I need the support and the science (being a science nerd myself *grin*). Was diagnosed pre-diabetic. I don't see that I have any other choice but this. Again, Thanks for your work here.

punkmarkgirl said...

Great blog! I’ve been trying to find information on the symptoms of ketosis and had never heard of “induction flu”. I did Atkins about 10 years ago and don’t remember it being this rough! I’m now on day 8 of low-carb dieting, and as of yesterday started in with the lethargy, lack of concentration, irritability, body aches and headaches. This all hit the day after I biked 3 miles at the gym and ran 1 mile – must have been too much for my ketosis-ridden body to handle. Feel a bit better today, but my brain still doesn’t feel up to par. My boyfriend thought I was going crazy last night, because I could barely remember words, I was exhausted, and even put my car keys in the refrigerator. It didn’t dawn on me until today that this was probably due to the low carb induction! Can’t wait until the next few days pass and I go back to feeling like myself.

SweetMomma said...
This comment has been removed by the author.
Durham_lass said...

Thank you for your blog. I have just started low carbing and think Ihave low carb flu. Your post really helped and encouraged me.

I keep a record of what I eat on my new blog Linda's Bits & Bobs

Unknown said...

It has taken two days for me to come out of it and I am not really sure if I have come out of it or if I came out of Ketosis because I ate food that I didn't realize had carbs in it over the weekend. I lost six lbs last week then gained 3 back over the weekend. I lost more weight sitting down all week on the computer and I gained three of it back in two days. During those two days I was really active too. Do you think that maybe I gained muscle to replace the fat?

Stargazey said...

Hi, Kimberly! The weight loss on low-carb is different from other diets. It's not slow and gradual, but comes in a more-or-less stair-step pattern. And water weight plays a much bigger role. It's easy to gain or lose a few pounds overnight when you eat more or fewer carbs than usual. (When I was in the weight loss phase, I graphed my weight so that I could be sure that the general trend was downward and that daily fluctuations didn't confuse me.)

You might want to join a group like Low Carb Friends or Active Low-Carber, and they will be able to give you encouragement as well as answer practical questions. You will have lots of them as you begin your low-carb journey!

Unknown said...

Thank you so much for this! I vomited at the gym today (very embarrassing) and I didn't know what happened or why. I'm on day three of stating Atkins for the first time. This was the best explanation I could find of what happened today.

Unknown said...

I was doing so well on induction and losing weigh and already half an inch on my waist. Then Day 11 I succumbed to the cravings and dinner was pasta followed by chocolate - I just lost the plot! So in light of that: 1) What will happen to my weight loss on induction (I have gone straight back to induction today) and 2) Should I extend induction and 3) What bearings will this have to my Atkins as a whole? Thank you also for such a helpful helpful blog.

Stargazey said...

Hi, Tania! You did exactly the correct thing in going straight back to induction. Low-carb is a lifelong journey. We all stumble here and there, but the thing that makes the difference is being able to get right back with the program.

Induction is there to switch your metabolism to a different way of processing food. It takes a few weeks, but once you've made the switch, the enzymes will be there for you to digest and utilize food in a more healthy way than you ever could in your high carb days.

You can do induction for as long as you like, but once the switch is well established, you can gradually add in some healthy carbs. The trick is not to add too many or to add ones that trigger cravings. The specifics are different for everyone. I'd recommend reading or rereading Atkins' New Diet Revolution. He explains the process very well.

Lisa @ .Simply Me. said...

Thanks so much for this post, it makes me feel a lot better. I started low-carbing and I was fine on days 1, 2 and 3. On day 4 (yesterday), I felt very nauseous, dizzy, irritable and could not concentrate. Before reading this post, I was worried that I was doing something bad to my body. I am still feeling it on day 5, but hopefully it won't be as bad as yesterday.

Michele said...

Day 6 of my change to a keto lifestyle. Felt great for first 5 days (but was only dipping small to moderate ketones), but today I seem to have the Keto flu. No energy at all. Interested to dip my urine and see where I am today for ketones and if I am finally in ketosis.