Sunday, February 18, 2018

Type 2 Nutrition #420: BMIs for the “elderly”

BMI’s for the “elderly”? Note: “elderly” is in quotes here deliberately. If I sound a little riled, it’s because I am riled. This post will be a rant. But I am NOT going to dissect all the epidemiological studies that give guidance to the medical establishment with respect to the optimal BMI for the elderly (≥65). I will reference them only and instead deal with n = 1, the specific individual, in other words, “me,” and maybe “you” too. Read on!
First of all, we (in the U. S. anyway) know what a ridiculous chart the BMI table is anyway. It was created by the infamous Ancel Keys in 1972 and adopted by the World Health Organization (WHO) in the 80s. Our NIH and CDC bought into it 1998. Now virtually everyone (the “elderly” anyway) is measured for height and weight and assigned a BMI practically every time they visit the doctor. Medicare and now the entire U. S. health care establishment follows the WHO public health guidelines and will sanction your doctor if (s)he doesn’t record these statistics every time you visit. Put simply: Their reimbursement by the government will be reduced!
The BMI chart is ridiculous for many reasons, among them: it only measures your height and weight. You are assigned a BMI on that basis regardless of your gender, age, frame or body composition (muscle vs. fat). That number is then used as “guidance” to tell them whether you are “normal,” “overweight,” or “obese.”
The flaws of such an arbitrary chart are myriad and manifest. So, even though your BMI number is indelibly inscribed in your permanent medical record, your doctor presumably has the discretion to provide you with individualized guidance, albeit that guidance less certainly noted on your medical chart. To provide guidance, epidemiologists have studiously pored over millions of medical records for the “elderly” and have concluded that the elderly shouldn’t be normal weight (as the young should). The elderly SHOULD be overweight!
This is interesting to me because, in my dotage, I have finally found, if not the Fountain of Youth, the secret to losing weight and improving my general and diabetic health through a lifestyle change (the Very Low Carb Way of Eating with full-day fasting). Now, for the first time since I was a teenager, I have a chance to be “normal” weight, or at least be on the cusp (BMI≤25). And now I’m reading that I’m too old to be normal weight!  My goal, having a while back becomenot half the man I once was,” is soon to maintain my weight between 172 (BMI=24.7) and 175 pounds (BMI=25.1), and thus maintain an altogether 200 pound weight loss.
However, lumping me in with all the other “elderly” in these studies, the WHO/NIH/CDC  tell me that my BMI should be no less than 27.5 (192 pounds), smack dab in the middle of the “overweight” range for my height. I just worked damn hard to lose that last 20 pounds, and they’re telling me I should be 20 pounds FATTER! The reason, they say, is that epidemiologically speaking, my risk of death (“all cause mortality”) is much higher in the “normal” (BMI<25) weight range. They say that for me a BMI of 27.5 is “ideal,” epidemiologically speaking.
My take: This epidemiological data only looks at the death statistics of the entire “elderly” population. It does not take into account wellness vs. frailty, smoking status, activity level, or even “advanced” age. It includes everyone at or over the age of 65, including nursing home populations and many elderly who are still living independently, some of whom indubitably are in declining health. And that’s not me! I’m actually thriving!
Most in this population are also not eating a nutritious low-carb diet of real food and healthy saturated and monounsaturated fats. And they are NOT avoiding “wheat, excessive fructose and excessive linoleic acid” (n6s).
To all this I say, damn the epidemiologists and anyone else who relies on this crapola to provide guidance to the healthy “elderly.” I’m 76 and I’m going for a BMI between 24 and 25, to maintain my weight between 172 and 175 pounds. My new wardrobe cost too much to just hang in the closet. And trust me, there’s still plenty of fat on my body to carry me through a long illness and to make a cushion for my fat butt at the ballpark.

Sunday, February 11, 2018

Type 2 Nutrition #419: “Secret Cure” for Type 2 Diabetes

I was diagnosed a type 2 diabetic in 1986. For the first 16 years my diabetes was treated, according to the ADA’s Standards of Medical Practice, as a “progressive” disease. I ate, according to the Dietary Guidelines for Americans, a “balanced” diet and was encouraged to exercise regularly. My doctor monitored my blood sugar and prescribed oral medications in increasing doses. Eventually, I was “maxed out” on two classes of oral meds and had started a third. I knew that when I maxed out on it, I would “graduate” to injecting insulin. 
Then in 2002, in an effort to get me to lose weight, my doctor, largely by accident, discovered effectively a “cure” for my type 2 diabetes as a side benefit of losing weight easily and without hunger. In this post I will recount the stunning discovery of this “secret cure” and how this “treatment” has evolved over the years.
After reading Gary Taubes’s “What If It's All Been a Big Fat Lie,” my doctor suggested I try the diet Taubes described to lose weight. As I was leaving his office, my doctor said, “This might even help your diabetes.” It did. In the 1st week, to avoid hypos, I had to eliminate or decrease all the anti-diabetic meds I was taking. I eliminated one and decreased the other 2 by half, TWICE. The diet described was a Very Low Carb diet, just 20 grams of carbohydrates a day. I followed it strictly for 9 months and lost 60 pounds.
With that diet, I counted carbs. I created an Excel table, wrote down everything I ate, just estimating the carb content. Four years later, over the summer, I regained 12 pounds, so I began a different program. This time I raised my daily carb intake to 30 grams and also counted protein, fat and total calories, again recording everything I ate. In the next year I lost 100 pounds and, a little later, 20+ more. Then, after a while, I stopped counting. It was a lot of work and no longer necessary. By that time I knew what to eat and what NOT to eat.
Over the ensuing years I re-gained and re-lost some, using the same principles I learned in the beginning. That included Macronutrient Ratios for food ingested that were a part of the Very Low Carb eating patterns that I started on. The ratios varied somewhat but they were always “Ketogenic.” I settled on 5% carb, 20% protein and 75% fat, mostly saturated and monounsaturated.  On 1200kcal/day that’s 15g of carbs, 60g of protein and 100g of fat. On such a Very Low Carb, high-fat diet, hunger disappears. You don’t need to eat more because, with a low blood insulin level, your body has access to its own fat for energy balance. Thus, the weight loss. ;-)
A couple of years ago, while struggling to lose some “re-gain,” I gave up breakfast. I wasn’t hungry anyway. It had been 2 eggs/2 strips of bacon, then just 3 eggs, with coffee and heavy cream. I kept the coffee and cream. Later, I also gave up lunch. Eating VLC, I wasn’t hungry then either. Lunch had been a small tin of sardines in EVOO, or kippered herring in brine. But I stalled, even on One Meal a Day. My “diet” needed to evolve again.
About a year ago I began full-day fasting. It was suggested to me on Facebook by Megan Ramos, IDM Program Director at Jason Fung’s practice in Toronto. Originally on alternate days (Tue & Thu), it soon evolved to 2-day and then 3-consecutive day fasts. My fast is not a true water fast. It includes the coffee with cream taken with morning pills and a red wine spritzer (5oz red wine + 8oz seltzer) with evening pills. I lost 60+ pounds, and my A1c dropped from 5.8% to 5.1%. Occasionally I cheated a little (I’m not perfect), but my Metformin handled it.
Most recently I added an after-supper apple cider vinegar “cocktail” to the mix. I got the idea at a Keto Dudes Festival last summer. In my wine glass I add 1 Tb Bragg’s apple cider vinegar, a dash of bitters and a little liquid stevia. I then add ice cubes, swirl the mix and fill the glass with seltzer. My FBG this morning was 87mg/dl, and 16 years after starting Very Low Carb, I have maintained my “non-diabetic” A1c and a 180 pound weight loss.
Make no mistake about it: Type 2 Diabetes IS REVERSIBLE. To be clear though, while it is REVERSED, it is NOT CURED. It is IN REMISSION. But, by the ADA’s Standards of Medical Practice, there is no simple blood test (fasting or A1c), that can detect it. Your doctor, therefore, clinically speaking, will consider you “cured.”

Sunday, February 4, 2018

Type 2 Nutrition #418: “The dose makes the poison”

The surprising popularity of “Triglycerides and Alcohol Consumption,” written obliquely several years ago for the benefit of my brother, gave me pause to contemplate how many others out there were interested in the subject. Unbelievably it was the #4 all-time favorite in the Readership Statistics list of “10 Most Popular” posts. Coincidentally, but in a completely different context, I read in another blog recently that, “The dose makes the poison.” This syzygy, a conjunction reflective of last year’s solar eclipse, thus provided a topic to write about.
Alcohol consumption, perhaps to excess, runs in my family. My father was probably, and my mother possibly, alcoholic. I have a drink almost every day. Some define alcoholism as the habit of drinking alcohol every day.
Since I began a 3-consecutive-day, modified fasting routine about a year ago, drinking a glass of wine has been part of my “fast” day routine. On “My Modified Fasting Plan,” on fasting days I make “supper” one red wine spritzer (5oz of red wine with 8 ounces of club soda), to take my evening pills. On non-fasting days, I double the dose. This “allowance” for alcohol is pleasing to me and, I know, to others who enjoy a drink (or two).
Unless we have company who also enjoy a drink before dinner, at home I don’t drink ethyl alcohol (“spirits”). And these days, as we get older, “company” happens less and less. In a restaurant, which we do about once a week, I usually have a cocktail or two, depending on the bartender. A few make them as strong as I do at home. Most do not, in which case I have two. Just once, at lunch with my editor and her husband in Nashville, I actually ordered three. I swear they were watered down…which is how I get to “the dose makes the poison.”
Paracelus, (1493-1541), a Swiss scientist and son of a doctor, is credited with this adage “intended to indicate a basic principle of toxicology” (Wikipedia).  He is generally credited as the “father of toxicology.” He told doctors to “study nature and develop personal experience through experiment” and thus to “emphasize the value of observation in combination with received wisdom.” This leads in turn to the concept of Hormesis.
More Wikipedia: “Hormesis is any process in an… organism [like you and me] that exhibits a biphasic response to exposure to increasing amounts of a substance or condition.” The “biphasic” conditions are “stimulation” and “inhibition.” Wiki continues, “The hermetic zone [is] generally a favorable biological response to low exposure to toxins and others stressors.” [I generally have a “favorable biological response” to one or even two glasses of wine or a “well-made” drink.[ “A pollution or toxin showing Hormesis thus has the opposite effect in small doses as in large doses.” This effect has been shown with stressors like fasting and exercise.
I wrote about “Calorie Restriction and Longevity” and “Calorie Restrition in Humans” years ago. W/r/t exercise, Wiki states, “Individuals with low levels of physical activity are at risk for high levels of oxidative stress, as are individuals engaged in highly intensive exercise programs; however, individuals engaged in moderately intensive, regular exercise experience lower levels of oxidative stress. High levels of oxidative stress have been linked by some with an increased incidence of a variety of diseases.” (all my emphases).
“Alcohol is believed to be hermetic in preventing heart disease and stroke, although the benefits of light drinking may have been exaggerated,” Wiki avers. But, “in 2012, researchers at UCLA found that tiny amounts… of ethanol doubled the lifespan of Caenorhabditis elegans, a round worm frequently used in biological studies.” At least all of our taxpayer money isn’t being wasted on useless scientific research!!!
 Wiki admits, though, “The biochemical mechanisms by which Hormesis works are not well understood.” And they conclude, “Hormesis remains largely unknown to the public.” But Paracelus has shown me how to manage the “stimulation” part: “study [your] nature and develop personal experience through experiment.” My personal interpretation: At home, be disciplined and adhere strictly to protocol. With guests, cater to their wishes. In a restaurant, choose your bartender carefully, and remember always, “The dose makes the poison.”

Sunday, January 28, 2018

Type 2 Nutrition #417: The NEXT 25 Most Popular Posts

Last week, in "Readership Statistics" (just scroll down), I listed the 10 most popular posts I’ve written since I started this blog in 2010. Since most of them were viewed as a result of a search engine query, the result is biased in favor of low-numbered posts. I was disappointed, therefore, that some of my personal favorites were not included.
In an effort to correct the low-number bias and include some of my own favorites, I decided this week to offer you the NEXT 25 most popular. It turns out, however, having now done the search, that most of the next 25 are also low-numbered. Maybe my recent subject matter is of lower-interest. Who knows? Let me know.
The NEXT 25 Most Popular Posts
1 #68 Triglycerides, Fish Oil and Sardines Compelling N=1 evidence; also #281, #282 and #283 to raise HDL-C.
2 #100 Liquid Calories A few good points about digestion, then the Harvard Public Health recommendations.
3 #19 The Archevore Way of Eating, and #18: From Kurt G. Harris: limit wheat, excess fructose and Omega 6s.
4 #32 Artificial Sweeteners Useful, but I and those “in the know” use pure stevia, either powdered or liquid.
5 #25 Understanding Your Lipid Panel Solid, easy to understand basics re: cholesterol; a must read!
6 #64 Very Low Carb Eating, 10 Years Later Good, big picture data; also see #387 for “15 years on VLC.”
7 #35 The Diet Doctor and the LCHF Diet 6 years old but still good. Andreas Eenfeldt is the majordomo of LCHF.
8 #72 How to Fix Your Cholesterol Good basics on the lipid panel & Friedewald formula; see also #25 above.
9 #99 Natural History of Type 2 Diabetes Ralph DeFronzo’s description of the evolution/progression of T2DM.
10 #94 Eating Clean About the manifesto of Singaporeans who subscribe to a “clean” lifestyle, and read me.
11 #194 Live Fermented Foods Just a primer, but informative. See also my reply to an old follower’s comment.
12 #54 Loren Cordain, Robb Wolf, and Kurt Harris A couple of book reviews, and another paean to Dr. Harris.
13 #160 Letterman to Hanks: "...through diet, mostly" An example of how the media usually gets it wrong.
14 #30 Is Fructose Toxic to the Liver? With #29, covers the story; lots of stuff from Lustig’s “The Bitter Truth.”
15 #55 The Beleaguered Gary Taubes A defense of the “Insulin Hypothesis” by the “prime mover” of VLC.
16 #140 Peanuts, my nemesis Mostly relies on the Jaminets’ “Perfect Health Diet.” Note: I am still addicted.
17 #126 Do you live to eat or eat to live? Transitioning is difficult and ongoing, but possible. I am progressing.
18 #59  What I Eat and Why: The VLCKD The title says it all: Why I eat a Very Low Carb Ketogenic Diet (VLCKD)
19 #89 Reversal of Type 2 Diabetes, Revisited This is a sequel to my #1 most popular post #88. See also #380.
20 #33 Omental Adiposity Good basic information, especially for men with beer bellies, who look pregnant!
21 #83 The 8-hour Diet I don’t recommend this huckster’s “diet,” although Intermittent Fasting (IF) is good.
22 #9 Metabolic Syndrome A seminal post, 8 years old, and only 32nd most read. See also #334 and #335.
23 #122 Macronutrient Ratios and Calorie Restriction Loaded with specifics and a good, clear message.
24 #158 Demolishing the Saturated Fat Bogeyman An authoritative review from the British Medical Journal.
25 #152 Set Point Theory This column is much more than Set Point theory. It is loaded with goodies!
I’ve published 223 columns since the highest numbered one on this list! Not one is among my Top 35. Further study of “search engine optimization” will be required to learn why. I need to get more readers for some of what I’ve written in the last few years! There’re lots of good “poop” out there that’s going on a fallow field.

Sunday, January 21, 2018

Type 2 Nutrition #416: Readership Statistics

As I have recently passed 300,000 page views on this blog, it occurred to my editor that my readers might be interested in who besides you reads it. So, using the bare analytics on the Blogger platform, I assembled a few statistics.
Only 41% of my viewers are from the United States. About as many come from the next 9 countries combined, in page view order: Ukraine, Israel, France, Russia, China, United Kingdom, Canada, Poland and Germany. The remaining +/-20% are from dozens of other countries, principally among them India, Australia and Singapore!
Ukraine is 2nd and figures prominently probably because someone there is “stealing” my intellectual property and regularly “hosting” a link to my columns in a health or nutrition-related newsletter. That’s fine with me. I do this for educational purposes, not financial ones. I offer no advertising, so I do not forego “income by hit.”
Israel comes in 3rd because someone there is reading my blog regularly and once in a while provides a link to their readership. And then, wow, 2,500 ‘hits’ in an hour. Same thing happened in Singapore a few years back.
I’ve been publishing this blog for 7 years, most of that time once a week. For a couple of years I posted twice a week and then burned out and took an 8 month break. My average monthly viewership for the last 4 years, including the 8-month hiatus, is over 5,300, or about 180 per day, with a wide monthly range: 9,781 to 2,404. Allowing for the decline during the period when I was not writing, that comes out to about 6k/mo. or 200/day.
Most viewers find this blog through a Google search and are not regular readers. They search by subject using “keywords.”  According to the Blogger analytics, 6 of 10 keywords were searched using an “88 search engine.” In the early years, many page views resulted from my shameless self-promotion, providing a link on sites like Livin la Vida Low Carb(Jimmy Moore), Authority Nutrition, and Canadian low-carb blogger Dr. Jay Wortman.
The 10 most popular posts (incorporating the 88 search engine) since I began writing this blog are as follows:
#88 “Reversal of Type 2 Diabetes” Made #1 by the coincidence of very high interest subject matter and #88.
#31   Carbohydrates and Sugars A decent primer, drawn mostly from the Wikipedia entry on the subject. 
#101 Why I'm Never Hungry A touchstone subject and one that I return to often.
#197 Triglycerides and Alcohol Consumption  A surprising hit; a lot of bibulous tipplers out there, I guess.
#108 "You're eating too much dairy."  This one is a compendium of excerpts from a few experts on the subject.
#38 "The Perfect Health Diet" A book review but, aside from that, probably searched for the subject matter.
#21 The Dangers of Polyunsaturated Fats An important and under-addressed subject. I’m delighted it’s a hit.
#281 HDL-C and Triglycerides With 282 & 283 a series on the transformation of my own HDL and TGLs on Very Low Carb.
#103 Your Mileage May Vary (YMMV) Everyone thinks they are a special case, so they want to believe this.
#61 Stefansson and the Eskimo Diet  Another surprise, popular because of the early link on Dr. Wortman’s site.
In my opinion, many of these top 10 are not my best efforts, but they do show what the reader is searching  for. As such they offer an insight for me to ponder as I contemplate what to write about next. I note, however, the list is heavily biased toward the low numbered posts, reflecting the time that those posts have been “out there” in the blogosphere and available to search engines. As such, many newer ones will eventually catch up.
Many of my personal favs did not make the Top 10 list. Some are among “The NEXT 25 most popular,” to be published next week as “Type 2 Nutrition #417.” If you’re interested, I hope you’ll look for it then. Other favs have hardly been read at all. To find those, you’ll just have to read all 400+ at .

Sunday, January 14, 2018

Type 2 Nutrition #415: Hypoglycemia? I’ve had it only three times

I recently read a scary piece by Beverly Hills endo, Professor of Medicine, and Endocrine Society spokesperson, Anne L. Peters, MD. Title: “Seizures, Vomiting, Fear of Dying: The Threat of Hypoglycemia.” Subtitle: “Patients with Diabetes Explain How They Experience Hypoglycemia.” There’s also a short video here at
Peters wrote, “As a physician, I'm judged on how my patients do with their A1c targets. I always want people to be at less than 7% so that they do not get horrible complications. But day in and day out, patients have to live with the overarching concern of being too low. That can happen anytime, day or night. A patient can go too low if they misjudge insulin by maybe a unit or two, eat too little, or exercise too much” (my emphases).
Those three things will surely do it. But saying, “Eat too little” is disingenuous. She means, “Eat too few carbohydrates,” thus inadvertently not RAISING your blood sugar. Equally, by wanting her patient’s A1c’s to be less than 7%, but not “too low,” she implies it is okay to be in a perpetual disease state (#397), according to the ADA’s “Standards of Medical Care.” A clinical diagnosis of type 2 diabetes requires an A1c ≥6.5%.
This approach to medical care, and NOT INCIDENTALLY medical practice liability, is deemed preferable to the patient being at risk of a blood sugar too low, i.e., at risk of “seizures, vomiting and…dying.” One commenter wrote, “My A1c is always around 6.7- 6.9%, and this is fine with me and my doctor.  I hate hypoglycemia!” I think most doctors would agree. They are, after all, ALL judged on how [their] patients do with their A1c targets, and the “Standards of Medical Care” call for it, too liberally, IMHO, to be just at or less than 7%.  
The message to patients is thus: If I die tomorrow from a low blood sugar, who cares what my A1c is?”
This concern, according to Dr. Peters, is “a real part of the experience” her patients have of “living with diabetes.”  For her part, “A real part of the experience of [her] giving insulin is the fear of hypoglycemia.” Do you see the corollary? “Living with diabetes” and “giving insulin”? One just follows the other, naturally.
Because of the advice you have received, you are in a perpetual disease state, and your type 2 diabetes will PROGRESS to where your doctor will be “giving (you) insulin.” You too WILL become an insulin-dependent type 2 at greater risk of “seizures, vomiting and…dying” and all the micro and macro vascular complications of type 2 diabetes. It will probably also be your cause of death, approximately 8 years earlier than your peers…. But, it doesn’t have to be this way. You can take responsibility for managing your own health
You started reading this post because I told you I have only experienced hypoglycemia three times in my life. All three were in the same week 15 years ago, when I began cold-turkey to eat Very Low Carb on the advice of my doctor. Two months earlier he had read a New York Times Sunday Magazine cover story by Gary Taubes, “What If It's All Been a Big Fat Lie.” My doctor tried the diet that Taubes described and lost 17 pounds. He then suggested I try it too, to lose weight. I’ve been eating a Very Low Carb diet ever since.
At the time I weighed 375 pounds and was eating a “balanced” diet including beaucoup carbs. I was on 3 types of oral anti-diabetic meds and 3 types of blood pressure meds. My fasting blood glucose was still out of control, and my blood pressure was border line. I was soon to become an insulin-dependent type 2.
My first episode of hypoglycemia occurred late on my first day on the new diet. I ate a candy bar and called my doctor. He told me to stop taking the 3rd class of diabetes drug he had recently prescribed. The next day I had another hypo. This time he said cut the dose of the other two drugs in half. But on the 3rd day I had yet another hypo, so he told me to cut the dose in half again! In all the years since then I have never had another hypo. I later dropped the SU (glyburide) altogether and continued with 500mg of Metformin for a decade. Last year I raised my Met to a “therapeutic” dose and, now with fasting, occasionally have FBGs in the 60s, without hypoglycemia. In the ensuing years, I’ve lost 185 pounds (“Not half the man I once was), and my most recent A1c was 5.1%.

Sunday, January 7, 2018

Type 2 Nutrition #414: To LOSE weight, do NOT eat a Ketogenic Diet

Do NOT eat a Ketogenic Diet to lose weight! If you’re “normal” weight, or you have intractable epilepsy and will benefit from a very high dietary fat diet, then okay.  Eat a high fat diet. But if you are overweight and want to burn body fat, you first need to get in a hormonal state conducive to fat burning – by eating Low Carb (LC). Or, if you have Insulin Resistance, eating Very Low Carb (VLC); then, while eating LC or VLC, and “enough” protein, you need to be careful not to over EAT fat because, you want to burn BODY fat.
A Ketogenic Diet, as defined here and elsewhere, is very high in dietary fat. Whatever else it is, the fat in the Ketogenic Diet is thus taken by mouth. But at the cellular level, the body doesn’t care where the fat comes from, and it has to do something with the fat you eat. So, while you’re hormonally in a “fat-burner” state, as your body digests the fat you eat, it’s going to burn what it needs and store what it doesn’t. And if it doesn’t need to burn your body fat, it keeps it in reserve, as it was intended to be. You have defeated your purpose.
So what does this do to the macronutrient ratios I have talked about for years? It doesn’t change the ratios. It just changes where they are sourced. Your biology hasn’t changed, just the way you (or I) pictured it. It’s a little harder to calculate, but the physiology is the same. The difference is that the macronutrient ratios are not measured where it is “taken by mouth” but where your body takes it up for energy – at the cellular level.
Most nutrients from food you eat are absorbed at the small intestine. From there they circulate in the blood or are held in the liver until needed. There are some exceptions: iodine is stored in breast tissue, lutein is stored in the macula of the eye, for example. When you eat VLC, and your hormonal state has transitioned from sugar-burner (glucose-based) to fat-burner, your body will first process all the foods you ate and then, to maintain energy balance (homeostasis), it will break down body fat (triglycerides) into fatty acids for fuel. Fatty acids will then circulate and mix with the other fuels in the blood until taken up wherever needed. It can do this, remember, only so long as you eat LC or VLC and remain in the fat-burner (vs. sugar-burner) state.
Your metabolism will NOT slow down and you will NOT excrete vitamins and minerals before they can be stored. Your metabolism will continue to run at full speed because you are not being “starved” by the absence of “food.” Your body has supplied the “food” it needed from the energy reserves it had stored.
So, in practical terms, what does this do to the macronutrient ratios, as traditionally applied to food ingested (taken by mouth)? The ratios don’t change. The carbs are exactly the same. The protein is exactly the same. Total fat is the same too, only it is divided between eaten fat and stored fat. And YOU will determine the fat ratio by how much fat you eat. To keep in energy balance, the remainder will be body fat that you burn.
Let’s do an example: A certain, mostly sedentary man (me) needs say 2,400kcal/day to maintain his “normal” weight. But, he’s overweight and wants to burn body fat, so he eats a diet with macronutrient ratios that gets his body in a hormonal state conducive to fat burning: 5% carbs. 20% protein and 75% fat. That’s 30 carb grams, 120 protein grams and 200 fat grams a day. If he eats this Ketogenic Diet (k/g ratio: 2.0), he will not be hungry. He will be fat-adapted and in ketosis, but he won’t lose weight. He’s EATING way too much fat.
Now, envision this same man eating the same 30 carb grams and the same 120 protein grams and but just 100 grams of fat. His “diet,” i.e. what he has taken in by mouth, is now 1,500kcal/day, but because he is still eating Very Low Carb, he is still in a hormonal state conducive to fat-burning, and his body will have to break down 100 grams of body fat a day to maintain the 2,400kcal his body requires for energy balance. His metabolism runs full speed, he is not hungry, and he loses weight. His macronutrient ratios (by mouth) are now 8% carb, 32% protein and 60% fat (k/g ratio just 1.4), but it doesn’t matter. At the cellular level – where the energy is used – they are unchanged. Both are Very Low Carb. He is still fat adapted but, at K:G=1.4, he is not ketogenic.