Next question sent in from Jessica. “You mentioned that keto is not a great idea for those with HPA axis dysfunction. Is there data to suggest keto contributes to elevated cortisol or cortisol resistance? For those who may not lose weight on keto, is this most likely due to HPA-D?”
Chris: No, it’s I don’t think it’s necessarily related directly to cortisol levels. It may be the case; I’ve never seen any data on that. I think the best way to think about it and to explain it to your patients is that the ketogenic diet can be a stressor, and you know now from this unit, if you didn’t already before, that a lot of things are beneficial through stress. Exercise is a hermetic stressor—it causes you stress if it’s done properly. If you don’t ever train, it causes a positive adaptation, and that’s true for fasting, and I think also true to some extent for keto.
And so, if the background level of stress is low or maybe even moderate and manageable and the patient’s getting enough sleep, they’re managing their stress, then adding additional stress with things like fasting, cold plunges, or strenuous exercise can be beneficial. But if the background level of stress is already very high and/or the resilience to metabolic reserve is already very low, then adding something that could be a hermetic stressor in a different situation actually just becomes a negative stressor in that situation.
We don’t need to make any hard and fast rules here. For some people with HPA-D, keto could be actually be helpful, but you just need to monitor it very closely and be aware that even if they have an initial positive response, that in three weeks, they may not be having the same response. I’ve seen this time and time and time again with my patients where they start out, they’ll feel great. Three weeks later they start feeling worse, but they don’t attribute it to keto because when they first started, they felt great. And so, they don’t actually make the connection that it’s keto that doing that.
We just always have to remember that things that have a short-term positive effect don’t always have a long-term positive effect.