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I don’t know about you, but I find these risks pretty damn concerning. The fact is that I want to be around to play with my grandkids, and considering that my genetic testing with 23andMe has revealed that I have a higher-than-normal risk for type 2 diabetes, I doubt that shoving more gooey gels and sugary sports drinks into my pie hole is going to do my health any favors. So if I can achieve similar levels of performance and body composition with carbohydrate restriction, I’m all in.

This article is excellent and I’ve actually read it a few times just to make sure I’m absorbing as much as possible. With that said can we talk a bit about protein? Why does it seem like protein is taking a back seat? What about the athlete who needs to maintain and/or increase muscle mass. I don’t want to make any assumptions and with all the research I’ve done along with personal testing into Keto it just seems to me that protein and its benefits are not a discussion point in this diet. Why?
BHB is the primary ketone your body can most efficiently use as fuel during exercise and at rest (especially when you’re keto-adapted), it is the most stable of the ketones, and it is actually found in nature in many foods including eggs and milk. A “BHB salt” is simply a compound that consists of sodium (Na+), potassium (K+), and the ketone body beta-hydroxybutyrate.
Yes, the carb backloading approach can definitely help. Honestly I have SO MANY ARTICLES here on the site about sleep. Just go ahead and use the search bar for sleep and you'll find a plethora of info. For targeted sleep advice, I'd be happy to help you via a personal one-on-one consult. Just go to https://bengreenfieldfitness.com/coaching. and then choose a 20 or 60 minute consult, whichever you'd prefer. I can schedule ASAP after you get that.
Lots of apps and websites offer keto diet challenges—basically, a blueprint for the keto diet with a fixed starting and ending point (they typically last for a week to a month, though some may be longer). Speaking of apps, plenty of keto-centric ones are right at your fingertips (a.k.a., your smartphone), like the KetoDiet app, which can help you calculate your macros and track your keto diet effectively.
Since the body’s acid-base buffering system cannot neutralize the vast amount of acidic ketones, the blood pH drops significantly. This buildup of acids in the blood poisons the body and can lead to ketoacidosis.12 Breathing becomes deep and rapid as the body attempts to compensate for excessive acids. Other symptoms of diabetic ketoacidosis include:
Long-term disruption of menstruation can bring on serious side effects, including low bone density. “This is because estrogen is very important to bone health,” says Yawitz. “Studies have also found prolonged menstrual irregularity to increase risk for cardiovascular disease, depression, anxiety, and sexual dysfunction. It’s important to contact your ob-gyn if your cycles become irregular or if you stop having periods.”
A lot of changes are happening in your body and you’re going to feel it! The first five to seven days can be pretty rough, but your body is getting over its dependency on sugar. During this time of transition it is essential that you supplement electrolytes. Your body is flushing out lots of water, and with that goes electrolytes. The Keto Flu can be greatly reduced if you add sodium, potassium and magnesium to your diet. Check out our supplements page for a list of electrolyte supplements we recommend. Stay on course and you’ll start feeling better in no time!
Thank you for this article as it cleared up a bunch of stuff for me. I started trying to get into ketosis back in August and lost 20lbs in about 6 weeks. Then it all stopped but had another 20lbs I wanted to loose. I had a hard time staying in ketosis and gave up about a week ago with the holidays approaching. Anyways I glazed over all the technical and science facts as it makes my head spin and might of missed it but my only question is what is the food portion of the diet like? The drinks are the easy part, do you have a diet plan that is good for someone that hits the gym hard 4-5 days a week for and hour and half. 45 min weights and 30-45 min cardio? It’s what I struggle with most the food and what attracted me to a ketogenic diet in the first place is eating 1 or 2 meals a day and being satisfied.
As I learned in a University of Connecticut lab experiment I mentioned earlier in this article (gory details here), a high-fat, low-carb diet can teach and allow the muscles to tap into more fat for fuel, making your body crave less use of oxygen in the large muscles of the legs, arms or other areas that you’ve learned oxygen gets shunted away from when deep underwater.
Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]
So if your high-fat diet includes a high amount of roasted seeds or roasted nuts, nut butters, heated oils such as heated coconut oil or heated extra virgin olive oil, barbecued meats or meats cooked at very high temperatures, then your triglyceride count is going to go up. You should have triglycerides that are less than 150mg/dL, and a triglyceride to HDL ratio that is no more than 4:1, and in most of the healthiest people I’ve worked with, triglycerides are under 100 and the triglyceride to HDL ratio is less than 2:1. If your ratio is whacked, your ketotic diet isn’t doing you any favors.
I'd recommend starting with glucose and hemoglobin A1C, along with a good multi like https://bengreenfieldfitness.com/multi and a fish oil like the one at greenfieldfitnesssystems.com – Anyways, I'd be happy to help you via a personal one-on-one consult. Just go to https://bengreenfieldfitness.com/coaching. and then choose a 20 or 60 minute consult, whichever you'd prefer. I can schedule ASAP after you get that.
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10]
Weight loss benefits ushered the keto diet into the spotlight. That’s how most people have likely heard about ketones, a fuel source created naturally by the body when burning fat. But more and more research points to diverse applications of ketones in the blood outside of just fat loss, from improved endurance performance to the treatment of medical conditions like epilepsy.
Similar to the BHB salts and MCT’s from the KETO//OS I discuss above, powdered forms of ketones are excellent if you don’t want to completely eliminate carbohydrates or protein (which can be gluconeogenic when eaten in excess) or eat copious amounts of fats, but want to simultaneously maintain high levels of blood ketones. It may also be used to ease the transition into a ketogenic state, because it can help alleviate the fatigue and lethargy some  people experience while making the transition from a glucose metabolism (carb burning mode) to ketone metabolism (fat burning mode).
In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[54]
the abnormal accumulation of ketones in the body as a result of excessive breakdown of fats caused by a deficiency or inadequate use of carbohydrates. Fatty acids are metabolized instead, and the end products, ketones, begin to accumulate. This condition is seen in starvation, occasionally in pregnancy if the intake of protein and carbohydrates is inadequate, and most frequently in diabetes mellitus. It is characterized by ketonuria, loss of potassium in the urine, and a fruity odor of acetone on the breath. Untreated, ketosis may progress to ketoacidosis, coma, and death. See also diabetes mellitus, ketoacidosis, starvation. ketotic, adj.
If I see a TSH above 2.0 or a trend towards higher values in someone who is testing repeatedly, I get worried – and prefer to see TSH at 0.5-2.0. Of course, this doesn’t mean that you begin to shove carbohydrates indiscriminately down the hatch. However, it means that your high-fat, low-carb diet should include thyroid supporting foods rich in iodine and selenium, such as sea vegetables and brazil nuts, and should also include carbohydrates timed properly, such as before, during or after workouts, when the carbohydrate is more likely to be utilized for energy and less likely to spike blood glucose levels.
In addition to adding in precious electrolytes such as potassium, magnesium, sodium, chloride, and calcium for supporting nerve impulses and muscle contraction, the Gaspari Nutrition R&D Team have also build their Osm Technology into this product. This “new way” of looking at carbohydrate drinks utilizes a proprietary method of tuning the electrolytes in solution with pure cyclic dextrin to get an optimal osmolality (mOsm). In a nutshell, this results in lower osmolality, and lower osmolality results in faster gastric clearance, and a clean, easy burn of your fuel.
A small Feb. 20, 2017, study looked at the impact of a six-week ketogenic diet on physical fitness and body composition in 42 healthy adults. The study, published in the journal Nutrition & Metabolism, found a mildly negative impact on physical performance in terms of endurance capacity, peak power and faster exhaustion. Overall, researchers concluded, “Our findings lead us to assume that a [ketogenic diet] does not impact physical fitness in a clinically relevant manner that would impair activities of daily living and aerobic training.” The “significant” weight loss of about 4.4 pounds, on average, did not affect muscle mass or function.

^ Hochachka PW, Storey KB (February 1975). "Metabolic consequences of diving in animals and man". Science. 187 (4177): 613–21. Bibcode:1975Sci...187..613H. doi:10.1126/science.163485. PMID 163485. In the terminal stages of prolonged diving, however, even these organs must tolerate anoxia for surprisingly long times, and they typically store unusually large amounts of glycogen for this purpose.
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