" "

Ben, great article! I recently did my own ketosis experiment and didn’t catch the 100-200g advise until later than I should have, I’m guessing. Great results for 1-2 months but after 3 months I quit sleeping through the night and would wake after about 4 hours of rest each night. My guess is that the extra carbs at night coupled with iodine supplements should allow me to “have my cake and eat it too?” Any other suggestions on the sleep issue? I’ve gone back to High Fat/Low Carb, have improved sleep but I do miss nutritional ketosis and want to try again once my sleep is stable. Thank YOU!!!
The difference between ketosis and ketoacidosis is the level of ketones in the blood. Ketosis is a physiological adaptation to a low carbohydrate environment like fasting or a ketogenic diet. There are situations (such as treatment-resistant epilepsy) where ketosis can be beneficial to health. Ketoacidosis is an acute life-threatening state requiring prompt medical intervention; its most common form is diabetic ketoacidosis where both glucose and ketone levels are significantly elevated.

I see a lot of people say that ketosis is great for insulin sensitivity. BUT, in my experience ketosis causes physiological insulin resistance whereby the muscles and liver are sparing glucose for the brain. Hence, glucose tolerance actually goes down during ketosis. As such, is it possible that post workout carbs could do a lot more damage than they would on a non-ketogenic diet? Or maybe, as Kiefer suggests, glucose uptake post workout is not moderated by insulin at all i.e. muscles soak up glucose regardless of their insulin sensitivity? Or maybe cyclical ketosis doesn’t allow liver glycogen to get low enough to trigger physiological insulin resistance?

A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]


Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
For someone more interested in health/muscle gain rather than weight loss, should I up the protein and good carb levels a bit? I’m around 10% BF and weigh 220, so I require a higher calorie intake the average. In just a few days striving for a Keto-diet, I’m averaging between 50-60g gross carbs (30g net), 160g protein and 220 fat (8%-22%-70%) DO you think that is a good target or should I try and adjust?

No-sugar diet plan: What you need to know Eliminating sugar from the diet can help prevent weight gain, diabetes, heart disease, and other problems. Whether cutting sugar out of the diet completely or simply cutting back, we have eight important tips for following a no-sugar diet, and some advice about fruits and other natural foods that contain sugar. Read now
3 years ago I was 500 pounds at my absolute worst. Went through a traumatic experience when I was 17 and afterwards the weight just seemed to add on over the years. I'd always been a big guy but it got really bad. Decided to start the keto diet after looking into healthier lifestyles and fast forward two years later (with intermittent fasting and gym training) I had lost 260 pounds. I kept under 1200 calories a day and the best feeling was not constantly being hungry. The last year has been more of a maintenance but with keto cycling.

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When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]
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:
A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[20] and followed-up by a report published in 2001.[21] As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.[21][22]
And here’s the reality of the situation. Not all carbs are created equal. There’s a lot of cleverly labeled and modified maltodextrin on the market claiming to be some technical polysaccharide. Or, there’s plain old cornstarch relabeled as super-duper muscle engorging waxy maize. Most of these aren’t proven to do anything except deliver false hopes, high blood sugar, and gut issues – as opposed to having multiple clinical studies in real athletes to support what it is they’re claiming.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
I started a ketogenic diet about 5 weeks ago and have experimented with KetoCaNa and KetoForce along with Now Foods MCT oil (which is made of caprylic and capric acid) in the hopes of easing the transition into ketosis. I don’t use it every day, but often before an aerobic based workout. I was wondering if taking these exogenous ketones at the beginning of a ketogenic diet helps you become keto adapted by up regulating the body’s handling of ketones. And conversely, does taking exogenous ketones down regulate or affect lypolysis since BHB is readily available? My main priority at this point is fat loss.
What are the ideal levels of blood sugar? A blood sugar or blood glucose chart identifies ideal levels throughout the day, especially before and after meals. The charts allow doctors to set targets and monitor diabetes treatment, and they help people with diabetes to self-assess. Learn more about guidelines, interpreting results, and monitoring levels here. Read now
The concentration of ketone bodies may vary depending on diet, exercise, degree of metabolic adaptation and genetic factors. Ketosis can be induced when a ketogenic diet is followed for more than 3 days.[34] This induced ketosis is sometimes called nutritional ketosis.[35] This table shows the concentrations typically seen under different conditions[1]
A study in the Journal of Applied Physiology showed that people who do twice-a-day workouts, but defy standard nutrition recommendations by not eating for two hours after the first session (thus depleting carbohydrate stores with the first session) experienced a better ability to burn fat (with no loss in performance) compared with a group that trained only once a day and ate carbohydrates afterward.
^ Ringberg TM, White RG, Holleman DF, Luick JR (1981). "Body growth and carcass composition of lean reindeer (Rangifer tarandus tarandusL.) from birth to sexual maturity" (PDF). Canadian Journal of Zoology. 59 (6): 1040–1044. doi:10.1139/z81-145. ISSN 0008-4301. Body growth and carcass composition were measured in lean reindeer during the juvenile growth period between birth and 3 years of age. Mean carcass weight in these lean reindeer was 56 ± 4% of body weight and the deposition of body muscle and bone mass was linearly correlated with body weight after the 1st month of age. The weight of the brain relative to body weight and carcass weight declined, while the relative changes in heart, liver, kidneys, parotid glands, and tissues of the gastrointestinal tract were small after the neonatal period. The extractable fat content in carcasses increased from 4.4 to 11.4% of wet weight or approximately 100 g fat at birth and 3.5 kg fat in adult reindeer. Fat-free dry matter represented a constant percentage (18–20%) of wet carcass weight independent of body weight after the neonatal period, while a significant inverse relationship between carcass fat and body water was found.
In dairy cattle, ketosis is a common ailment that usually occurs during the first weeks after giving birth to a calf. Ketosis is in these cases sometimes referred to as acetonemia. A study from 2011 revealed that whether ketosis is developed or not depends on the lipids a cow uses to create butterfat. Animals prone to ketosis mobilize fatty acids from adipose tissue, while robust animals create fatty acids from blood phosphatidylcholine (lecithin). Healthy animals can be recognized by high levels of milk glycerophosphocholine and low levels of milk phosphocholine.[76] Point of care diagnostic tests are available and are reasonably useful.[77]
Intermittent fasting is another way to achieve ketosis. This doesn’t suggest going days without food, but rather intermittent fasting. You can eat for eight hours and then fast for 16 hours, or eat a low-calorie diet for a few days (about 1,200 daily calories if you’re a woman and 1,500 daily calories if you’re a man). As you take in less food, your body uses more of its fat stores for fuel.
This article really bothers me in that if you do a few incorrect things with this diet, it will actually do more harm than a full carb diet. I have been in ketosis for a month or so but to what detriment? Based on the “ketosis darkside” list you highlighted, i could be doing any or all of these without realising. Could i share with you my meal plans and see if in your opinion they are beneficial and healthy or if im digging myself an early grave?
Would highly recommend listening to Tim Noakes and his trail in Cape Town – he was pretty much the trigger for me to switch to LCHF and now I am starting to educate myself on what I need to follow a path that works for me. The information on Verta is giving me more information to enable me to ask my Dr for what I want – I know this will be an uphill battle and this information will help me avoid getting railroaded into the so called norms. It also give the Dr a way out because then I am asking him to help me go down a certain path that he is not responsible for recommending if it bucks the system.
It seems like everyone is talking about the keto diet — the high-fat, low-carb eating plan that promises to turn your body into a fat-burning machine. For that reason, keto has surged in popularity over the past year as a lose-weight-fast strategy. Thank Hollywood A-listers and professional athletes like Halle Berry, Adriana Lima, and Tim Tebow who’ve publicly touted the diet’s benefits, from shedding weight to slowing down aging. Here’s everything you need to know about going keto.
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A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]
Physical or mental fatigue during workouts (or while you’re sitting at your office) is caused by the low blood glucose that occurs as your carbohydrate fuel tank approaches empty (also known as the infamous “bonk”, which is awesomely demonstrated in this funniest running cartoon I’ve ever seen). Because it is generally (and sadly) accepted as orthodox knowledge that the human body can’t burn fat as a reliable fuel source – especially when you’re exercising for long periods of time or at high intensities – nearly every shred of nutrition science is simply looking for ways to somehow increase the size of your carbohydrate fuel tank and hack the body to allow it to store more carbs or absorb carbs more quickly.
Keto-adaption is a complex set of metabolic processes in which the body shifts from using primarily glucose for energy to using largely ketones and fat for energy. Achieving ketosis doesn’t mean the body is maximizing the use of these ketones; it takes longer than a few days for the body to get used to burning fat and ketones as its predominant fuels.

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.

The diet is extremely regimented and very difficult to stick to, as just one baked potato and one slice of bread could hold an entire day’s worth of carbohydrates. While this is a deterrent for many, Christy Brissette, RD, a private-practice dietitian in Chicago, notes that many of her patients like the diet because of its strictness. “Some of my clients feel that the keto diet works for them because it doesn't involve any calorie counting and the rules are simple to understand,” she says. “They feel they have strict parameters that can take the guesswork out of dieting.”
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
This is why Gaspari Nutrition chose highly branched cluster dextrin for what we consider to be the gold standard of recovery and performance drinks. This high molecular weight carbohydrate has a special helical structure, which gives it unique properties unlike many of the corn starches or polysaccharides out there. I'll be real with you and say this stuff isn’t cheap, but you certainly pay for what you get, and highly branched cluster dextrin is unlike any carb source I've found – especially if you want to control blood sugar levels and gut issues.
I have that thing on a “real” ketogenic diet where I wake up at 3 am with my mind/heart racing and can’t sleep. It happens the very first day I reduce my carbs and continues as long as my carbs are reduced (5 weeks is the longest I’ve been able to put up with this to see if I could fix it and stay ketogenic). Magnesium and/ or cal-mag before bed does not help. Is carb loading at night the only hope for fixing this? I already take great care with bluelight and EMF.
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
Yes, they're technically a fruit, but we think olives deserve a shout-out all of their own, since they're also a great source of healthy fats and are one of a few keto-approved packaged foods. Plus, they're a great source of antioxidants, will satisfy your craving for something salty, and are blissfully low-carb. “About a palm's worth only has 3 grams of net carbs,” Sarah Jadin, RD, told Health in a previous interview.
For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (two weeks), but the long-term seizure reduction rates are unaffected.[44] Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.[9]
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]

A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
The Gatorade Sports Science Institute (GSSI) is widely considered one of the world’s top go-to resources for cutting-edge exercise and nutrition science advice – which is probably why Gatorade vending machines dot the campus here, and the majority of the kids seem to be walking around campus with a never-ending big gulp-sized cup full of sports drink.
The addition of MCT powder to ketones serves the purpose of maintaining endogenous production of ketone bodies by stimulating fatty acid oxidation in the liver, which then causes the production of even more ketone bodies. In this transcript from a podcast with Dr. Dom D’Agostino it is mentioned that MCT’s cross the blood-brain barrier straight to the brain. So not only are the ketones being used by the brain as an alternative fuel but so are MCT’s.
Now I though about taking keto supplement to boost my ketosis (I’m also looking to boost my overall electrolyte and vitamin/mineral). I’m unsure what product to take. Should I take keto os or ketocana (or else)? Should I take it in the morning while I’m empty stomack for the next 6 hours (wake up at 5) with my mg cap so I get a boost in electrolyte and keto in the morning? Should I take more? Depending on the set, I might not have to take mg cap anymore since they all include some in it.
^ Jump up to: a b c Taboulet P, Deconinck N, Thurel A, Haas L, Manamani J, Porcher R, Schmit C, Fontaine JP, Gautier JF (April 2007). "Correlation between urine ketones (acetoacetate) and capillary blood ketones (3-beta-hydroxybutyrate) in hyperglycaemic patients". Diabetes & Metabolism. 33 (2): 135–9. doi:10.1016/j.diabet.2006.11.006. PMID 17320448.
Fascinating stuff and I am quite curious how we know for certain one is actually in ketosis i.e. using ketones as primary fuel source BECAUSE we do know that glucose has a shorter metabolic pathway to burn and under most conditions, given the presence of glucose, that is what the body will default to which is why high fat and high sugar together in diet is so detrimental. So if we use one or more of the above “boosters” and show high levels of blood ketones but also highish levels of glucose (during initial transition) will be mostly burning ketones or still defaulting to glucose?
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.[3]
After increasing water intake and replacing electrolytes, it should relieve most all symptoms of Keto Flu. For an average person that is starting a ketogenic diet, eating 20-30g of net carbs a day, the entire adaptation process will take about 4-5 days. My advice is to cut your carbs to fewer than 15g to ensure that you are well on your way into ketosis within one week. If you are experiencing any more keto flu symptoms, double check your electrolyte intake and adjust.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
I've been on the diet for about a month and a half now and I've noticed that my vaginal odors have gotten MUCH stronger... (It smells like a mix between urine and discharge... I'm not exactly sure how vaginas are 'supposed' to smell like. Many say 'musky' but I feel like that's too mild of a word... It's much stronger than 'musk' for me :/ ). My discharge is white in color and it doesn't smell fishy. Sometimes when it dries on my underwear it's a light yellow? Has this happened to anyone before? Is it because of my change in diet (if so, can anybody explain why?), or could it be something else?
Alcoholic ketoacidosis (AKA) presents infrequently, but can occur with acute alcohol intoxication, most often following a binge in alcoholics with acute or chronic liver or pancreatic disorders. Alcoholic ketoacidosis occurs more frequently following methanol or ethylene glycol intoxication than following intoxication with uncontaminated ethanol.[11]

Then there’s medium chain triglycerides (MCT’s). Most dietary fat has to be converted into water soluble molecules that then need to enter the liver via your lymph system. Your liver then converts these molecules to fatty acids and ketone bodies. But unlike most other forms of dietary fats, MCT’s can enter your liver directly without having to go through your lymph system. This means that consuming MCT’s gives your body an opportunity to quickly produce ketone bodies.
Western diets are high in carbohydrates, leading to high blood sugar levels, whereas the ketogenic diet enforces a small amount of carbs to be consumed. It can take some weeks of keto dieting to reach increased levels of blood ketones. For others, after 2 - 4 days of low-carbohydrate, high-fat ketogenic dieting, ketone levels in the blood can increase to ~1 - 2 mM, achieving ketosis.5
This article really bothers me in that if you do a few incorrect things with this diet, it will actually do more harm than a full carb diet. I have been in ketosis for a month or so but to what detriment? Based on the “ketosis darkside” list you highlighted, i could be doing any or all of these without realising. Could i share with you my meal plans and see if in your opinion they are beneficial and healthy or if im digging myself an early grave?

^ 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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