" "

Another possible nutrient deficiency: potassium, a mineral important for both electrolyte balance and blood pressure control, notes MedlinePlus. “Inadequate intake of potassium is likely when consumption of fruits and starchy vegetables are decreased,” says Asche. She recommends adding lower-carb sources of potassium to the diet, including avocado and spinach — as well as lower-carb sources of fiber, such as chia seeds and flaxseed (be sure to enjoy ground for the best health benefits).

The ketogenic diet doesn’t put a cap on saturated fat or even trans fats. The latter are fats you should always avoid. Read ingredient labels and avoid any food with partially hydrogenated oils, aka trans fats. These fats heighten your LDL (“bad”) cholesterol levels and lower your HDL (“good”) cholesterol levels. They also raise your risk of heart disease and stroke, according to the American Heart Association.
In nondiabetics, ketosis (also called nutritional ketosis) is regulated and controlled in the body so that ketone levels never reach the harmful levels associated with diabetic ketoacidosis. Ketoacidosis is an acute, life-threatening condition that occurs in severely uncontrolled diabetes (mainly type 1) when ketones rise to massive, supranormal levels.
“Muscle loss on the ketogenic diet is an ongoing area of research,” says Edwina Clark, RD, a dietitian in private practice in San Francisco. “Small studies suggest that people on the ketogenic diet lose muscle even when they continue resistance training. This may be related to the fact that protein alone is less effective for muscle building than protein and carbohydrates together after exercise.” Meanwhile, according to a small study published in March 2018 in the journal Sports, people following the keto diet for three months lost about the same amount of body fat and had about the same muscle mass changes as people following normal diets. Yet the folks on keto did lose more leg muscle.
Net carbs are what we track when following a ketogenic diet. This calculation is pretty straightforward. Net Carbs = Total Carbs – Fiber. For example, one cup of broccoli has 6g of total carbs and 2.4g of fiber. That would mean one cup of broccoli has 3.6g of net carbs. We count Net Carbs  because dietary fiber does not have a significant metabolic effect. 

"Keto is not a great long-term diet, as it is not a balanced diet," Nancy Rahnama, M.D., M.S., an internal medicine and bariatric specialist, told Reader's Digest. "A diet that is devoid of fruit and vegetables will result in long-term micronutrient deficiencies that can have other consequences. The keto diet can be used for short-term fat loss, as long as it is under medical supervision."
Hi, I am a parent of son with epilepsy. On our last EEG we found out he is having 10 absence seizures per hour as well as bimonthly grandmal seizures . People have been using the ketogenic diet for seizure control for years. Our neurologist mentioned that seizure control is effected by blood insulin as well as ketones. I know the original Keto esters came from DR. D’Augustino’s work with Navy Seals who were having seizures due oxygen toxicity. The main reason we have not been using the Keto diet is lack of compliance and it so easy for kids to get out of ketosis. I am wondering if we could get seizure control with a zonish/adkins diet with keto os, brain octain supplementation. Even an educated guess would be appreciated. Thanks, Mike
2) I'm currently using Ketocana and in that section you state "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 fat or eat copious amounts of fats, but want to simultaneously maintain high levels of blood ketones." – How would eating copious amounts of fat be a negative? Wouldn't that help contribute to a ketogenic state?
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:
Selecting the right food will be easier as you become accustomed to the Keto approach. Instead of lean meats, you’ll focus on skin-on poultry, fattier parts like chicken thighs, rib-eye steaks, grass-fed ground beef, fattier fish like salmon, beef brisket or pork shoulder, and bacon. Leafy greens such as spinach, kale and lettuce, along with broccoli, cauliflower and cucumbers, make healthy vegetable choices (but you’ll avoid starchy root foods like carrots, potatoes, turnips and parsnips). You can work in less-familiar veggies such as kohlrabi or daikon.
I just discovered your site and have been thoroughly enjoying many of the articles and appreciate that you get so in depth in your explanations. I’m in my late 40’s and, while not an extreme endurance athlete, I am moderately active with 18-20 mile rides 3x a week as well as some boxing and body weight resistance (push up, pull up, etc) mixed in. I’ve generally been paleo and stick to quality macros for the most part (grass fed meats/dairy, organic veg and oils) and zero supplements. I recently started following keto (after reading this article) about 10 days ago and things seem good thus far. I do, however, want to avoid any of the negative side effects you mention and also not lose any lean muscle. I’m currently about 174 lbs, 5’8″ and about 19% bodyfat – I’m taking in about 95g protein, 130g fat and <20g net carbs. I'm eating all quality – wild salmon, grass fed beef, pastured eggs, coconut oil, Brain Octane and Grass fed butter in coffee, sardines, etc. With a smattering of organic veg, but it seems real easy to bust through the carb barrier. *I'M ALSO TAKING KETOCANA PRE-WORKOUT* and I notice this is keeping me going throughout a ride or the gym.

The reason purity matters is that C17 is a byproduct of most MCT oil production processes, and it, along with C6, is a major cause of throat burning and gut irritation. Most MCT’s on the market are manufactured via chemical and solvent based refining, which involves using chemicals like hexane and different enzymes and combustion chemicals, such as sodium methoxide. But ideally, you should get an MCT oil that is made using triple steam distillation in a non-oxygen atmosphere to avoid lipid oxidation and create a purer end-product.
In sheep, ketosis, evidenced by hyperketonemia with beta-hydroxybutyrate in blood over 0.7 mmol/L, occurs in pregnancy toxemia.[78][79] This may develop in late pregnancy in ewes bearing multiple fetuses,[78][79] and is associated with the considerable glucose demands of the conceptuses.[80][81] In ruminants, because most glucose in the digestive tract is metabolized by rumen organisms, glucose must be supplied by gluconeogenesis,[82] for which propionate (produced by rumen bacteria and absorbed across the rumen wall) is normally the principal substrate in sheep, with other gluconeogenic substrates increasing in importance when glucose demand is high or propionate is limited.[83][84] Pregnancy toxemia is most likely to occur in late pregnancy because most fetal growth (and hence most glucose demand) occurs in the final weeks of gestation; it may be triggered by insufficient feed energy intake (anorexia due to weather conditions, stress or other causes),[79] necessitating reliance on hydrolysis of stored triglyceride, with the glycerol moiety being used in gluconeogenesis and the fatty acid moieties being subject to oxidation, producing ketone bodies.[78] Among ewes with pregnancy toxemia, beta-hydroxybutyrate in blood tends to be higher in those that die than in survivors.[85] Prompt recovery may occur with natural parturition, Caesarean section or induced abortion. Prevention (through appropriate feeding and other management) is more effective than treatment of advanced stages of ovine ketosis.[86]
These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
Remember how important it is to measure ketone blood levels accurately? Same goes for food tracking. A food tracking app, like MyFitnessPal, provides insight into macronutrient intake and thus the ability to tweak the diet to achieve ketosis. Tracking diet (inputs) and measuring ketones levels (outputs) delivers the best shot at optimizing the keto diet plan.
There’s also some evidence that it might help with type 2 diabetes. “An emerging body of research is finding that a keto plan may have some real benefits thanks to its ability to improve the body’s ability to use insulin and also help control appetite, which can result in easier weight loss,” says Karen Ansel, R.D.N., co-author of Healthy in a Hurry.
That was really interesting and useful information. But I wanted to ask you about what Dom said at time (52min). What does he mean,when he says 1 mml increase is about 10% increase of substrate to the brain? Is that (same glucose amount in brain) + (typical ketone amount in brain)+ and 10% more? Or does it substitute glucose? And if it is so, does the brain use that energy or does it just stay around the brain without being used? I know we can’t know for sure, but it would be helpful if you said what you think. Thanks in advance!
I would do breath ketone measurements. That's exactly what I do and this is what I use :https://greenfieldfitnesssystems.com/product/ketonix-breath-ketone-monitor/
Great post!! I’m a 41 year old Master CrossFit athlete, been in keto / LCHF Primal lifestyle for the past 9 years. I feel that my performance has improved a lot and continues to improve pretty significantly. I was a top 200 Master Open Qualifier on 2016 and 2017 and I’m usually on the podium of local competitions so my performance is really not bad…and I’m totally fat adapted. I follow sort of a TKD where I sometimes eat carbs at night during the week, but never above 100g so It doesn’t even kick me out of ketosis due to activity level. I’ve been playing with some measurements and I noticed that my BG reading after high intensity training sessions is really high (up to 180mg/dl). But it goes down fast (sometimes it goes down to 50mg/dl but I show no side effect of hypo, function completely normal). From my research, the high glucose post high intensity is normal and due to the stressful response of the exercise and also because my liver is producing the glucose from gluconeogeneses to provide it for the workouts, when needed. This only happens when the workouts are long, above 30 minutes.
They mimic ketosis, to answer your question in short. Best to get fat adapted and use ketones to get the best of both worlds and to enhance fat burning abilities. They will allow you to use glucose and fatty acids simultaneously, yes. 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.
As you may know, "keto diet" is short for ketogenic diet, because who has the time to say "genic." It is a high-fat, moderate-protein, and low-carb diet with approximately 80% of your calories from fat, 15% from protein, and only 5% from carbohydrates. The goal of the diet is to induce ketosis in your body. The theory is that typically your body may rely on burning the carbs that you eat rather than the fat stores in your body for energy. The thinking is that by severely restricting the amount of carbs in your diet your body may then be forced to burn your body fat instead. Breaking down this fat then results in ketones, which is not some acapella group, but instead organic compounds made up of carbon, hydrogen, and oxygen atoms. One type of ketone produced is acetone, which is in certain types of nail polish removers. This accumulation of ketones may result in "keto breath", which is a rotten fruit or metallic smelling bad breath that can smell a bit like, surprise, surprise, nail polish remover.
Amazing article – gonna have to print it and read it again. To much to break down in one sitting. Thanks Ben – you’ve pulled together so much insight and references that’s given me greater confidence and conviction. I’m 50 and use to be super active and a seasoned athlete but after a few ‘mid life surgical interventions’ I had to find a better way… Ketogenics has been that for me… no more inflammation… I can’t tell you how great it’s been to be pain free! Keep leading from the front.
The keto diet changes the way your body converts food into energy. Eating a lot of fat and very few carbs puts you in ketosis, a metabolic state where your body burns fat instead of carbs for fuel. When your body is unable to get glucose from carbs, your liver converts fatty acids from your diet into ketones, an alternative source of energy. Burning ketones in place of glucose reduces inflammation and spurs weight loss.[1]
In addition to the seaweed and glycogen carbohydrates mentioned above, the Inuit can access many plant sources. The stomach contents of caribou contain a large quantity of partially digested lichens and plants, which the Inuit once considered a delicacy. They also harvested reindeer moss and other lichens directly. The extended daylight of the arctic summer led to a profusion of plant life, and they harvested plant parts including berries, roots and stems, as well as mushrooms. They preserved some gathered plant life to eat during winter, often by dipping it in seal fat.[71]
In theory, all of this is possible. A study published in the Journal of Nutrition did find an association between having more severe bacterial vaginosis and consuming diets higher in total fat and saturated fat. But the keto diet is still a relatively new rage, and not enough scientific studies have been done to determine whether "keto crotch" is really a risk of the keto diet.
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 am not an athlete. I am a mid 30’s male with a sedentary lifestyle. I am 5’10” and 250lbs. I have mild hypertension, high triglycerides, and pre-diabetes. I have eaten whatever I want and as much as I want for years. I have recently started walking/jogging 3-4 times a week, taking fish oil, and eating significantly less carbs plus added fish and steak. Is this diet appropriate and safe for me?
The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[7]
One more thing that I noticed is that my HR does not move Beyond a certain point. I can still perform quite at a high level and faster than most people at my box but weirdly enough it’s like there’s a block on my HR which doesn’t allow it to move beyond 160 bpm. I’m not sure if this is good or bad! Could I go even faster if my HR would pass this limit?? It is a physiological barrier created by the glycogen sparing mechanism that doesn’t allow my body to move after a certain point so it won’t have to tap into my glycogen stores or force my body to go into gluconeogenesis?? If I added some more carbs around my workouts would it be easier to get the glycolytic pathway to work more effectively since it’d be faster and easier fuel? I read about the downregulation of PDH enzymes after prolonged keto and I constantly worry that I dont use my glycolytic pathway as effective anymore. I LOVE this lifestyle but at the same time, as athletes; we’re always thinking on how to improve performance. What are your thoughts?! Thank you so much!!
In other words, I personally found that while following “strict ketosis”, things became eerily similar to the days in college when I was a competitive bodybuilder pursuing sub-3% body fat percentages. I simply wasn’t the most fun guy to hang out with in social situations due to my extreme dietary restrictions, the intense self-control became nearly exhausting, and when I traveled, I missed out on many culinary experiences, such as homemade ravioli in Rome, freshly baked crostinis in the Basque regions of Spain, and Korean rice bowls in Seoul.

Your glycogen stores can still be refilled while on a ketogenic diet. A keto diet is an excellent way to build muscle, but protein intake is crucial here. It’s suggested that if you are looking to gain mass, you should be taking in about 1.0 – 1.2g protein per lean pound of body mass. Putting muscle on may be slower on a ketogenic diet, but that’s because your total body fat is not increasing as much.5Note that in the beginning of a ketogenic diet, both endurance athletes and obese individuals see a physical performance for the first week of transition.

-Nervous System Damage: It’s been shown that patients with neuropathy whose after-meal glucose readings were above the diabetic threshold sustained damage to their large nerve fibers. Even neuropathy patients whose glucose readings remained well within the normal range showed damage to their small nerve fibers. Studies have shown that within any blood sugar range, the higher the glucose, the greater the damage to nerve fibers.
Hi Ben great science & sound advice. May I share with the group? I’m 42, in australia, have been an alcoholic for 10 yrs. In April 2016 I gave up drinking & started living strictly ketogenic. In 3 months I dropped 25 kilos. I have cheated on weekends but I go through a fast of sorts on Mondays to get back into ketosis by Tues. I work afternoon / evenings so I wake at 10.30am take a pre workout drink with raspberry ketones & a splash of mct oil & all my vitamins as well. I then do weights for an hr then get ready to go to work. I take 2 800ml protein shakes consisting of 20 ml mct & 30grm amino enhanced protein. I work in warehousing so I walk anywhere between 10 km & 5 km a nite. I feel great all the time, thanks largely to your research & advice. If have any thoughts or opinions I’d love hear them.

When you burn key tones as a funeral, whether they are from a supplement or whether they are the ones that your body makes, you do indeed become more efficient utilizing ketones. So that is one advantage. You are correct in that if you simply use these and you do not restrict carbohydrate intake then you're not going to get quite as much benefit. I am a fan of combining these with intermittent fasting, MCT oil, and a high-fat diet.
After 2 years in ketosis suddenly I find my blood glucose has risen to high levels even while in ketosis. I thought it was the dawn phenomenon, stress hormones like cortisol but now I am beginning to think I am eating too many exongenous keytones like too much MCT oil? I am not taking exogenous keytone supplements but wondering if too much oil/ fat in the diet generates exogenous keytones which inhibits the livers production of endogenous keytones. I have read if the liver is producing endogenous keytones it is not at the same time producing glucose through gluconeogenisis? 
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