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Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[35] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[36] However, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.[9] Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[37]

The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]
Hi Ben, I have a question about being in ketosis. So from what I understand, a serving of Keto os will keep you in ketosis for about 4-6 hours or so……my question is doesn’t your body have to be in constant ketosis in order to really experience the benefits of using the fat as fuel? Also, if someone is not following the Keto diet, what happens to the glucose they are still consuming if they are supposedly using ketones for energy? Also, do you see any benefit from using Keto os vs. Brain Octane? I ask because there is a significant difference in price. Thank you so much!!
Great article! As someone who just started a “ketogenic diet” two weeks ago, I am opting to hold off on using ketone supplements for the following reason. You state how “Keto-adaptation occurs when you have shifted your metabolism to relying on fat-based sources, instead of glucose (sugar) sources, as your primary source of fuel.” If the goal is to “switch” our body’s energy supply to ketones and one uses supplemental ketones, how do they really ever know if their body has successfully accomplished this goal if they are using supplemental ketones? Aren’t they getting a false sense of ketosis if their blood or breath tests show them above 0.5 millimolar through the use of the supplements? I understand that it may take me longer to reach ketosis naturally but I guess I see it was worth it to truly reap all of the benefits that you outline in your article.
Elevated blood ketone levels is the sign of ketosis, while certain subjective symptoms can also signal ketosis. Increased mental clarity, less brain fog, and diminished appetite are fairly common among people in ketosis. The ketogenic diet specifically has its own assortment of symptoms. Fortunately, the negative symptoms such as constipation, diarrhea, and bad breath are often temporary and tend fade as your body becomes better at fat burning and naturally producing ketones. The positive symptoms of ketosis coincide with higher levels of ketones in the blood. This may occur after several weeks of adhering to the ketogenic diet or very shortly after ingesting exogenous ketones.
Hi Ben – Great article. I had trouble at the end figuring out if you were now eating high fat (60-80% of calories), or if you went back to something closer to 50% fat calories and higher carbs and are using exogenous ketones to get int ketosis when needed. Are you doing any carbs at night or a refeed, or just having higher carbs on most days? Thanks
Along with biomarker testing, subjective symptoms can provide an indication of your ketosis. Sometimes, early side effects of the diet result from carbohydrate withdrawal. This can be known as the "keto flu;" symptoms include nausea, fatigue, headache and dry mouth. They're short-term, typically lasting about a week or less. Keep in mind, however, that we are all different. Our bodies react in different ways. Some of us may experience these symptoms later than sooner, to a lesser extent, or not at all.

The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
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]
As insulin levels plummet from carb-cutting, more water is flushed out, along with excess sodium (in contrast, excess insulin from carbs causes sodium and water retention).4 In some people, dehydration contributes to constipation, which can also result from avoiding fiber-rich carbohydrate foods. While less common, diarrhea or loose bowels can be triggered by a number of factors including too much or too little fat, dairy intolerance, or changes in gut flora. 

Protein will induce an insulin response in the body, if consumed in high amounts. The most intuitive way to start a keto diet for most people is by removing all of the carbs they have been eating. Typically people will replace those calories by increasing their lean meat consumption. That's a recipe for disaster! Keeping protein moderate is an often overlooked, but very important part of a keto diet. Most people need around 0.6g to 1.0g of protein per pound of lean body mass.


Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions.[19] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[18]
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/
Burns fat: You can drop a lot of weight — and quickly — on the keto diet.[3] Ketones suppress ghrelin — your hunger hormone — and increase cholecystokinin (CCK), which makes you feel full.[4] Reduced appetite means it’s easier to go for longer periods without eating, which encourages your body to dip into its fat stores for energy. Learn more here about the keto diet and weight loss. 
^ Fumagalli M, Moltke I, Grarup N, Racimo F, Bjerregaard P, Jørgensen ME, Korneliussen TS, Gerbault P, Skotte L, Linneberg A, Christensen C, Brandslund I, Jørgensen T, Huerta-Sánchez E, Schmidt EB, Pedersen O, Hansen T, Albrechtsen A, Nielsen R (September 2015). "Greenlandic Inuit show genetic signatures of diet and climate adaptation". Science. 349 (6254): 1343–7. Bibcode:2015Sci...349.1343F. doi:10.1126/science.aab2319. hdl:10044/1/43212. PMID 26383953.
Fuels and feeds your brain: Ketones provide an immediate hit of energy for your brain, and up to 70% of your brain’s energy needs when you limit carbs.[6] Fat also feeds your brain and keeps it strong. Your brain is at least 60% fat, so it needs loads of good fats to keep it running.[7] Essential fatty acids such as omega-3s help grow and develop the brain, while saturated fat keeps myelin — the layer of insulation around the brain — strong so your neurons can communicate with each other.
There are many misconceptions about ketosis. The most common is mixing it up with ketoacidosis – a rare and dangerous medical condition that mostly happen to people with type 1 diabetes if they don’t take insulin. Even some health care professionals tend to mix up these two situations somewhat, perhaps due to the similar names and a lack of knowledge about the distinct differences.
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][31][32] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.[9][33]
On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.
After about two to seven days of following the keto diet, you go into something called ketosis, or the state your body enters when it doesn't have enough carbs for your cells to use for energy. That's when you start making ketones, or organic compounds that your bod then uses in place of those missing carbs. At this point, your body also starts burning fat for more energy, says Beth Warren, R.D., founder of Beth Warren Nutrition and author of Living A Real Life With Real Food.

There are several ways to approach the “intermittent” part of food restriction. One of the most common is limiting the window in which food is consumed to about eight hours a day. Another is fasting for a full 24 hours once a week, or once a month. Fasting beyond three days can be stressful on the body and should be done with medical advice and supervision.
No offense brother, but this whole article is a big selling advertisement. The health benefits of a “low – carb, high – fat” diet are well known and proven. I directly blame nutritionists, like yourself, for the fact that ~70% of American is considered obese now, not fat, obese. And the fact that Heart Disease is the number 2 killer in America now, second only to cancer.
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