The situation for Type II diabetics is different because some insulin production remains and some cells of the body can still respond to insulin. It is worth noting that insulin sensitivity can be different between the different tissues of the body such as liver, adipose tissue and muscle. A small amount of insulin release can help to prevent development of DKA unless the body is totally insulin resistant. Insulin resistance is a term used to indicate that for a given amount of insulin, the cells of the body are less responsive and take up less glucose. This means that blood glucose levels remain higher for longer when insulin resistant Type II diabetics eat a carbohydrate rich meal. Over time, the pancreas secretes more insulin to compensate for reduced insulin sensitivity, which can damage the insulin producing (beta) cells. Furthermore, having high blood glucose can lead to a number of side effects:
Glucose-sensitive neurons have been identified in a number of CNS regions including the metabolic control centers of the hypothalamus. Medeiros et. al. have used patch-clamp electrophysiology to examine whether neurons in a specific specialized region known as the subfornical organ (SFO), an area where the blood-brain barrier is not present, are also glucose sensitive or not. These experiments demonstrated that SFO neurons are glucose-responsive and that SFO is an important sensor and integrative center of circulating signals of energy status (Medeiros et al., 2012).
Humans have always relied on ketones for energy when glucose sources were scarce (i.e. no fruits available during winter). It is a normal state of metabolism. In fact, most babies are born in a state of ketosis. However, with abundant sources of carbohydrate, people rarely access ketosis and it becomes a dormant metabolic pathway.Our ancestors likely had frequent periods of time when high carbohydrate food wasn’t immediately available. For this reason, our bodies are amazing at adapting to burning of ketones for fuel.
In order to obtain the most comparable measures, it is useful to measure blood ketones at the same time each day. Measuring immediately on waking means that there are fewer potential variables that could alter the measurement, such as exercise, or different food intake. However, it can also be useful to check ketone levels around 60-90 minutes after an intervention such after eating a fat rich meal or consuming exogenous ketones.      
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] 

Also make sure that you know what foods have mostly carbs, fat, and protein, so you can make the right choices. For instance, it’s not just bread, pasta, chips, cookies, candy, and ice cream that contain carbs. Beans may contain protein, but they’re also very high in carbohydrates. Fruit and veggies also mostly contain carbs. The only foods that don’t contain carbs are meat (protein) and pure fats, like butter and oils.


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.
But comprehensive transcriptional profiling of glucose-sensing neurons is challenging, as glucokinase (Gck) and other key proteins that transduce glucose signals are expressed at low levels. Glucose also exerts a hormonal-like action on neurons; electrophysiological recordings demonstrated, for example, that hypoglycemia activates growth hormone-releasing hormone (GHRH) neurons, suggesting a mechanistic link between low blood glucose levels and growth hormone release (Stanley et al., 2013).
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.
In this study by Dr. Dominic D’Agostino it is also mentioned that your blood brain barrier (BBB) “is relatively impermeable to most hydrophilic substances, such as ketone bodies. Therefore, the transport of ketones across the BBB is highly dependent on specific carrier-mediated facilitated transport by a family of proton-linked monocarboxylic acid transporters”. Basically, what this means is that MCT powder may act as a carrier to shuttle the ketone bodies across the BBB.

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.
The DNA test does not necessarily take into account your goals (e.g. breathholding, Ironman, cognition, etc.) and if your goals would benefit from ketosis, then you may want to choose it as a dietary strategy even though it could indeed be true that for FAT LOSS a higher carb intake may suit you. So it all depends on your goals. Or you could just us the supplements like ketones AND eat more carbs and get "best of both worlds".
This is because you get rid of the foods that cause high blood sugar, also known as glucose. Glucose is the easiest way for your body to get energy, but it can lead to energy crashes if you get too much in a short time. To get rid of the glucose and use it up, the body needs to produce insulin. As we produce more and more, our bodies become resistant to it, and this can lead to diabetes.
Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
So how does our body make ketones out of the stored fat?  First blood sugar and insulin have to be low enough to allow access to stored fat.  If they are, stored fat (in the form of triglyceride) can be mobilized as a fuel source. A substance called hormone sensitive lipase (HSL) breaks the triglyceride compound down into one glycerol molecule and 3 fatty acid molecules. These fatty acid molecules come in various lengths of carbon based chains.
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?
Consume more beef and high-fat dairy. These keto foods contain high amounts of a fatty acid called Conjugated Linoleic Acid (CLA). CLA has been found to improve fat loss by a variety of different mechanisms. To get as much CLA as possible, source your dairy and beef from 100% grass-fed cows. CLA content is 300-500% higher in beef and dairy from grass-fed cows, compared to grain-fed cows.
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Risks to Note Koche says to hold off until you’ve adapted to keto, which means your body is used to turning to fat for fuel, before adding these high-carb days, as it can slow down the possible benefits and results of being in ketosis. Kizer notes that keto cycling can cause fluctuations in body water, which can lead to dizziness. “It can also be hard on the heart for those with some cardiac conditions,” she adds.
Today we had a wellness clinic at work! I have not been to a PCP in about 7 or 8 years due to white coat syndrome, but with my new found confidence, I decided it was time to step into some tests. At the clinic they tested Blood Pressure, Blood Glucose, Total and Good Cholesterol, and Bone Density. I stepped into the ring and was very anxious to get it over with, I felt my blood pressure elevate and I felt like my forehead was gonna pop while waiting in line for my blood pressure to be read...it doesn't help that I had a venti coffee from starbucks and 32oz of black tea throughout the morning. Waited for the results which were elevated as expected, but only the top number...I was actually 140/62. Next up was blood glucose and cholesterol, I was excited to see what KETO had done for me here! The nurse pricked my finger and filled the testing unit, she said "Wow, excellent!" My total Cholesterol was 100 and my good cholesterol was 57 and my Blood Glucose was 90! She asked me how I was doing it and we had some discussion about KETO and how I have lost almost 100 pounds and she bought right in and said " I think I was meant to meet you today!" That brought a big smile to my face. Next was Bone Density and then off to a healthcare specialist. They took a look at my numbers and the only concern they had was my bone density. They suggested weight training and they were super impressed with my weight-loss journey.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[3] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[47] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[3]
How It Works You’ll follow the keto diet as usual until 30 to 45 minutes before exercise — then it’s time to eat about 25 g of carbs, says Daniela Torchia, PhD, a registered dietitian based in Loma Linda, California. The idea is that you’ll have just enough carbs to fuel your workout and still be able to return to ketosis easily after you cool down. Choose carbs that are easy to digest (for instance, white bread or white rice) and be sure not to add calories to your daily total — simply redistribute them, Dr. Torchia says.
1. If a set number ketones in the blood is an indicator that my body has transitioned to ketosis and not necessarily the cause (the cause being limited access to glycogen because of limited carb intake) then how does using exogenous ketones put me in ketosis as opposed to mimic being in ketosis (because when measuring blood ketones suddenly there are more because I put them there, I didn’t create them)?
Thank you for this honest post on how Keto affected you. I did Keto for 6 weeks. I did lose 7 lbs but I struggled with depression and not using the bathroom regularly nice I started the diet. I searched and found carbs help with serotonin uptake which explained my depression. Everywhere I look people are pro Keto instead of discussing some the side effects. My gym friend told me she cried the last 4 days she did Keto before saying enough is enough. If it works for others, that’s great, but it’s refreshing to hear that I am not the only one who struggled and stopped Keto.
The fatty acids then flow into the bloodstream and are taken up by body tissues.  Once in the cells, the fatty acids are transported into the mitochondria of the cell to be metabolized carbon by carbon in a process called beta-oxidation. As glucose levels fall and fatty acid levels in the blood rise, the liver cells ramp up beta-oxidation which increases the amounts of a molecule called Acetyl-CoA. As the level of Acetyl-CoA rises, it is shunted to a process called ketogenesis. Ketogenesis generates a ketone body called acetoacetate first, and this ketone is then converted into the two other types of ketones: beta-hydroxybutyrate, and acetone.  Meanwhile, the glycerol part of the fat molecule gets converted into glucose in a process called gluconeogenesis, which means "make new sugar".

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.
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.
Anecdotally speaking, people do lose weight on the keto diet. Heather Wharton, a 35-year-old business relationship manager from Tampa, Florida, lost 140 pounds since starting the keto diet in January 2016: “I plan on being on the keto diet for the rest of my life,” says Wharton. “My husband and I consider ourselves to be food addicts, and the keto diet is what we use as a form of abstinence from trigger foods that have sugar and other carbohydrates." A typical day of eating for Wharton includes coffee with a protein supplement, a cup of unsweetened cashew milk, cauliflower rice with ground turkey and liquid aminos (a carb-free substitute for soy sauce), spinach, six slices of turkey bacon, six eggs, and a little salsa.

It is possible that you don’t have as much fat to lose as you think. There are several ways to measure body fat, which will give you an accurate gauge of how much you need to lose. A DEXA Scan is an x-ray that measures bone mineral density and body fat percentage. While it’s most accurate, it’s also expensive. You can also use skinfold calipers at a gym or your doctor’s office to get a body fat percentage estimate. This information gives you a good indication of your body fat stores and how much you have to lose healthfully. The silver lining in this case — the more fat you have, the more you have to lose.
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?
Don’t stop tracking your ketones when you’re trying to lose weight. An excellent way to keep your ketone levels up is taking exogenous ketones. Just put a scoop in your favorite drink to get back into ketosis — it’s easy and delicious. If you want more keto food inspo, follow Perfect Keto founder Dr. Anthony Gustin (@dranthonygustin). This is how he mixed his iced green tea with Peach & Cream exogenous ketones:
Normal dietary fat contains mostly long-chain triglycerides (LCT). Medium-chain triglycerides are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[3] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhoea and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[3]
But people who started following the keto diet noticed weight loss for a few reasons: When you eat carbs, your body retains fluid in order to store carbs for energy (you know, in case it needs it). But when you’re not having much in the carb department, you lose this water weight, says Warren. Also, it's easy to go overboard on carbohydrates—but if you're loading up on fat, it may help curb cravings since it keeps you satisfied.

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.
This was a great post. I did Keto last year, really strictly, and dropped 13 lbs in about 3 weeks. Then the holidays came and I had cookies. I’ve struggled since then to get back into the Keto mode. I do well for a few days, drop a few lbs and then have a “bad” weekend and back up I am. I’ve literally been gaining and dropping the same 5 lbs. for a year. I also miss certain carbs. I love bread and homemade bread can be healthy. I miss yams and beans, etc. I’m beating myself up because I want these foods I’ve eaten my entire life and now “can’t”. I appreciate your comments about accepting and loving our bodies no matter what size. Yes, I want to be healthy but I’m tired of obsessing about every single thing that I put in my mouth. This article is inspiring.

"I was on Reddit one day when I saw a weight loss transformation of a guy who had lost 140 pounds in a year using the keto diet. I started reading the keto subReddit and began researching the science behind it. After years of using upcoming events as excuses not to diet, I chose to start keto in January when the holidays were over and there weren’t any weddings or parties for the next few months. 
Maintain adequate protein intake. Too little protein and you lose muscle mass and starve the few parts of your body that can’t use ketones as an energy source, like portions of your red blood cells, kidneys and brain. Too much protein and you inhibit ketone production. Make sure you consume enough protein to support your vital functions, but not too much that protein becomes your alternate glycogen source.
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