Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” N Engl J Med 2003; 348:2074-2081. http://www.nejm.org/doi/full/10.1056/NEJMoa022637.
The problem with this is that MOST people don’t turn to keto as a lifestyle. Many turn to it and use it as a diet for quick weight loss. If you love keto and live a keto lifestyle, not feeling deprived in any way, then okay, eat keto! But I don’t agree that we need to demonize certain foods. This can lead to eating disorders and an unhealthy relationship with food, and this is why I wrote this article, to help people like me who have to deal with this.
If you would like to read more on ketogenic diets and ketosis, Jeff Volek and Steve Phinney discuss the new method of checking blood ketones in their book "The Art and Science of Low Carbohydrate Performance", and they also offer another good book "The Art and Science of Low Carbohydrate Living", which is a good book for those who need an introduction to the science of ketogenic diets.
To understand exogenous ketones, you should know that there are three types of ketones: beta-hydroxybutyrate (BHB), acetoacetate (ACA) and acetone, and all three are the normal by-products of fat breakdown by your body. In much the same way as glucose, ketones can be used by your tissues, especially your brain, diaphragm and heart and are actually a far more efficient fuel source than glucose.
Carbohydrates are necessary for the conversion of inactive thyroid hormone to active thyroid hormone, and if you’re on an extremely strict low carbohydrate diet, then you may actually be limiting this conversion. Your TSH is what tells your thyroid gland to “release more hormone,” so your TSH rises when your thyroid gland is underactive, or conversion of inactive to active thyroid hormone is inadequate. A high TSH means that the pituitary gland is releasing its hormone to try to get the thyroid to respond and produce more thyroid hormone. Because of inadequate carbohydrates, TSH will often elevate in a high-fat, low-carber – indicating potential for long-term thyroid and metabolic damage.
The diet that worked for me was keto. Thanks for the recommendation for the keto strips- I ordered the exact ones and used my first test strip this morning- it worked great!! So I’ve got something else to keep me in check. Dropped 100 pounds after my first child (I really went overboard about eating for two- I thought I was doing something good) and then dropped 30 after my second child. Since then, it’s the same 10-15 pounds that I keep losing and gaining back. Love your mantras- I’ve written a few down in my journal and some just ring in my head like a music track- never two in a row!! Can’t outrun your fork!! With keto, it gets me fantastic and very quick results and I go with a recarb meal (not recarb day) once a week. Eat a little more carbs after workouts. Now with the strips, I can see if what I’m doing post-workout keeps me in keto. Thanks for all your resources- they are so eye-opening and so motivating (and funny)!! I did hours of research about keto- if your article had come out a couple of months earlier- it would havr saved me all that time!! Great knowing that if I feel like I need the boost with 1-1 coaching it is available. Keep up the outstanding work!
I originally started this “diet” because I am the Maid of Honor in my best friends wedding. She made me order a size down than I was comfortable with and it fit, if you didn’t zip it up. I tried it on a couple weeks later and it REALLY didn’t fit, I couldn’t pull it up past my hips. I was mortified and super embarrassed, how was I going to be in this wedding if I can’t even fit in this dress. Cut to now, I just tried on my dress and it’s too big! I’m so excited that I have to get it altered.
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.
The gastrointestinal tract (GIT) plays a central role in the control of energy balance. Many molecules produced by the GIT exert hunger or satiety effects on the brain. Ghrelin is a peptide produced mainly by the stomach's oxyntic cells that stimulates ghrelin secretion in the hypophysis and has some neuroendocrine activities. However, its orexigenic properties are the most relevant to us and ghrelin is the only known peripheral orexigenic hormone (Date, 2012). Cholecystokinin (CCK) is a peptide produced mainly in the duodenum and jejunum that acts on the vagus nerve and directly on the hypothalamic nuclei. CCK is an anorexigenic factor and it reduces food intake, meal size and duration (Murphy et al., 2006). Three other related hormones are pancreatic polypeptide (PP), amylin, and peptide YY (PYY). PP is a peptide produced by the endocrine pancreas in relation to the caloric content of meals, and it reduces food intake both in rodents and humans. Amylin is a peptide co-secreted with insulin; its main effect on food control is a reduction of meal sizes and food intake (Murphy et al., 2006). Peptide YY (PYY) is produced in the gut and is similar to PP. PYY is stored in intestinal cells and released into the circulation as PYY3−36, a truncated form of PYY. The release of PYY3−36 is dependent on a meal's caloric and fat content (Veldhorst et al., 2008). The glucagon-like peptide 1 (GLP-1) is produced by the cleavage of pro-glucagon gene in the intestine. It acts as incretin at a pancreatic level, promoting insulin secretion and as neuro hormone on hypothalamic nuclei, inducing satiety (Valassi et al., 2008).
The keto diet has been on everyone's radar for a while now. The low-carb, high-fat diet is said to be a game changer for many people who want to lose weight. Although it may seem like a trend diet, it certainly shouldn't be treated as one; many experts say that the keto diet requires close supervision. However, many people who have done keto the right way have experienced great weight-loss success from the diet. Here are 20 before-and-after photos that prove just how effective this diet can be.
Pretty soon, I became scared to eat too much protein for fear that it would turn into sugar via gluconeogenesis. I became scared of fruit and many vegetables. I became scared to eat out for fear of things being cooked in unhealthy oils. I didn’t celebrate my kid’s birthdays with pizza and cake because God forbid I eat that many carbs and get kicked out of ketosis. I became obsessed with tracking my fat intake and trying to get it lower and lower, spending so much time planning my day so I would never go over that 5% carb intake. I started losing energy. I got really, really bloated and couldn’t figure out why.
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
As ketones are the only other metabolic substrate that can fuel the brain, there is a compelling mechanism whereby ketosis could improve brain energy metabolism and therefore improve symptoms of AD. Despite a declining ability of the brain to use glucose, cerebral ketone metabolism is preserved in AD (Castellano2015). This means that ketosis could be used to prevent an energy deficit in the brain. Another possibility is that ketone metabolism decreases mitochondrial damage caused by oxidative stress in the brain52. Individuals with AD tend to have increased mitochondrial oxidative stress, which can worsen brain energy production and increase plaque and tangle formation53.
The handheld devices that are available for home testing (such as FreeStyle by Abbott, or KetoMojo) require a small droplet of blood (obtained by a finger prick with a lancet) to be placed on a testing strip. A new testing strip must be used each time a reading is taken. The machine delivers a numerical blood BHB measurement in the unit milli molar (mM) after ~8 seconds.
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. 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.
I decided to try going “keto-ish” after nearly a year of unsuccessful weight loss. Before trying Keto, I was hungry all the time and the number on the scale wasn’t budging despite meticulously sticking to my meal plan and exercising 3-5 days a week. It’s been about three weeks since I’ve started this new approach to eating and the pounds are flying off. It’s amazing. I’ve discovered riced cauliflower and zoodles, two things I never knew that I loved.
A systematic review in 2018 looked at sixteen studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein (LDL), high total cholesterol, and weight loss.
Fasting: As with caloric restriction, any benefits of fasting are likely to stem from the lowering of glucose, and insulin plus the elevation of ketone bodies. However, fasting may not be a good fit for patients who are already subject to a huge physiologic stress, particularly when being treated with chemotherapy or radiotherapy. Patients are frequently immunocompromised and may also experience muscle wastage (cachexia). However, fasting may sensitise cells to the effects of chemotherapy95, so a short fast prior to a treatment cycle could potentiate the drug’s efficacy.
In the end, I'm pleased with my keto diet results both internally and externally. I lost 4 pounds in two weeks, gained some energy and efficiency with my training, and more often than not felt that I could see better muscle tone instead of feeling bloated or weighed down. While the ketogenic diet may not be my go-to on a regular basis, Dr. Axe's final feedback was encouraging: He says because I've now had a successful keto trial run, if I wanted to cycle through some keto weeks (or even a month, next time), I'd be able to easily, potentially reaching ketosis even more quickly. While going full-force back on the carbs could derail me or anyone else who wants to keto-cycle, Dr. Axe says the odds are in my favor. “Ninety percent of the time if someone's done it once, they will get into ketosis quicker and easier the next time,” he says.
“Mark is doing that keto diet,” his wife, Kelly Ripa, said on Live with Kelly and Ryan on Tuesday. “Since he’s been doing that I’ve been on a mostly carb diet. He’ll have the burger but he won’t have the bun. Then I see that little bun sitting there with burger juice on it and the condiments and yeah, I’m not a big meat eater so I just eat that bun with the lettuce and the tomato and I’m a happy camper.”
This is in part because patients need to be in deep ketosis to see an impact on epilepsy, likely deeper than the average dieter, but without a nutritionist guiding you it’s still hard to get down into ketosis. It’s not exactly clear why ketosis seems to improve epilepsy, but it seems to have something to do with the brain’s use of ketone bodies in place of glucose, which only happens when you’re nearly in starvation mode. (It's important to note here that "starvation mode" is not in reference to how hungry you feel.)
Risks to Note Torchia says not to try targeted keto until you’ve been following a standard keto diet for a month or two. “This idea is called ‘keto adaptive,’ and once your body is used to using fat as fuel, it can go back and forth more readily with moderate carbs,” she says. She warns not to try this (or any version of keto) before talking with a physician if you have diabetes and are insulin dependent, as it could lead to a too-low blood sugar level.
Note to all potential buyers: these are meant to support a ketogenic diet (no carb, high fat, moderate protein), a specific diet which takes time and dedication to engage in. These are not “silver bullets” that will cause rapid weight loss without diet and exercise, so don’t expect it. No such products exist, on Amazon or otherwise. On the other hand, if you’re following a ketogenic diet already and need a little boost every now and then, these are for you. Watch out, though, they have a lot of caffeine. Three pills have 200 mg, the equivalent of several cups of coffee. If you can tolerate it, go for it. Just don’t make a regular habit of it.
I work with a naturopath to help heal my issues. She uses a ZYTO Elite to figure out the bodies frequences, food issues, and viruses. I was then told I had Candida in my tissue, leaky gut, liver congestions, etc. I was fairly sick. Been walking this road since October. She read me my food sensitivities and what my gut couldn’t tolerate. I was on a candida diet for 4 months, which is zero carb. Yet, she told me NEVER to be in ketosis. Impossible task. So, I lost 30lbs effortlessly on that. I’ve been noticing I went from muscle tone to NONE. Like, even if I flex my arm, you see no muscle. I was also very week and not able to exercise on keto. This is normal, I read. In March, I abruptly stopped losing weight, gained inches galore, and nothing had really changed, diet wise. I put on 10lbs. I re-scanned a few weeks ago and she was concerned that being in keto affected me. I came across your article and what HIT ME was that just 3 weeks ago she put me on potassium, magnesium, celtic sea salt, and some other herbs. But, all the ones you mentioned here. She stressed, again, please never go into ketosis. I can only tolerate sweet potatoes and yams now that i’m healing my gut, but so far i’m still not losing. I’m maintaining. BUT, i’m able to exercise now, so that is good. I think you are SPOT ON, from my own life experience with it, and thank you for sharing even though you’ll likely be torn to pieces.
"I'll typically have two chocolate peanut butter fat bombs. They save me. Lately, there’s been a keto cheesecake in the fridge and I’ll sneak a bite, but won’t have a whole piece. I try not to go too hard on the snacks anymore. I’m noticing that laying off the almond flours, coconut flours, and baked sweets has helped me feel better overall. If I want a crunch I’m reaching for the pork cracklings."
The process of generation ketones (ketogenesis) is kept in check by the presence of insulin in the body. Insulin regulates the flow of fatty acids from our fat cells, and it acts in a feedback loop to regulate ketogenesis. As long as insulin is circulating within the body, in general, the flow of fatty acids and the production of ketone bodies will be limited to a range that is not dangerous. In contrast, ketoacidosis is a condition associated with a lack of insulin. For example, it can manifest in type 1 diabetics who fail to inject enough insulin, or who are newly diagnosed.
Eat the right amount of protein. Too much protein can increase insulin levels and decrease ketone levels, while not consuming enough protein can cause you to burn muscle rather than fat. If you exercise, protein levels should be hovering around 0.8g – 1.0g protein per lean pound of body mass a day. This helps with muscle mass retention and growth. However, if you are not exercising – your protein intake doesn’t need to be as high. A protein intake of 0.6g – 0.8g of protein per lean pound of body mass is going to be fine for sedentary individuals.
I completely agree with you. It’s all about moderation and by the sound of this blog, you went too deep into it and didn’t allow yourself exceptions which are encouraged on keto at times. Being too strict with any diet is not a good thing. It sounds more like a borderline eating disorder which I have suffered from in my past. Different things work for different people and It’s about finding the right balance which also includes exercise. People want to lose the weight fast without having to work at it. It’s not just about losing the weight though, it’s about creating a healthier way of living whether it be with keto or not. My last suggestion is never step on the scale to guide your progress. Gauge it by how your clothes are fitting and how you are feeling because in the end, THAT is the only thing that matters. Best of luck to you.
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?
However, the researchers noted that it was still substantial and noted that “Evidence from this systematic review demonstrates that low-carbohydrate/high-protein diets are more effective at 6 months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to 1 year.”  They emphasized, however, that more research needs to be done to evaluate the long-term effects of the ketogenic diet on weight-loss.
I am not a doctor and this is not to be taken, interpreted or construed as medical advice. Please talk with a licensed medical professional about this. These are just my own personal thoughts and not a prescription or a diagnosis or any form of health care whatsoever. Your mother can avoid the "keto flu" by adding sufficient sodium to her diet and staying well hydrated, especially in the first few days of starting to reduce carbohydrates. The keto flu could also be called “carbohydrate withdrawal symptoms” because of the effects on hormonal and electrolyte balance. If you're not already using a device to measure ketones in your body, I recommend this one: https://bengreenfieldfitness.com/ketonix As far as how much to take, it all depends….you can actually do more than two servings per day if you want, and you can experiment to see how many servings your body should handle. You should know that it would be very difficult to overdose on ketones. They are water soluble, so any excess ketones will be eliminated mainly via the urine. Hope this helps!
You said you saw Dr. Jeff Volek at UCONN. I am interested in ketosis to help me with my M.S. I still have questions related to M.S. and not so much as it effects on athletes. I do live in CT, but was unable to locate Dr. Volek at either the Storres or Farmington campus. Would you be able to give me either his e-mail address or telephone number so that I can contact him directly? Your help would be greatly appreciated.
Since the birth of my daughter 32 years ago, I have struggled with my weight. I remember when “fat free” was the only way to go. So for a year, I avoided fat like the plague and ended up with hair loss, gray dry skin and just an overall unhealthy look despite the fact I was at my healthy weight. Now we are suppose to eat massive amounts of fat according to the professionals. I have since learned that going from one of extreme to the other is not the answer and your blog has helped me to realize that I need to do what works for my body. It is as if you gave me permission to not listen to all the so called experts. I have started eating natural, If God made it I eat it. I no longer eat foods that come out of a box or that was created in a lab. I completely agree with your blog. Thanks for speaking out!
Lately anecdotal evidence has been building that a ketogenic diet can yield transformative results with respect to weight loss: with people taking to social media to share ‘before and after keto’ photos and to stories of ‘how keto changed my life.’ Despite this, concrete clinical evidence confirming that a ketogenic diet is superior to any other diet that creates a calorie deficit is lacking. At the moment the most accurate statement is that ‘the best diet for you is one you can stick to,” a pattern of eating that maintains a small calorie deficit should, over time, lead to weight loss.
I also found that I put on weight quite easily while eating low carb. I thought that being in ketosis meant I was burning my body fat, when in fact, I was just burning the fat that I was eating. Eventually, my female sex hormones tanked and I started gaining weight no matter what I did. I firmly believe this was because my body was in such a state of stress from not eating enough carbs.
So which MCT to pick? Brain Octane (pure C8) provides the fastest rise in ketones and burns the cleanest, with minimal gut irritation. XCT oil is more affordable but works more slowly with less direct cognitive effects. The capric acid C10 in XCT Oil doesn’t break down into ketones as quickly as pure caprylic C8, but capric acid C10 is more affordable, so you can save money by going with the XCT oil. XCT oil still goes to brain energy, just not as quickly as Brain Octane. Both can be used for energy without processing by the liver, unlike many other fats and oils.
Advocates of the keto diet will say that while their total cholesterol will increase, it’s only the good kind (HDL) that increases, not the bad kind (LDL.) However, a study using the keto diet as a form of treatment for epileptic seizures in children found that after 6 months of administering the diet, triglyceride levels increased, total cholesterol levels increased, and HDL and LDL increased. So if heart disease runs in your family, you may want to do more research before jumping on the Keto bandwagon.
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose). Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.
Enter keto cycling. Keto cycling involves following the keto diet for a certain amount of time and then having a day (or more) off. “It’s also called carb cycling,” says Molly Devine, RD, a Durham, North Carolina–based registered dietitian with KetoLogic, a website designed to educate people on keto. “That’s another term for it because there are higher-carb days and lower-carb days.”
Russell Wilder 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.
He is convinced that carbohydrate-heavy, low-fat diets are a major reason we're seeing high rates of diabetes, high blood pressure, obesity, and cancer. That's because a diet high in sugar can quickly raise insulin levels in the body. Over time, those spikes can lead to insulin resistance and eventually to long-term health issues like high blood pressure, Type 2 diabetes, inflammation, and obesity.
So I was following a ketogenic plan for the past month in an effort to lose about 4-5% body fat and try to turn down the inflammation in my body to help with my hashimotos and psoriasis. I don’t eat meat, so it was ALOT of eggs (from the farmers market), primal mayo, wild caught salmon and cold smoked lox (vital choice), brain octane oil, coconut oil, avocado oil with VERY little carbs…like 85% fat, 10% protein and 5% TOTAL carbs. I was eating about 1100-1200cal per day and BELOW 18g TOTAL carbs…Couldn’t get above .6 in AM fasted blood ketones or below 80 fasted blood sugar. I do 90min of Ashtanga yoga (primary and half of second series) 5 days a week and 20-30min weight/HIIT style workouts about 3-4 days per week (Kettlebell, jump rope, plyometrics and free weights). I take Concentrac Trace Minerals along with my d3/k2, l-carnitine, l-glutamine, forskollei, green pastures butter/cod liver oil and probiotics. I have been at the Bulletproof Conference this weekend and I bought the new Bulletproof exogenous Ketones to try.
Ketone bodies are acidic, but acid-base homeostasis in the blood is normally maintained through bicarbonate buffering, respiratory compensation to vary the amount of CO2 in the bloodstream, hydrogen ion absorption by tissue proteins and bone, and renal compensation through increased excretion of dihydrogen phosphate and ammonium ions. Prolonged excess of ketone bodies can overwhelm normal compensatory mechanisms, defined as acidosis if blood pH falls below 7.35.
Like the ketogenic diet, the subjects aimed to eat 20 grams of carbohydrates per day or less for a 2-3 month induction phase; then, they were asked to eat 50 grams of carbohydrates daily for the following 9-10 months. All participants were instructed to maintain a calorie deficit and utilize professional support to adjust to their diet and make sure that they stayed healthy. Additionally, the research team emphasized general health-promoting behaviors such as regular exercise and using nutritional supplements.
If you under-consume food, your body thinks it’s in starvation mode. Your metabolic rate drops to protect organs and normal bodily functions. Likewise, in an effort to conserve itself, your body slows down in response to insufficient energy levels or excessive exercise. So while you may think you’re making great strides toward your weight loss goals by eating less, you’re actually setting yourself up for failure. The bottom line: your body needs the right amount of high-quality food in the right proportions to reach a healthy weight.
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.