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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
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]
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Take coconut oil for example. The coconut oil industry loves to market the idea that relatively inexpensive and abundant coconut oil is a great source of MCTs because it’s “62% MCT oil”, but the problem is that studies show you can’t get many useful ketogenic MCT’s from just eating coconut oil or even most brands of “MCT oil”, which are often is diluted with lauric acid, a cheap, hugely abundant part of coconut oil that is typically marketed as an MCT oil.
It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]
Although you'll be cutting way back on carbohydrates and sugar, some fruits are still okay to eat on the keto diet (though you'll still want to be mindful about quantity in order to remain in ketosis). The fruits that make the cut contain far fewer carbs than their off-limits cousins such as apples, pears, bananas, pineapples, papayas, grapes, and fruit juices in general.

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?
I am curious if someone takes any or too much MCT oil (5-10 tablespoons/day) or Exogenous Ketones will the liver slow/stall or shut off endogenous ketone production as you are providing the ketones exogenously and thereby you may NEED to supplement ketones to maintain ketone levels or you may suffer a short term ketone deficit while the liver adjusts to making them on its own again. A parallel I am thinking of is exogenous testosterone supplementation and the hypothalamus/endocrine system slowing/stopping endogenous testosterone production (seen in bodybuilders).
Keto is short for ketogenic. If you didn’t already know, it’s a high-fat, low-carb diet. The goal of the ketogenic diet is to get your body into a “ketogenic state,” or a physiological state in which your body is not burning carbohydrates -- which break down to glucose -- but an alternative energy source called ketones, which are produced by the liver when your body is depleted of glucose. Ketones are formed from fat stores. In order for your body to start producing ketones, it needs to first run out of glycogen stores. After you deprive your body of carbs, it takes a bit of time for the glucose to clear out.

In its 2016 report “Healthy Eating Guidelines & Weight Loss Advice,” the Public Health Collaboration, a U.K. nonprofit, evaluated evidence on low-carbohydrate, high-fat diets. (The Keto diet falls under the LCHF umbrella.) Among 53 randomized clinical trials comparing LCHF diets to calorie-counting, low-fat diets, a majority of studies showed greater weight loss for the Keto-type diets, along with more beneficial health outcomes. The collaboration recommends weight-loss guidelines that include a low-carbohydrate, high-fat diet of real (rather than processed) foods as an acceptable, effective and safe approach.
Acetone, the least abundant ketone, is present in the breath and is responsible for the unpleasant odor. Acetone is a solvent in nail polish, if that gives you an idea of what it might smell like. But it's not as bas as it sounds; acetone breath is a sign of ketosis and fat burning. It's the ketone measured in breath tests used for detecting ketosis.6

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]
Some Inuit consume as much as 15–20% of their calories from carbohydrates, largely from the glycogen found in raw meats.[43][44][47][45][50] Furthermore, the blubber, organs, muscle and skin of the diving marine mammals that the Inuit eat have significant glycogen stores that are able to delay postmortem degradation, particularly in cold weather.[51][52][53][54][55][56]
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

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] 

"Many of the richest sources of fiber, like beans, fruit, and whole grains are restricted on the ketogenic diet," registered dietician Edwina Clark told Everyday Health. "As a result, ketogenic eaters miss out on the benefits of fiber-rich diet such as regular laxation and microbiome support. The microbiome has been implicated in everything from immune function to mental health."
For example, in trained people and athletes who eat a low-carbohydrate, high-fat diet (not to be confused with a low-carbohydrate, high-protein diet), a large amount of fat burning can take place at intensities well above 80 percent maximum oxygen utilization (VO2 max) – allowing for very-high-intensity or long efforts with low calorie intake and also allowing for use of fat fuel stores during long steady-state exercise, even at a relatively fast pace (so much for the “fat burning zone” giving you the best bang for your buck). With high-fat, low-carb intake, you can go hard and still burn tons of fat. In addition, this means that more carbohydrate stores will be available when you really need them, such as for an all-out, 100%, maximum effort.
I am not a doctor and this is not to be taken, interpreted or construed as medical advice. If you have poor liver or gallbladder function, it can be a good idea to take care of that prior to a high fat diet, yes. But a healthy high fat diet would not cause liver issues per se. These are just my own personal thoughts and not a prescription or a diagnosis or any form of health care whatsoever.
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]

Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.
Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) 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,[18] 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, diarrhea, 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.[18]

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.
^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
If you are already in ketosis and accustomed to high-fat, low-carb diets, you can take one heaping scoop in about eight ounces of water fifteen minutes prior to working out. It stays in your system and will provide your body with elevated ketone levels for about three hours. When taken as a pre-workout, KetoCaNa has also been shown to decrease the amount of oxygen consumed at a given power output.
So in the end, I ordered 1kg of pure BHB Magnesium from a supplier in China and I will be developing my own Ketone product with 30 servings as a lower price than all the competitors, and with more Magnesium, and Calcium in it than Sodium so that it tastes the best and actually helps with weight loss (which Magnesium is proven to do at the right amount). What the companies don’t tell you is that actually Sodium BHB is the cheapest, then Calcium BHB and then Magnesium BHB to source so I would be interested in knowing if what you wrote is actually true or just an excuse to make the product cheaper. Probably a mix of both.
In a state of ketosis, your body breaks fat down in the liver and converts it into ketones to be used for energy. Fat doesn't generate an insulin response, so insulin levels remain stable. This makes it much harder to store excess fat, and easier to tap into body fat stores for energy. Not only will this allow you to maintain your weight, but it will greatly encourage weight loss.
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).
Thanks for all of the great info!! I have Hashimoto’s and would really like to try a high fat/low carb diet. You mentioned that this might not be a good option for people with thyroid issues. How do you recommend I modify my diet to lose weight taking into consideration the Hashimoto’s. I take Westhroid, a non-synthetic thyroid supplement to help with my sluggish thyroid. Thanks so much for any advice you can give me. :)
Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show specific very-low-carb diets help people with metabolic syndrome, insulin resistance, and type 2 diabetes. Researchers are also studying the effects of these diets on acne, cancer, polycystic ovary syndrome (PCOS), and nervous system diseases like Alzheimer's, Parkinson's, and Lou Gehrig's disease.
The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[18] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug.[1] Some evidence indicates that adolescents and adults may also benefit from the diet.[9]
Before you consume a BHB salt, these individual components are held together by ionic bonds. However, when you consume a supplement containing a BHB salt, it is absorbed into the blood where it dissociates into free sodium (Na+), potassium (K+), and finally, the actual ketone. This means that consuming a product containing a BHB directly and immediately puts ketones into your blood, without the need for you to eat tons of fats or engage in carbohydrate restriction or fasting to generate the ketones.
Lemons are also keto-friendly, so go ahead and add a spritz of lemon juice to your ice water. One typical lemon wedge has about 0.5  g of net carbohydrates and only 0.2 g of sugar. The fruit also offers  3.7 mg of vitamin C, which is 6.2 percent of the DV. Lemon water contains antioxidants that fight free radicals, and it also promotes healthy digestion, according to the Cleveland Clinic.
Following the ketogenic diet and achieving ketosis may be beneficial if you’re living with type 2 diabetes and need to manage your symptoms. Limiting carbohydrate intake is crucial with type 2 diabetes because too many carbs can increase blood glucose levels, which can damage blood vessels and lead to vision problems, kidney problems, and nerve problems.

Twenty elite ultra-marathoners and ironman distance triathletes performed a maximal graded exercise test and a 180 min submaximal run at 64% VO2max on a treadmill to determine metabolic responses. One group habitually consumed a traditional high-carbohydrate (HC: n = 10, %carbohydrate:protein:fat = 59:14:25) diet, and the other a low-carbohydrate (LC; n = 10, 10:19:70) diet for an average of 20 months (range 9 to 36 months).
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.
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)?
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