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In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]

Ketones are also a cleaner-burning fuel than carbs. They’re burned for energy in the mitochondria, and fewer free radicals (a highly-reactive, short-lived uncharged molecule) are generated when compared to burning glucose.15 What’s more, ketone molecules themselves cause a decrease in production of free radicals,21,22 while also increasing glutathione–a powerful antioxidant protecting against mitochondrial damage induced by free radicals.23
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?
Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 

I asked James Fell if he had some practical advice on sustainable dieting. “When it comes to weight loss,” he said, “the only thing that matters is caloric deficit. However, quality of diet affects quantity. A higher quality diet is more likely to be one that allows you to eat a lower quantity of calories and still be satisfied. That being said, there are many different ways to find a high-quality diet.”
About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether.[18] Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions.[46] This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.[9]
So far in my experiments I don’t find that “fake ketosis” induced via taking brain octane oil to get purple urine strips (while eating about 70 grams of total carbs/day) has the same satiating, craving-busting effects for me as “real ketosis” (eating under 50 grams of total carbs/day). In “fake ketosis” I still feel the need to eat something every 2-3 hours and constantly crave carbs. Does anyone else on a supplemental ketone diet experience this or are they able to eat less frequently?
Now open your eyes. Unfortunately, you still have the same amount of self-control as you before. Your roommate still wants to get margaritas and tacos next week. Butter still doesn’t taste good in coffee. Small-smilers on public transport are almost never going to say anything to you. The ketogenic diet is an empty promise, propagandized by brainwashed influencers and companies that want to profit from you. There’s no need to meditate on what being keto actually looks like -- just observe closely as the people around you, without apprehension, recreate their world based on diet blog listicles and tell you that you should, too -- until they realize the myth and quit and say nothing about it.

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!!


The same goes for people with type 2 diabetes. While some preliminary research suggests the keto diet may be safe and effective for certain people with type 2 diabetes, there’s still the risk for low blood sugar, especially for those on insulin, and the keto diet omits certain food groups known to benefit those with this disease. For example, a study published in September 2016 in the journal Nutrients highlights the importance of whole grains for helping to control weight as well as episodes of high blood sugar. Whole grains are off-limits on the ketogenic diet.
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.
I asked James Fell if he had some practical advice on sustainable dieting. “When it comes to weight loss,” he said, “the only thing that matters is caloric deficit. However, quality of diet affects quantity. A higher quality diet is more likely to be one that allows you to eat a lower quantity of calories and still be satisfied. That being said, there are many different ways to find a high-quality diet.”
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.
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You’re transitioning. Your body is equipped to process a high intake of carbs and a lower intake of fat. Your body needs to create enzymes to be able to do this. In the transitional period, the brain may run low on energy which can lead to grogginess, nausea, and headaches. If you’re having a large problem with this, you can choose to reduce carb intake gradually.

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.
And here’s the reality of the situation. Not all carbs are created equal. There’s a lot of cleverly labeled and modified maltodextrin on the market claiming to be some technical polysaccharide. Or, there’s plain old cornstarch relabeled as super-duper muscle engorging waxy maize. Most of these aren’t proven to do anything except deliver false hopes, high blood sugar, and gut issues – as opposed to having multiple clinical studies in real athletes to support what it is they’re claiming.

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.
But wait, there’s one loophole. Have polycystic ovary syndrome (PCOS)? Then the keto diet may help regulate your periods. “Women with PCOS have high insulin levels, which cause sex hormone imbalances,” notes Yawitz. In a small study published in the journal Nutrition & Metabolism, subjects with PCOS following a ketogenic diet for six months noted improvements in their menstrual cycles — and a small number of women became pregnant, overcoming previous infertility obstacles. “This study was very small, so we can’t make recommendations for all women with PCOS based on its findings,” says Yawitz. “And really, any diet that leads to weight loss should help in PCOS.”
If you’ve decided keto is a good fit for your wellness goals, and you want to add fruit to your meal plan, choose fruits with the least amount of net carbs, which is the total amount of carbohydrate content in a fruit minus its fiber content (since the body can’t digest fiber), according to the website for the popular low-carb diet Atkins. The keto diet allows for about 25 g of net carbs per day, per the healthy-lifestyle website Ruled.me. Dietitians recommend reaching for the following.
Cyclical keto diet: The Bulletproof Diet falls into this category. You eat high fat, low carb (less than 50 grams of net carbs a day) five to six days of the week. On day seven, you up your carb intake to roughly 150 grams, during what’s called a carb refeed day. Carb cycling this way helps you avoid the negative effects some people experience when they restrict carbs long term, like thyroid issues, fatigue and dry eyes.[9][10]  Learn more here about how carb cycling works.

Diabetic ketoacidosis occurs when ketone levels become too high, due to a lack of insulin, and poison the body. This condition can happen to anyone with diabetes, but it is more common in people with type 1 diabetes because their bodies don’t make insulin. In the event that their ketone level rises, their bodies are unable to produce insulin to slow down this production. If left untreated, this condition can lead to a diabetic coma or death.


As a matter of fact, from a pure biology perspective, lauric acid should actually be considered a LCT, because unlike C8 and C10 forms of MCT, lauric acid gets processed by your liver. This matters because your body metabolizes MCT’s differently than LCT’s: unlike LCT’s, MCT’s get very quickly converted into ketone energy to fuel your brain and body instead of requiring a pit stop in the liver for processing.
Hi Ben, great article. I have been a keto-adapted athlete for over 2 years, all through nutrition (65/25/10). I have recently discovered UCAN, KetoOS and MAP Aminos. So, here’s my question: If I am going out for a 4-hour ride, and I want to fuel myself just on these supplements and my body’s natural fat stores, how and in what order should I take them? If I take them all together, will the aminos in the KetoOS interfere with MAP Aminos? Or should I just make a mix of the UCAN and KetoOS in 10oz of water and use it to wash back my 6 MAP tablets, 15-mins before my ride? Thanks for your advice!
Eat fewer calories by lowering your fat intake. On keto, protein and carb intake is usually the same for everyone, but you may want to adjust your fat intake to eat fewer calories than you're eating now. Because keto has a metabolic advantage over other weight-loss diets, you may only need to reduce your calories slightly (around 300 kcal less a day).

“Given that there is no known detriment to consumption of a high-carbohydrate diet (other than body weight gain due to water retention) and some research reports a benefit, it is recommended that all athletes consume a high-carbohydrate training diet, i.e., at least 60-70% of energy as carbohydrate (7-10 g/kg), and increase this to 65-85% for the few days before competition. Use of a carbohydrate supplement before and during exercise will likely improve performance of intermittent, high-intensity sprints.”
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-adaption is a complex set of metabolic processes in which the body shifts from using primarily glucose for energy to using largely ketones and fat for energy. Achieving ketosis doesn’t mean the body is maximizing the use of these ketones; it takes longer than a few days for the body to get used to burning fat and ketones as its predominant fuels. 

A lot of changes are happening in your body and you’re going to feel it! The first five to seven days can be pretty rough, but your body is getting over its dependency on sugar. During this time of transition it is essential that you supplement electrolytes. Your body is flushing out lots of water, and with that goes electrolytes. The Keto Flu can be greatly reduced if you add sodium, potassium and magnesium to your diet. Check out our supplements page for a list of electrolyte supplements we recommend. Stay on course and you’ll start feeling better in no time!
The bottom line is that there have not been enough scientific studies, especially longer term ones, to really determine all the potential risks and benefits of the keto diet. Many of the claims out there on the Internet, social media, or television in either direction are anecdotal, meaning that they are individuals telling stories about what has supposedly been their experiences. Take everything you hear that is not supported by scientific evidence with a grain of salt (but not too much salt because too much can be bad for 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?

The bottom line? If you’re thinking about trying the ketogenic diet, run it by your doctor first — regardless of any preexisting health conditions. And consult a registered dietitian nutritionist (find one at EatRight.org) to find a nutrition professional who can work with you to create a meal plan you can stick to. People with kidney disease or a history of disordered eating should avoid the diet, and people with type 1 diabetes may want to avoid it, as well. If you have risk factors for heart disease, you’ll want to speak with your doctor before considering the diet.
There’s not enough of it to matter in coconut oil, it tastes bad, and it often results in stomach/gastric upset, but it does get converted quickly into ketones. If your MCT oil brand of choice makes your throat burn or has a weird flavor, one reason may be that the distillation did not remove enough of the C6. There are other reasons this can happen too, discussed below.

Those issues can be part of what's known as the “keto flu,” Warren says. Other side effects of the keto diet, all of which are tied to carb withdrawal, can include lightheadedness, nausea, mental fog, cramps, and headaches, in addition to tiredness. Luckily, the keto flu doesn't usually last more than a week—which is coincidentally about when people start to see the number on the scale go down, says Warren.


Thank you for this article as it cleared up a bunch of stuff for me. I started trying to get into ketosis back in August and lost 20lbs in about 6 weeks. Then it all stopped but had another 20lbs I wanted to loose. I had a hard time staying in ketosis and gave up about a week ago with the holidays approaching. Anyways I glazed over all the technical and science facts as it makes my head spin and might of missed it but my only question is what is the food portion of the diet like? The drinks are the easy part, do you have a diet plan that is good for someone that hits the gym hard 4-5 days a week for and hour and half. 45 min weights and 30-45 min cardio? It’s what I struggle with most the food and what attracted me to a ketogenic diet in the first place is eating 1 or 2 meals a day and being satisfied.
If you have a functioning pancreas that can produce insulin – i.e. you don’t have type 1 diabetes – it would be extremely hard or, most likely, impossible to get ketoacidosis even if you tried. That’s because high ketone levels result in release of insulin, that shuts down further ketone production. In other words, the body has a safety net that normally makes it impossible for healthy people to get ketoacidosis.
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]
The diet is extremely regimented and very difficult to stick to, as just one baked potato and one slice of bread could hold an entire day’s worth of carbohydrates. While this is a deterrent for many, Christy Brissette, RD, a private-practice dietitian in Chicago, notes that many of her patients like the diet because of its strictness. “Some of my clients feel that the keto diet works for them because it doesn't involve any calorie counting and the rules are simple to understand,” she says. “They feel they have strict parameters that can take the guesswork out of dieting.”
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.
On a low carb or ketogenic diet my fasting blood sugar is 90-120. I think it may get higher the lower carb I go. Most internet sources say don’t worry about it, worry about your Ha1c. Is this insulin resistance? Anyone have better information? If I do a water fast my morning blood sugar will go down and down each day, til it reaches about 50 in 4 days. But as soon as I start eating it pops right back up.
“Certainly, the quality of fat counts,” says Yawitz. “There’s a big difference nutritionally between bacon and almonds. As much as possible, people set on the keto diet should emphasize plant-based, unsaturated fats like nuts, seeds, olive oil, and avocado, which have even been shown to protect the heart.” If you have high cholesterol or other risk factors for heart disease, you should speak with your doctor before beginning the keto diet. This is because the diet may — but doesn't have to — include large amounts of saturated fat. Some studies have shown increases in cholesterol and triglycerides in people following the diet, while other research reveals that the keto diet may actually decrease heart disease risk as well as saturated fat intake. 
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