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.
When HVMN Ketone was tested in mice, they performed 38% better on a maze solving challenge, so it's possible there may be a cognitive boost for humans also.9 While following a ketogenic diet, you avoid the energy peaks and troughs that come from quick-energy carbs. Producing ketones from stored body fat provides the brain with a steady, sustainable supply of fuel.

If you want to make some enemies very quickly, just jump on to social media and say "the keto diet stinks." Because there are certainly a number of people who swear by the keto diet. Some of them will even swear at you if you say anything bad about the diet. Supporters of the diet claim that the keto diet will help lose weight relatively quickly, clear your mind, make you feel better, and even clear up your acne, because you no longer are taking in carbohydrates that "cause inflammation." People who question the diet have raised concerns about whether maintaining such a high fat diet is effective and healthy in long run. After all, high fat diets could raise the risk of various chronic medical conditions such as heart disease and cancer.

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. 
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]

Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more

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]
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.
As you may know, "keto diet" is short for ketogenic diet, because who has the time to say "genic." It is a high-fat, moderate-protein, and low-carb diet with approximately 80% of your calories from fat, 15% from protein, and only 5% from carbohydrates. The goal of the diet is to induce ketosis in your body. The theory is that typically your body may rely on burning the carbs that you eat rather than the fat stores in your body for energy. The thinking is that by severely restricting the amount of carbs in your diet your body may then be forced to burn your body fat instead. Breaking down this fat then results in ketones, which is not some acapella group, but instead organic compounds made up of carbon, hydrogen, and oxygen atoms. One type of ketone produced is acetone, which is in certain types of nail polish removers. This accumulation of ketones may result in "keto breath", which is a rotten fruit or metallic smelling bad breath that can smell a bit like, surprise, surprise, nail polish remover.
My question is, does the benefit to using KetoCaNa only extend to significant decreases in oxygen demand/ increases in physical performance/ heightened mental acuity/cognitive performance.? Of course, these are all great benefits, but if I were to use KetoCaNa as a pre-workout, is it going to impair my endogenous ketone production? I usually train fasted with a strong black coffee and L-Carnitine.

"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
Hi Stacey, I can’t give medical advice and definitely recommend following your doctor’s recommendations. You can ask him/her if low carb would be better suited for you. Also, you may want to double check with him/her if the kidney concern was related to high protein, because that is a common misconception about keto – it is not a high protein diet/lifestyle.
On the ketogenic diet I feel very shaky/anxious from when I wake up til about noon. Eating doesn’t really help. It could be electrolyte related but seems possibly more related to excess cortisol/adrenaline as noon is also when I start to crash and get tired on a more normal diet, and because those 3 am awakenings that worsen simultaneously in ketosis seem to also have to do with HPA axis stuff. Does this side effect potentially also have to do with my fasting blood sugar being elevated? 

Similar to the BHB salts and MCT’s from the KETO//OS I discuss above, powdered forms of ketones are excellent if you don’t want to completely eliminate carbohydrates or protein (which can be gluconeogenic when eaten in excess) or eat copious amounts of fats, but want to simultaneously maintain high levels of blood ketones. It may also be used to ease the transition into a ketogenic state, because it can help alleviate the fatigue and lethargy some  people experience while making the transition from a glucose metabolism (carb burning mode) to ketone metabolism (fat burning mode).

Keep up electrolytes. The major electrolytes in our bodies are sodium, potassium and magnesium. Because a low carb diet (especially a keto diet!) reduces the amount of water you store, this can flush out electrolytes and make you feel sick (called “keto flu”). This is temporary, but you can avoid or eliminate it by salting your food liberally, drinking broth (especially bone broth), and eating pickled vegetables. Some people also choose to take supplements for electrolytes, but it’s best to first consult a doctor that understands and supports keto/low carb lifestyles.


I never stopped eating Keto friendly. I think I was just over eating and snacking, they have always been problems for me. My birthday, Christmas, New Years, overconfidence, my own depression, and an injury that keeps me from the gym, I let it add up. Joining in with my family with stevia desserts and cheese plates, it might be okay for some folks on Keto, not me. I didn't gain, so now I understand maintenance mode, I just couldn't break my low weight, I don't know how many times I relost the same 5 pounds.
Whether ketosis is taking place can be checked by using special urine test strips such as Ketostix. The strips have a small pad on the end, which the user dips in a fresh urine specimen. Within seconds, the strip changes color to indicate the level of acetoacetate ketone bodies, which reflects the degree of ketonuria, which, in turn, gives a rough estimate of the level of hyperketonemia in the body (see table below). Alternatively, some products targeted to diabetics such as the Abbott Precision Xtra or the Nova Max can be used to take a blood sample and measure the β-hydroxybutyrate ketone levels directly. Normal serum reference ranges for ketone bodies are 0.5–3.0 mg/dL, equivalent to 0.05–0.29 mmol/L.[29]
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]
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]
I’ll warn you: when you first start using BHB salts like KetoCaNa, it can cause some temporary GI upset until you get acclimated to use. For me, this manifested in just a little bit of gas and bloating that subsided after about one week of use. Additionally, you should know that this product contains salt, so it counts as part of your daily salt intake.
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.”
My keto journey began with chicken and avocado, like many high-fat brethren before me, until I eventually found the paleo cookbooks and created a little diet-friendly life for myself, devoid of family party-friendly foods but productive and communal in its own way. I was joining the online forums. I was reading studies about the health benefits of keto. I was drinking the bone-broth Kool-Aid, believing my fasting states and butter coffee were catapulting me towards some sort of psychophysiological excellence. I lost around 15lbs in 2015 because I didn’t allow myself most of the foods I usually “overdid” and was motivated not only by the progress but by the exclusive, cultish energy of ketosis. We were not the Google diet generation -- we were Google scholar. We treated epilepsy, after all, and our fearless keto leaders preached the Good News to all who would listen, then verbally abused well-meaning bloggers and medical professionals who suggested that extreme dieting might be unhealthy and unsustainable. Amen?
Note that urine measurements may not reflect blood concentrations. Urine concentrations are lower with greater hydration, and after adaptation to a ketogenic diet the amount lost in the urine may drop while the metabolism remains ketotic. Most urine strips only measure acetoacetate, while when ketosis is more severe the predominant ketone body is β-hydroxybutyrate.[36] Unlike glucose, ketones are excreted into urine at any blood level. Ketoacidosis is a metabolic derangement that cannot occur in a healthy individual who can produce insulin, and should not be confused with physiologic ketosis.

A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >
On the ketogenic diet I feel very shaky/anxious from when I wake up til about noon. Eating doesn’t really help. It could be electrolyte related but seems possibly more related to excess cortisol/adrenaline as noon is also when I start to crash and get tired on a more normal diet, and because those 3 am awakenings that worsen simultaneously in ketosis seem to also have to do with HPA axis stuff. Does this side effect potentially also have to do with my fasting blood sugar being elevated?
I am trying to get back into keto. I did it before and I was so happy when I lost 10lbs (I did the keto for a month). I am ready to go back to this lifestyle. All this information is very helpful, I have written it all down so it can be easier for me to remember what is allowed and what is not. Looking forward to get back on this keto journey. Thank you for all the great info.
Peak fat oxidation was 2.3-fold higher in the LC group (1.54 ± 0.18 vs 0.67 ± 0.14 g/min; P = 0.000) and it occurred at a higher percentage of VO2max (70.3 ± 6.3 vs 54.9 ± 7.8%; P = 0.000). Mean fat oxidation during submaximal exercise was 59% higher in the LC group (1.21 ± 0.02 vs 0.76 ± 0.11 g/min; P = 0.000) corresponding to a greater relative contribution of fat (88 ± 2 vs 56 ± 8%; P = 0.000). Despite these marked differences in fuel use between LC and HC athletes, there were no significant differences in resting muscle glycogen and the level of depletion after 180 min of running (−64% from pre-exercise) and 120 min of recovery (−36% from pre-exercise).
Great post!! I’m a 41 year old Master CrossFit athlete, been in keto / LCHF Primal lifestyle for the past 9 years. I feel that my performance has improved a lot and continues to improve pretty significantly. I was a top 200 Master Open Qualifier on 2016 and 2017 and I’m usually on the podium of local competitions so my performance is really not bad…and I’m totally fat adapted. I follow sort of a TKD where I sometimes eat carbs at night during the week, but never above 100g so It doesn’t even kick me out of ketosis due to activity level. I’ve been playing with some measurements and I noticed that my BG reading after high intensity training sessions is really high (up to 180mg/dl). But it goes down fast (sometimes it goes down to 50mg/dl but I show no side effect of hypo, function completely normal). From my research, the high glucose post high intensity is normal and due to the stressful response of the exercise and also because my liver is producing the glucose from gluconeogeneses to provide it for the workouts, when needed. This only happens when the workouts are long, above 30 minutes.
An interview with University of Florida researcher and scientist Dominic D’ Agostino. In that episode, “A Deep Dive Into Ketosis: How Navy Seals, Extreme Athletes & Busy Executives Can Enhance Physical and Mental Performance With The Secret Weapon of Ketone Fuel“, Dominic highlights his research into the use of ketones to enhance breathhold time and reduce the brain’s requirements for oxygen.

Under these circumstances, as soon as the body’s limited reserves of glucose starts to run out, your entire body switches its fuel supply to run almost completely on fat. The levels of the fat-storing hormone insulin levels become very low, and fat burning increases dramatically. You thus get easy access your fat stores, and can burn them off. This is great for losing excess weight. Studies prove that keto diets result in more weight loss, faster. There are also more potential benefits.
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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.
When your body burns its stores of fat, it can be hard on your kidneys. And starting a ketogenic diet -- or going back to a normal diet afterward -- can be tricky if you’re obese because of other health issues you’re likely to have, like diabetes, a heart condition, or high blood pressure. If you have any of these conditions, make diet changes slowly and only with the guidance of your doctor.
Let’s meditate for a second. Close your eyes. What do you see when you picture yourself on keto? Naturally, carb deprivation has carved out Michelangelo's David from your block of pudgy carrara marble. You have so much more energy now, thanks to the chunk of grass-fed butter (or ghee!) you’ve slid into your morning coffee. You're so spry, in fact, that you’re considering investing in bitcoin even though you’re late to the game, or writing a novel even though you don’t read, or getting into a relationship just because you’re overwhelmed by the trove of eligible suitors now bashfully small-smiling at you on public transport.
That was really interesting and useful information. But I wanted to ask you about what Dom said at time (52min). What does he mean,when he says 1 mml increase is about 10% increase of substrate to the brain? Is that (same glucose amount in brain) + (typical ketone amount in brain)+ and 10% more? Or does it substitute glucose? And if it is so, does the brain use that energy or does it just stay around the brain without being used? I know we can’t know for sure, but it would be helpful if you said what you think. Thanks in advance!
Acetyl-CoA can be metabolized through the TCA in any cell, but it can also undergo a different process in liver cells: ketogenesis, which produces ketone bodies.[27] Ketone bodies are also produced in mitochondria, and usually occur in response to low blood glucose levels.[28] When glucose levels are low, oxaloacetate is diverted away from the TCA cycle and is instead used to produce glucose de novo (gluconeogenesis). But when oxaloacetate is unavailable to condense with acetyl-CoA, acetyl-CoA cannot enter the cycle, and so the body has evolved an alternative way to harvest energy from it.
I’ve been experimenting with MCT Oil Brain Octane. I have one questions. I’ve been eating about 20 – 25 gr. of carbs per day on a high fat, medium protein diet. I’m measuring ketones in the morning before taking the MCT and after. I’ve been taking btw. 1-2 tbsp of MCT Brain Octane with butter (Bulletproof coffee) – I measure again after 30 min., 1hr, 2 hrs. and don’t see a raise in my blood ketones. Anything I’m missing, would love to hear your thoughts, Ben. – Thx I’m measuring with Precision Xtra and Ketonix Red.
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.

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]
-Cardiovascular Disease: High blood sugar has been shown to increase the risk for cardiovascular events, cardiovascular disease, and cardiovascular mortality—while lower glucose levels result in lower cardiovascular risk. Coronary artery disease risk has been shown to be twice as high in patients with impaired glucose tolerance, compared with patients with more normal glucose tolerance. The risk for stroke increases as fasting glucose levels rise above 83 mg/dL. In fact, every 18 mg/dL increase beyond 83 results in a 27 percent greater risk of dying from stroke. Incidentally, glucose can “stick” to cholesterol particles and render these particles extremely dangerous from a heart health standpoint, which is why it’s all the more important to control blood sugar levels if you’re eating a “high-fat diet.”

Longer-term ketosis may result from fasting or staying on a low-carbohydrate diet (ketogenic diet), and deliberately induced ketosis serves as a medical intervention for various conditions, such as intractable epilepsy, and the various types of diabetes.[6] In glycolysis, higher levels of insulin promote storage of body fat and block release of fat from adipose tissues, while in ketosis, fat reserves are readily released and consumed.[5][7] For this reason, ketosis is sometimes referred to as the body's "fat burning" mode.[8]


Use fat as a lever.  We’ve been taught to fear fat, but don’t! Both keto and low carb are high fat diets. Fat is our source of energy as well as satiety. The key to understand, though, is that fat is a lever on a low carb or keto diet. Carbs and protein stay constant, and fat is the one you increase or decrease (push the lever up or down) to gain or lose weight, respectively. So if your goal is weight loss, eat enough fat to be satisfied, but there’s no need to “get your fats in” once you’re satisfied.
In ketogenesis, two acetyl-CoA molecules instead condense to form acetoacetyl-CoA via thiolase. Acetoacetyl-CoA momentarily combines with another acetyl-CoA via HMG-CoA synthase to form hydroxy-β-methylglutaryl-CoA. Hydroxy-β-methylglutaryl-CoA form the ketone body acetoacetate via HMG-CoA lyase. Acetoacetate can then reversibly convert to another ketone body—D-β-hydroxybutyrate—via D-β-hydroxybutyrate dehydrogenase. Alternatively, acetoacetate can spontaneously degrade to a third ketone body (acetone) and carbon dioxide, although the process generates much greater concentrations of acetoacetate and D-β-hydroxybutyrate. When blood glucose levels are low, ketone bodies can be exported from the liver to supply crucial energy to the brain.[28]
Ben – curious about your thoughts on this. I went into ketosis (using LOTS of coconut oil) but it raised my cholesterol and doc was worried about my lp(a) level (17mg/dL on VAP) even though crp was 0.5, trigs 51 and a1c was 5.2. Advised a low fat diet. Have you seen this before with folks on a lchf/ketosis diet and is there anything to be concerned about? Off to read your coconut oil article. Thank you!
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