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.

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]

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!
Hi Ben, I have a question about being in ketosis. So from what I understand, a serving of Keto os will keep you in ketosis for about 4-6 hours or so……my question is doesn’t your body have to be in constant ketosis in order to really experience the benefits of using the fat as fuel? Also, if someone is not following the Keto diet, what happens to the glucose they are still consuming if they are supposedly using ketones for energy? Also, do you see any benefit from using Keto os vs. Brain Octane? I ask because there is a significant difference in price. Thank you so much!!
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 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?

Great article, thanks for the info. My question would be this: Is there any benefit for weight loss by taking the Keto/OS and not making any dietary changes (eating standard American diet) In other words, will the Keto/OS help me to lose weight without going on a special diet? Do I have to work out in order to benefit (weight loss) from using this product?
I am new to Keto, but not new to a low carb diet. I just started a keto diet 8 days ago. My goals for being on the diet is a little body recomp (nothing major, a few pounds of fat loss), and moving to fat as primary fuel for endurance with a focus on trail ultra marathon races and training. Along with Keto I am doing heart rate training using MAF and OFM as a guide. supplemented with body weight and free weight strength training and some HITT.
Ben, great article! I recently did my own ketosis experiment and didn’t catch the 100-200g advise until later than I should have, I’m guessing. Great results for 1-2 months but after 3 months I quit sleeping through the night and would wake after about 4 hours of rest each night. My guess is that the extra carbs at night coupled with iodine supplements should allow me to “have my cake and eat it too?” Any other suggestions on the sleep issue? I’ve gone back to High Fat/Low Carb, have improved sleep but I do miss nutritional ketosis and want to try again once my sleep is stable. Thank YOU!!!
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]
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
The keto diet is often called a fad diet. Make no mistake: it is. But unlike other trendy diets, the keto diet is unique because it actually pushes the body into an alternate, natural metabolic state called ketosis. When this happens, you can reliably expect a few negative side effects, notably those that come with the "keto flu." But other side effects emerge only when people implement the keto diet poorly, typically by failing to eat balanced, nutrient-rich foods as a part of a high-fat, low-carb diet.
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).
Long-term disruption of menstruation can bring on serious side effects, including low bone density. “This is because estrogen is very important to bone health,” says Yawitz. “Studies have also found prolonged menstrual irregularity to increase risk for cardiovascular disease, depression, anxiety, and sexual dysfunction. It’s important to contact your ob-gyn if your cycles become irregular or if you stop having periods.”
Intermittent fasting is another way to achieve ketosis. This doesn’t suggest going days without food, but rather intermittent fasting. You can eat for eight hours and then fast for 16 hours, or eat a low-calorie diet for a few days (about 1,200 daily calories if you’re a woman and 1,500 daily calories if you’re a man). As you take in less food, your body uses more of its fat stores for fuel.
First, a little background: Eric Westman, MD, director of the Duke Lifestyle Medical Clinic, explained to Health in a previous interview that in order to successfully follow the keto diet, you need to eat moderate amounts of protein, reduce your carb intake, and increase fats. When you reduce your carb consumption, your body turns to stored fat as its new fuel source—a process called ketosis. To stay in ketosis, followers of the keto diet must limit their carbs to 50 grams a day, Dr. Westman says.
Ketosis is a nutritional process characterised by serum concentrations of ketone bodies over 0.5 mM, with low and stable levels of insulin and blood glucose.[1][2] It is almost always generalized with hyperketonemia, that is, an elevated level of ketone bodies in the blood throughout the body. Ketone bodies are formed by ketogenesis when liver glycogen stores are depleted (or from metabolising medium-chain triglycerides[3]). Ketones can also be consumed in exogenous ketone foods and supplements.

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. 
After about two to seven days of following the keto diet, you go into something called ketosis, or the state your body enters when it doesn't have enough carbs for your cells to use for energy. That's when you start making ketones, or organic compounds that your bod then uses in place of those missing carbs. At this point, your body also starts burning fat for more energy, says Beth Warren, R.D., founder of Beth Warren Nutrition and author of Living A Real Life With Real Food.

The benefits above are the most common ones. But there are others that are potentially even more surprising and – at least for some people – life changing. Did you know that a keto diet can help treat high blood pressure, may result in less acne, may help control migraine, might help with certain mental health issues and could have a few other potential benefits?
What is the link between ketones and diabetes? Ketone is a chemical produced by the body when fats are broken down for energy. Ketone testing is important for people with diabetes, because high levels can lead to diabetic ketoacidosis (DKA), when acid levels become too high in the blood and the person loses consciousness. Find out when and why to do ketone testing. Read now

Long-term disruption of menstruation can bring on serious side effects, including low bone density. “This is because estrogen is very important to bone health,” says Yawitz. “Studies have also found prolonged menstrual irregularity to increase risk for cardiovascular disease, depression, anxiety, and sexual dysfunction. It’s important to contact your ob-gyn if your cycles become irregular or if you stop having periods.”
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!
^ Lawrie 2014, pp. 92-. "A much delayed onset of rigor mortis has been observed in the muscle of the whale (Marsh, 1952b). The ATP level and the pH may remain at their high in vivo values for as much as 24h at 37ºC. No adequate explanation of this phenomenon has yet been given; but the low basal metabolic rate of whale muscle (Benedict, 1958), in combination with the high content of oxymyoglobin in vivo (cf 4.3.1), may permit aerobic metabolism to continue slowly for some time after the death of the animal, whereby ATP levels can be maintained sufficiently to delay the union of actin and myosin in rigor mortis."
This benefit surprised me when I first discovered it, but eating fewer carbohydrates during a workout can actually help you recover from workouts faster. The repair and recovery of skeletal muscle tissue is dependent on the “transcription” of certain components of your RNA. And a bout of endurance exercise combined with low muscle-carbohydrate stores can result in greater activation of this transcription. In other words, by training in a low-carbohydrate state, you train your body to recover faster.
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.

Wow! Amazing article. I don’t read blogs regularly, but I’ll be reading more of yours. I am on day 11 of a fast to get me into ketosis; 7 days bone broth and now on day-4 water only. Intentions are weight loss (10# down, 15# more to go) and immunity improvement/gut help. Planning 9 days of whey water, fermented veggies and mad probiotics when the water days are done (day 14?). After this fast I want to stay fat adapted, start training again and get down to 8% body fat. I believe you have cut that journey significantly with this article. Thank you.
Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]
"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.
Around this time, Bernarr Macfadden, an American exponent of physical culture, popularised the use of fasting to restore health. His disciple, the osteopathic physician Dr. Hugh William Conklin of Battle Creek, Michigan, began to treat his epilepsy patients by recommending fasting. Conklin conjectured that epileptic seizures were caused when a toxin, secreted from the Peyer's patches in the intestines, was discharged into the bloodstream. He recommended a fast lasting 18 to 25 days to allow this toxin to dissipate. Conklin probably treated hundreds of epilepsy patients with his "water diet" and boasted of a 90% cure rate in children, falling to 50% in adults. Later analysis of Conklin's case records showed 20% of his patients achieved freedom from seizures and 50% had some improvement.[10]

^ Hochachka PW, Storey KB (February 1975). "Metabolic consequences of diving in animals and man". Science. 187 (4177): 613–21. Bibcode:1975Sci...187..613H. doi:10.1126/science.163485. PMID 163485. In the terminal stages of prolonged diving, however, even these organs must tolerate anoxia for surprisingly long times, and they typically store unusually large amounts of glycogen for this purpose.

Watermelon is a staple summer fruit and another low-carb way to help satisfy your sweet tooth on keto. Each ½ cup of diced watermelon has 5.4 g of net carbs. It’s also an acceptable choice when dieting because of its high water content. The ½ cup serving size of watermelon has about 23 calories and 4.7 g of sugar. This juicy fruit also offers 432 IU of vitamin A, which is 8.6 percent of the DV.

Moreover, recent studies show that the Inuit have evolved a number of rare genetic adaptations that make them especially well suited to eat large amounts of omega-3 fat.[57][58][59] And earlier studies showed that the Inuit have a very high frequency—68% to 81% in certain arctic coastal populations—of an extremely rare autosomal recessive mutation of the CPT1A gene—a key regulator of mitochondrial long-chain fatty-acid oxidation[60][61]—which results in a rare metabolic disorder known as carnitine palmitoyltransferase 1A (CPT1A) deficiency and promotes hypoketotic hypoglycemia—low levels of ketones and low blood sugar.[62] The condition presents symptoms of a fatty acid and ketogenesis disorder.[62] However, it appears highly beneficial to the Inuit[60] as it shunts free fatty acids away from liver cells to brown fat, for thermogenesis.[63][64] Thus the mutation may help the Inuit stay warm by preferentially burning fatty acids for heat in brown fat cells.[64] In addition to promoting low ketone levels, this disorder also typically results in hepatic encephalopathy (altered mental state due to improper liver function), enlarged liver and high infant mortality.[65] Inuit have been observed to have enlarged livers with an increased capacity for gluconeogenesis, and have greater capacity for excreting urea to remove ammonia, a toxic byproduct of protein breakdown.[57][66][67][68] Ethnographic texts have documented the Inuit's customary habit of snacking frequently [69] and this may well be a direct consequence of their high prevalence of the CPT1A mutation[70] as fasting, even for several hours, can be deleterious for individuals with that allele, particularly during strenuous exercise.[57][70] The high frequency of the CPT1A mutation in the Inuit therefore suggests that it is an important adaptation to their low carbohydrate diet and their extreme environment.[57][60][70]
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.
Make things yourself. While it’s extremely convenient to buy most things pre-made or pre-cooked, it always adds to the price per pound on items. Try prepping veggies ahead of time instead of buying pre-cut ones. Try making your stew meat from a chuck roast. Or, simply try to make your mayo and salad dressings at home. The simplest of things can work to cut down on your overall grocery shopping.
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 will begin a medically supervised weight loss program on Tuesday, that is intended to put me into ketosis via a very low calorie, high protein diet of shakes for two meals per day and one (controlled) regular meal. The overview of the program says to expect up to 2 weeks of foggyness and crankiness while getting in to ketosis. Will taking KetoCaNa 3 times a day for two days in advance of starting the diet (and during the introduction to the diet) help move me more quickly through the foggy, cranky phase? And should I also be eating (a ketogenic diet) during those two days or only drinking the KetoCaNa? My thanks in advance for any light you can shed on this!
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][31][32] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.[9][33]
I have been taking Ucan 30 Minutes before run and take UCAN 1 Hour into run and 1 hour later. Also take BCAA powder in 8 ounce liquid during run. I have been doing HFAT and LCARB diet. Problem i slow down after 1 1/2 hour during my long run. I need your advice help fueling my run after 14 miles. This my first Marathon, I have run 7 Half Marathon around 1.58.

^ Lockyer, Christina (1991). "Body composition of the sperm whale, Physeter cation, with special reference to the possible functions of fat depots" (PDF). Journal of the Marine Research Institute. 12 (2). ISSN 0484-9019. Retrieved 2014-04-25. The significant levels of carbohydrate, probably mostly in the form of glycogen, in both blubber and muscle, may represent an instant form of energy for diving via anaerobic glycolysis.
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.