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.
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]
Since the body’s acid-base buffering system cannot neutralize the vast amount of acidic ketones, the blood pH drops significantly. This buildup of acids in the blood poisons the body and can lead to ketoacidosis.12 Breathing becomes deep and rapid as the body attempts to compensate for excessive acids. Other symptoms of diabetic ketoacidosis include:
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.

It’s easy to get caught up on the “low-carb” part of the diet and not give enough attention to the “high-fat” part. Fat is what makes you full, gives you energy (when in ketosis), and makes food taste delicious. For most people this figure should be north of 70 percent of daily calories. Keep carbs under 20g, hit your protein goal, and eat fat until you’re full.


Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
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. 
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.
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
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[58] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[56]
Hi Gigi, Low carb and keto is about the balance of macronutrients eaten (fat, protein and carbs), not specifically meat or lack thereof. Most people on keto do eat meat, though some people do vegetarian keto. Fat is actually necessary for many body processes. There is no issue for the kidneys with a high fat diet, but if you eat too much protein that isn’t great for the kidneys. It’s a common misconception that keto is high protein (it isn’t). Keto is great for diabetics as it naturally helps stabilize insulin. All of this being said, please know I’m not a doctor and you should consult your doctor on any medical questions or before starting any diet. If you have more questions that aren’t medical questions, I recommend our low carb & keto support group here.
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).

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 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
The ketogenic diet is not a benign, holistic, or natural treatment for epilepsy; as with any serious medical therapy, complications may result.[28] These are generally less severe and less frequent than with anticonvulsant medication or surgery.[28] Common but easily treatable short-term side effects include constipation, low-grade acidosis, and hypoglycaemia if an initial fast is undertaken. Raised levels of lipids in the blood affect up to 60% of children[38] and cholesterol levels may increase by around 30%.[28] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and if persistent, by lowering the ketogenic ratio.[38] Supplements are necessary to counter the dietary deficiency of many micronutrients.[18]
Now, there a few things you should know before you begin using KETO//OS. First, ketones naturally act as a diuretic, so you lose salt, potassium, calcium and magnesium, and it is generally encouraged to increase sodium intake with ketones. That’s why there is extra sodium added to KETO//OS. The combination of BHB with sodium also acts as a bit of a buffer to buffer natural ketone acidity.
Great article! As someone who just started a “ketogenic diet” two weeks ago, I am opting to hold off on using ketone supplements for the following reason. You state how “Keto-adaptation occurs when you have shifted your metabolism to relying on fat-based sources, instead of glucose (sugar) sources, as your primary source of fuel.” If the goal is to “switch” our body’s energy supply to ketones and one uses supplemental ketones, how do they really ever know if their body has successfully accomplished this goal if they are using supplemental ketones? Aren’t they getting a false sense of ketosis if their blood or breath tests show them above 0.5 millimolar through the use of the supplements? I understand that it may take me longer to reach ketosis naturally but I guess I see it was worth it to truly reap all of the benefits that you outline in your article.
"But plenty of people have dietary restrictions," you say. And you're right. Plenty of people have allergic reactions or seizures if they don’t restrict their diets -- that’s why you don’t often find someone allergic to peanut butter spooning a jar of smooth Skippy at midnight to get that fix. Diets are largely psychological; there must be a big, sustainable answer to why am I dieting? And fear of dying is, obviously, a lifelong motivator.
Endogenous ketone production denotes ketones produced naturally by the body. It's the body’s natural adjustment to the absence or restriction of carbohydrate in the diet. Without enough glucose from carbs to fuel its cells, the body turns to fat to replace glucose as its primary source of energy. In the liver, fat that is not burned for energy directly is converted to ketones. This means that you are in a ketogenic state. Ketone levels increase in the bloodstream and provide an alternate and efficient fuel source for the body and brain. As a result, muscle protein is spared from being converted to glucose for energy.
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.

Hi Barb, That can definitely be it. Losing when you are close to goal can be more difficult. It could also be that your body’s healthy weight is a little higher than what you’d like – which doesn’t mean you can’t lose, but makes it more difficult. If just eating Keto foods isn’t working, double check the macros for your weight and see if the amount you’re eating needs to be adjusted. You’ll find more help and support in our support group here.
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.
To get the most benefit from the Keto diet, you should stay physically active. You might need to take it easier during the early ketosis period, especially if you feel fatigued or lightheaded. Walking, running, doing aerobics, weightlifting, training with kettlebells or whatever workout you prefer will boost your energy further. You can find books and online resources on how to adapt Keto meals or snacks for athletic training.
Basically, the proven science is in the pudding. A highly cited low-carb study from The New England Journal of Medicine concludes with the statement, “The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year.” The study mentions health benefits from the low carb diet, of course, but that it’s largely unsustainable.
You indicate that exogenous ketones do not shut down the ability, of your body, to oxidize fat. Is that to say it does not have an effect on your body at all? My specific question is… does my body oxidize less fat, when supplementing with exogenous ketones? I think you indicate in your article that it could. I would expect it to, in that if I supplement then my body would not “need” to oxidize the fat to provide the energy.
I see a lot of people say that ketosis is great for insulin sensitivity. BUT, in my experience ketosis causes physiological insulin resistance whereby the muscles and liver are sparing glucose for the brain. Hence, glucose tolerance actually goes down during ketosis. As such, is it possible that post workout carbs could do a lot more damage than they would on a non-ketogenic diet? Or maybe, as Kiefer suggests, glucose uptake post workout is not moderated by insulin at all i.e. muscles soak up glucose regardless of their insulin sensitivity? Or maybe cyclical ketosis doesn’t allow liver glycogen to get low enough to trigger physiological insulin resistance?
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.
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.
First, it’s important to understand how keto may help you lose weight. The purpose is to kick your body into ketosis, a natural metabolic state that forces your body to burn fat rather than carbs. This happens because, on the keto diet, you’re usually taking in 50 grams (g) or fewer of carbs per day, says Deborah Malkoff-Cohen, RD, a nutritionist based in New York City. While several types of the keto diet exist, the standard approach to this plan requires you to take in about 75 percent of your calories from fat, 20 percent from protein, and 5 percent from carbs.
2) I'm currently using Ketocana and in that section you state "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 fat or eat copious amounts of fats, but want to simultaneously maintain high levels of blood ketones." – How would eating copious amounts of fat be a negative? Wouldn't that help contribute to a ketogenic state?

Me, I was a lot of things before I was keto: vegan, high starch, skinny, an Adderall abuser, paleo, Catholic, raw till 4, pescatarian, etc. The reason I went high fat/low carb was because some very smart-sounding people on the internet told me that I could “hack my body” and eat some fun things (bacon) if only I’d cut out a food group that was probably giving me constipation and cancer anyway.
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