Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
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.
Ken, not 100% sure I understand your question but if you're asking if you should take any more supplements through out the week, it's hard to know without getting some blood testing done. If you want to go into detail, book a consult at bengreenfieldfitness.com/coaching and choose 20 or 60 mins and we'll get you scheduled. If you want to know specifically about fueling for your runs, have a read through this: https://bengreenfieldfitness.com/2013/07/what-…

Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]


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]
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.
Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.1There are scientifically-backed studies that show the advantage of a low-carb, ketogenic diet over a low-fat diet. One meta-analysis of low-carbohydrate diets showed a large advantage in weight loss. The New England Journal of Medicine study resulted in almost double the weight loss in a long-term study on ketone inducing diets.
In this study by Dr. Dominic D’Agostino it is also mentioned that your blood brain barrier (BBB) “is relatively impermeable to most hydrophilic substances, such as ketone bodies. Therefore, the transport of ketones across the BBB is highly dependent on specific carrier-mediated facilitated transport by a family of proton-linked monocarboxylic acid transporters”. Basically, what this means is that MCT powder may act as a carrier to shuttle the ketone bodies across the BBB.
I've tried that before(enzymedica digest gold for example) but it didn't seem to help much. It seems from testing that I have some heavy metal stuff going on and there might have been a chronic mold exposure in the past that is still reeking havoc and I imagine that might be affecting this pretty heavily. I will definitely be sticking to the avocadoes and coconut and 100% dark chocolate because I can't tolerate dairy. The hard part is figuring out what is the bare minimum of starch to make my gut feel good and be regular and at the same time become fat adapted and get those increased cognition and longevity benefits!!
Carbohydrates help control blood sugar levels, which are of particular importance for people with diabetes. A study published in May 2018 in the journal Diabetic Medicine shows that while a keto diet may help control HbA1c levels (a two- to three-month average of blood sugar levels), the diet may also cause episodes of hypoglycemia, which is a dangerous drop in blood sugar. Echoing many registered dietitians, the Lincoln, Nebraska–based sports dietitian Angie Asche, RD, says she is “hesitant to recommend a ketogenic diet for individuals with type 1 diabetes.”
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.

The difference between ketosis and ketoacidosis is the level of ketones in the blood. Ketosis is a physiological adaptation to a low carbohydrate environment like fasting or a ketogenic diet. There are situations (such as treatment-resistant epilepsy) where ketosis can be beneficial to health. Ketoacidosis is an acute life-threatening state requiring prompt medical intervention; its most common form is diabetic ketoacidosis where both glucose and ketone levels are significantly elevated.
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So how does our body make ketones out of the stored fat?  First blood sugar and insulin have to be low enough to allow access to stored fat.  If they are, stored fat (in the form of triglyceride) can be mobilized as a fuel source. A substance called hormone sensitive lipase (HSL) breaks the triglyceride compound down into one glycerol molecule and 3 fatty acid molecules. These fatty acid molecules come in various lengths of carbon based chains.
In fact, most folks have enough stored body fat to fuel aerobic activity for days and days without running out of energy. For example, a 150 pound dude at a hot, sexy and ripped at 8% body fat still carries 12 pounds of storage fat – which at 3500 calories per pound of fat can easily liberate 42,000 calories of useable fuel for exercise. You’ve got those same thousands of calories sitting around your waist, abs, hip, butt and thighs – just sitting there, waiting to be burnt.
Weight loss is my favorite side effect of keto. Coming in a close 2nd, 3rd, and 4th, and 5th is higher energy levels, no bingeing, clear skin, and lowered blood glucose! I don’t mind telling people that I’m Keto...or shutting down a conversation where they try and spew their online doctor degree about how I’m killing myself. This WOE work is for me, my bloodwork is the best it has ever been, and I feel great. Keto on, friends.
I'd recommend starting with glucose and hemoglobin A1C, along with a good multi like https://bengreenfieldfitness.com/multi and a fish oil like the one at greenfieldfitnesssystems.com – Anyways, 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.
Other causes of diarrhea on the keto diet include consuming a diet low in fiber (fiber helps ward off diarrhea by bulking up stool) and eating processed low-carb foods like shakes and bars that may contain sugar alcohols. These sugar alcohols can ferment in the gut and cause gastrointestinal discomfort. Yawitz suggests limiting foods labeled “sugar free” if you’re prone to gas or diarrhea when you eat them. And you may want to gradually adjust your carbs downward and your fats upward. “Also build your diet around [naturally] high-fiber, low-carb foods like avocado and nonstarchy vegetables such as broccoli, cauliflower, and asparagus,” she says. Other keto-friendly ways to get more fiber include chia seeds, almonds, and coconut.

On the keto diet, your body begins to shed fat, water and glycogen, and as this happens you lose key electrolytes, such as sodium, potassium and magnesium. When you're running low on these electrolytes, you might experience headaches or extreme fatigue. These losses are most pronounced during the first few weeks after you enter ketosis, so if you're going to start the keto diet it's best to plan ahead to make sure you get healthy amounts of these electrolytes — and other vitamins and minerals — either through supplements or a thoughtfully-designed meal plan.
Hey Alex, thanks for commenting and great to have you as a new listener! For this kind of thing, because it requires so going into detail, I'd suggest you book a consult with me by going to
Humans have always relied on ketones for energy when glucose sources were scarce (i.e. no fruits available during winter). It is a normal state of metabolism. In fact, most babies are born in a state of ketosis. However, with abundant sources of carbohydrate, people rarely access ketosis and it becomes a dormant metabolic pathway.Our ancestors likely had frequent periods of time when high carbohydrate food wasn’t immediately available. For this reason, our bodies are amazing at adapting to burning of ketones for fuel.
High blood sugar levels coupled with high blood ketones, on the other hand, will mean that you have a pathologically low level of insulin – something non-diabetics do not suffer from. This can lead to ketoacidosis – a potentially life-threatening condition. If this happens, you’ll need to inject more insulin; if you’re at all unsure of what to do, contact a medical professional. Coveting really high blood ketones for weight control is not worth the risk for type 1 diabetics.
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]
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.

On the keto diet, your body begins to shed fat, water and glycogen, and as this happens you lose key electrolytes, such as sodium, potassium and magnesium. When you're running low on these electrolytes, you might experience headaches or extreme fatigue. These losses are most pronounced during the first few weeks after you enter ketosis, so if you're going to start the keto diet it's best to plan ahead to make sure you get healthy amounts of these electrolytes — and other vitamins and minerals — either through supplements or a thoughtfully-designed meal plan.


For any long 90+ minute workouts or competitions for which glycogen depletion is a potential issue, use Glycofuse, but use half of the recommended serving of it, and add one scoop of Catalyte electrolytes, one scoop of Aminos, and one serving of medium chain triglycerides in the form of Brain Octane, KetoCaNa or KETO//OS (pick your poison, it’s up to you).
Ketosis is a metabolic state where most of the body's energy supply comes from ketone bodies in the blood, in contrast to a state of glycolysis where blood glucose provides most of the energy. Ketosis is characterized by serum blood concentrations of ketone bodies over 0.5 millimolar with low and stable levels of insulin and blood glucose. However, with ketone supplementation (as you’ll learn about later in this article) ketosis can actually be induced even when there are high levels of blood glucose.
A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]