There are many misconceptions about ketosis. The most common is mixing it up with ketoacidosis – a rare and dangerous medical condition that mostly happen to people with type 1 diabetes if they don’t take insulin. Even some health care professionals tend to mix up these two situations somewhat, perhaps due to the similar names and a lack of knowledge about the distinct differences.
“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.
After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]
These are the widely recognized LCT’s, or long chain fatty acids in coconut oil, mostly saturated, including stearic acid (C18:0), oleic acid (C18:1), and linoleic acid (18:2). The exact percentage of each depends on region the coconut is grown, time of harvest, and other growing variables. They are good as a fuel source in your food, and have some of the tastiness of coconut oil, if your goal is getting into ketosis fast, you won’t benefit from eating a lot more of them compared to eating true medium chain fatty acids.
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.

“If you’re going to do keto, there’s a better and a worse way to do it,” says Yawitz. “Loading your plate with meats, and especially processed meats, may increase your risk for kidney stones and gout,” which is a painful type of arthritis. “High intake of animal proteins makes your urine more acidic and increases calcium and uric acid levels. This combination makes you more susceptible to kidney stones, while high uric acid can increase your risk for gout,” adds Yawitz.
Fascinating stuff and I am quite curious how we know for certain one is actually in ketosis i.e. using ketones as primary fuel source BECAUSE we do know that glucose has a shorter metabolic pathway to burn and under most conditions, given the presence of glucose, that is what the body will default to which is why high fat and high sugar together in diet is so detrimental. So if we use one or more of the above “boosters” and show high levels of blood ketones but also highish levels of glucose (during initial transition) will be mostly burning ketones or still defaulting to glucose?
Typically, to gain lean body mass one needs to have some degree of caloric surplus, or at the very least, not be in a significant deficit. This is especially true when looking to add muscle mass. It is certainly possible to gain muscle mass on a ketogenic diet. For most individuals this would require consuming adequate protein (while still remaining in ketosis), enough calories to support growth, sufficient electrolytes to support muscle function, as well as incorporating progressive resistance training. The type and volume of resistance exercise needed to add lean body mass will be very dependent on the individual and their age, training status, health status, etc. Therefore, the answer to this question can become quite nuanced, but in simple terms, yes, it is very possible to gain lean body mass on a ketogenic diet while still taking advantage of the health promoting effects this way of eating provides.
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.
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. 

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.
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]
Meat products make up a big part of the keto diet, but experts stress the importance of choosing quality. "Since the keto diet is based a lot on animal proteins, it's important to buy organic poultry and grass-fed, organic beef," says Aimee Aristotelous, RD. "Not only do organic selections help with limiting environmental toxins, but grass-fed options of red meats even change the composition of fats." The result, she explains, is that your body is able to better absorb those healthy fats.
Note: Because you'll be excluding some major food groups on the keto diet (grains, many fruits) you should definitely think about taking a multivitamin—especially one that contains folic acid, which helps your body make new cells and is often found in enriched breads, cereals, and other grain products, says Julie Upton, R.D., cofounder of nutrition website Appetite for Health.

These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.


The presence of abnormally high levels of KETONES in the blood. These are produced when fats are used as fuel in the absence of carbohydrate or available protein as in DIABETES or starvation. Ketosis is dangerous because high levels make the blood abnormally acid and there is loss of water, sodium and potassium and a major biochemical upset with nausea, vomiting, abdominal pain, confusion, and, if the condition is not rapidly treated, coma and death. Mild ketosis also occurs in cases of excessive morning sickness in pregnancy.


^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.

A small Feb. 20, 2017, study looked at the impact of a six-week ketogenic diet on physical fitness and body composition in 42 healthy adults. The study, published in the journal Nutrition & Metabolism, found a mildly negative impact on physical performance in terms of endurance capacity, peak power and faster exhaustion. Overall, researchers concluded, “Our findings lead us to assume that a [ketogenic diet] does not impact physical fitness in a clinically relevant manner that would impair activities of daily living and aerobic training.” The “significant” weight loss of about 4.4 pounds, on average, did not affect muscle mass or function.
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.
"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.
Considered a symptom of the keto flu, your breath on this diet often smells fruity at first. This is because acetone is a by-product of ketosis and is eliminated mostly through the lungs and the breath, according to a study in the journal International Journal of Environmental Research and Public Health in February 2014. Acetone is a type of ketone known for having a fruity aroma in smaller concentrations. “It’s hard to say exactly how long it will last as it depends on the person, but it’s common for someone to experience this side effect for a few weeks,” says Asche.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
I just discovered your site and have been thoroughly enjoying many of the articles and appreciate that you get so in depth in your explanations. I’m in my late 40’s and, while not an extreme endurance athlete, I am moderately active with 18-20 mile rides 3x a week as well as some boxing and body weight resistance (push up, pull up, etc) mixed in. I’ve generally been paleo and stick to quality macros for the most part (grass fed meats/dairy, organic veg and oils) and zero supplements. I recently started following keto (after reading this article) about 10 days ago and things seem good thus far. I do, however, want to avoid any of the negative side effects you mention and also not lose any lean muscle. I’m currently about 174 lbs, 5’8″ and about 19% bodyfat – I’m taking in about 95g protein, 130g fat and <20g net carbs. I'm eating all quality – wild salmon, grass fed beef, pastured eggs, coconut oil, Brain Octane and Grass fed butter in coffee, sardines, etc. With a smattering of organic veg, but it seems real easy to bust through the carb barrier. *I'M ALSO TAKING KETOCANA PRE-WORKOUT* and I notice this is keeping me going throughout a ride or the gym.
If you remain under your optimal net carbs limit, then you should enter ketosis within 2 to 3 days. But it can take up to 7 days. The fastest way to get into ketosis is to exercise on an empty stomach, in order to accelerate the depletion of glycogen in your body. You can also do a Fat Fast for a few days (eating more fat) to speed up the rate at which you enter ketosis AND start to cut out refined carbs (like sugar) before you go for full ketosis. Another option is to do a water fast, (only drinking water) which also speeds up getting into ketosis.
What would your advice be to a high raw vegan who wants to try an HRV keto diet? The supps you recommended above look vegan, but aren’t the results based on those of omnis? Would they work the same way on vegans? Also I heard you mention in the recent Keto Summit that SE Asians need a little more carb and I happen to be one. I’m a petite 39-YO female and I’ve been raw for the past 11 years. I have been practicing intermittent fasting in the last 7 years and try to eat only twice a day. Up to how many grams of carbs can I consume to get into ketosis?

In addition to adding in precious electrolytes such as potassium, magnesium, sodium, chloride, and calcium for supporting nerve impulses and muscle contraction, the Gaspari Nutrition R&D Team have also build their Osm Technology into this product. This “new way” of looking at carbohydrate drinks utilizes a proprietary method of tuning the electrolytes in solution with pure cyclic dextrin to get an optimal osmolality (mOsm). In a nutshell, this results in lower osmolality, and lower osmolality results in faster gastric clearance, and a clean, easy burn of your fuel.


First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48] 

So I was following a ketogenic plan for the past month in an effort to lose about 4-5% body fat and try to turn down the inflammation in my body to help with my hashimotos and psoriasis. I don’t eat meat, so it was ALOT of eggs (from the farmers market), primal mayo, wild caught salmon and cold smoked lox (vital choice), brain octane oil, coconut oil, avocado oil with VERY little carbs…like 85% fat, 10% protein and 5% TOTAL carbs. I was eating about 1100-1200cal per day and BELOW 18g TOTAL carbs…Couldn’t get above .6 in AM fasted blood ketones or below 80 fasted blood sugar. I do 90min of Ashtanga yoga (primary and half of second series) 5 days a week and 20-30min weight/HIIT style workouts about 3-4 days per week (Kettlebell, jump rope, plyometrics and free weights). I take Concentrac Trace Minerals along with my d3/k2, l-carnitine, l-glutamine, forskollei, green pastures butter/cod liver oil and probiotics. I have been at the Bulletproof Conference this weekend and I bought the new Bulletproof exogenous Ketones to try.
Keto-adaptation, AKA “becoming a fat burning machine”, occurs when you have shifted your metabolism to relying on fat-based sources, instead of glucose (sugar) sources, as your primary source of fuel. Your body increases fat oxidation, and breaks down fats into ketones to be used as the primary energy source. Depending on your current level of carbohydrate intake (takes longer if you’re pretty sugar addicted), this process can take two weeks to six months to fully train your body to, but once done, it’s done, and you have achieved fat-burning status that can stick with you for life.
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The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[18] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug.[1] Some evidence indicates that adolescents and adults may also benefit from the diet.[9]
You need to do a “common man’s” version of a good ketogenic nutrition program or discussion. Great article, and I leaned a few things. Those Ketone Salts and other supplements can get pricey. I eat a very low carb and high fat diet and meander in and out of ketosis during the week. A pure ketogenic diet is so restrictive that meals it can get very repetitive during the week. I’d like to learn more about cooking with oils and how temperature effects their qualities. I can only handle eating so much raw food, and I love to cook my greens and other vegetables in bacon fat and coconut oil. It will be next May before I can get my blood work performed (insurance reasons) so until then I’ll need to be careful and hold back on those after supper dark chocolate excursions! Thanks!!
The reason purity matters is that C17 is a byproduct of most MCT oil production processes, and it, along with C6, is a major cause of throat burning and gut irritation. Most MCT’s on the market are manufactured via chemical and solvent based refining, which involves using chemicals like hexane and different enzymes and combustion chemicals, such as sodium methoxide. But ideally, you should get an MCT oil that is made using triple steam distillation in a non-oxygen atmosphere to avoid lipid oxidation and create a purer end-product.
A high-fat diet also trains your body to burn even more fat during exercise, even at high intensities. Fat is released faster and in greater amounts from your storage adipose tissue and transported more quickly into your muscles and mitochondria. Your muscles also store more energy as fat and use this fat-based fuel more efficiently and quickly. Even more interestingly, a high-fat diet can cause a shift in the gene expression that codes for specific proteins that increase fat metabolism – and create very similar adaptations to exercise itself. So the mere act of shifting primary fuel intake from carbohydrates to fat begins to make you more “fit”, even if you’re not exercising.
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Adipose tissue can be used to store fatty acids for regulating temperature and energy.[21] These fatty acids can be released by adipokine signaling of high glucagon and epinephrine levels, which inversely corresponds to low insulin levels. High glucagon and low insulin correspond to times of fasting or to times when blood glucose levels are low.[23] Fatty acids must be metabolized in mitochondria in order to produce energy, but free fatty acids cannot penetrate biological membranes due to their negative electrical charge. So coenzyme A is bound to the fatty acid to produce acyl-CoA, which is able to enter the mitochondria.
^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
In the US especially, coconut oil and MCT oil manufacturers are legally allowed to claim that lauric acid is an MCT because chemists named it that way, even though it does not act like other true biological MCT oils. If you are relying on plain coconut oil or “MCT-labeled” oil to get enough useful MCTs, think again and check the label: odds are you’re getting very few of the potent, ketogenic shorter chain MCTs (also known as “C8” and “C10”), and instead getting mostly cheaper but ineffective lauric acid.
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.
Awesome… I am a newbie to this i took the keto os for 2 months for weight loss and did well. It a bit pricey. I try hard to conform to lchf diet daily but see no change other than I crave sweets. In 5’7 270 and stuck! My highest weight was 390 had gastric band put in 10 years ago but its just keep me from consumption of large amounts at on time. Is there a more economical way to stay in ketosis? I wAnt more energy… In not an exercise person usually have no energy. In willing to try other ideas.
Normal body cells metabolize food nutrients and oxygen during cellular “respiration”,  a set of metabolic pathways in which ATP (adenosine triphosphate), our main cellular energy source is created. Most of this energy production happens in the mitochondria, tiny cell parts which act as powerhouses or fueling stations. There are two primary types of food-based fuel that our cells can use to produce energy:
Frankly, the results of my foray into ketosis and eventually keto-adaptation were astounding. I had the best Ironman triathlon season of my life and shocking levels of mental focus and physical ease, especially for races and workouts that lasted longer than two hours. Without experiencing muscle loss, hunger pangs or brain fog, I found I could go the entire day without eating, which was enormously helpful for business and personal productivity. My gas, bloating, fermentation and GI “issues” disappeared. My blood levels of inflammatory markers like HS-CRP and cytokines dropped to rock-bottom, while my levels of good cholesterol, vitamin D, and anti-inflammatory fatty acids skyrocketed.
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