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.

Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[18] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[51] Other formula products include KetoVolve[52] and Ketonia.[53] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[53]
-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.”
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.

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.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[18]

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.
When glucose levels are low, especially over time, most cells will switch to using ketone bodies for fuel. Ketones allow cells to be metabolically flexible, so to speak. Even the brain and nerve cells, which are heavily dependent on glucose can utilize ketone bodies for fuel. This ability of most normal cells to use ketones when glucose is unavailable indicates that their cellular mitochondria are healthy and functioning properly. 
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.
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.
Koia Keto is our answer to your Keto needs! We start with a coconut milk base, blend in our Koia proprietary protein blend of pea, rice and chickpea proteins, then add ingredients you need on your Keto journey, like MCT oil, to create a 100% plant based protein beverage. Each flavor is crafted to be a deliciously indulgent treat, with choices like Chocolate Brownie and Cake Batter, so you don’t feel like you’re missing out on that midnight ice cream just because you’re staying Keto. Every bottle is packed with 14g of MCT oil, providing healthy fats for fuel, with 0g added sugar. Koia Keto is the indulgent solution for any time your sweet tooth is calling.

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.
A computer program such as KetoCalculator may be used to help generate recipes.[47] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[37]

In the 1960s, medium-chain triglycerides (MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides).[15] MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system.[16] The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[15] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[10]

If you’re serious about maximizing the benefits of ketosis, then forego coconut oil, MCT liquid oil, olive oil, etc. and instead use Brain Octane as your oil of choice for recipes like bulletproof coffee, or in teas, salad dressings, or as a sushi or entrée flavor enhancer. For a slightly less expensive, but not quite as effective form of MCT, use XCT oil.

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.
If you’re following the keto diet, you will need protein, but you should limit your intake to about 20 percent of your total daily calories. (1) This is important because when you consume more protein than you need, your body converts the excess protein into carbs through a process called gluconeogenesis. This process pushes your body out of ketosis.
If you’ve never heard of rhubarb, it might be time to broaden your palate. Rhubarb tastes tart, and you can enjoy it raw, roasted, or puréed in a small, low-carb smoothie or moderate portion of sauce. A ½-cup serving contains about 1.7 g of net carbs and only about 13 calories. Rhubarb also has 176 mg of potassium (3.7 percent DV), 62 international units (IU) of vitamin A (1.2 percent DV), 4.9 mg of vitamin C (8.2 percent DV), and 52 mg of calcium (5.2 percent DV). Just remember to remove the leaves before eating, as they can be toxic in large amounts.
Hi Ben…first, I have learned so much from you, thank you! I’m interested in using exogenous ketone supplements and I have a question for you. I just read the transcript of an interview Dave Asprey did with Dr. Richard Veech (episode 299). He advises against them, and says they can even be harmful. I was disappointed to read this, and wanted to ask you about it, since I respect your opinion greatly….thank you.
There’s also some evidence that it might help with type 2 diabetes. “An emerging body of research is finding that a keto plan may have some real benefits thanks to its ability to improve the body’s ability to use insulin and also help control appetite, which can result in easier weight loss,” says Karen Ansel, R.D.N., co-author of Healthy in a Hurry.
Ketosis is deliberately induced by use of a ketogenic diet as a medical intervention in cases of intractable epilepsy.[12] Other uses of low-carbohydrate diets remain controversial.[14][15] Carbohydrate deprivation to the point of ketosis has been argued to have both negative[16] and positive effects on health.[17][18] Ketosis can also be induced following periods of fasting (starvation),[19] and after consumption of ketogenic fats (such as medium chain triglycerides[citation needed]) or exogenous ketones.[20]
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.

The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals, and calcium-rich foods. In particular, the B vitamins, calcium, and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[18] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises three small meals and three small snacks:[28]
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]

I would do breath ketone measurements. That's exactly what I do and this is what I use :https://greenfieldfitnesssystems.com/product/ketonix-breath-ketone-monitor/


The diet is extremely regimented and very difficult to stick to, as just one baked potato and one slice of bread could hold an entire day’s worth of carbohydrates. While this is a deterrent for many, Christy Brissette, RD, a private-practice dietitian in Chicago, notes that many of her patients like the diet because of its strictness. “Some of my clients feel that the keto diet works for them because it doesn't involve any calorie counting and the rules are simple to understand,” she says. “They feel they have strict parameters that can take the guesswork out of dieting.”
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.
Hello, may I ask if someone has some experience week fasting for 14 days? I was told that the food which should be started taken after 14 days of fasting has to be in very simple and in slow amount. Unfortunately 1-2 days after fasting I am allowed to take only bouillon out of buckwheat, barley, from the 3rd day buckwheat mush, and only from 5th day milk or sour cream, oil since 11th day. Can anyone advice how should I adopt this come back food path to Ketogenic diet? Thank you in advance, Maria

This is the second shortest form of MCT, also rare and comprising about 8% of coconut oil. It is slower to turn into energy but less expensive than C8. XCT Oil is triple-distilled in a non-oxygen atmosphere with no solvents, and it contains C10 and C8, because these are the only two MCT oils that turn into ATP quickly without the liver. You would need 6 tablespoons of coconut oil to get one tablespoon of XCT oil.


The popular low-carb diets (such as Atkins or Paleo) modify a true keto diet. But they come with the same risks if you overdo it on fats and proteins and lay off the carbs. So why do people follow the diets? "They're everywhere, and people hear anecdotally that they work," McManus says. Theories about short-term low-carb diet success include lower appetite because fat burns slower than carbs. "But again, we don't know about the long term," she says. "And eating a restrictive diet, no matter what the plan, is difficult to sustain. Once you resume a normal diet, the weight will likely return."
The longer cholesterol circulates in your bloodstream, the higher the likelihood that it will dig its way into an endothelial wall and potentially contribute to atherosclerosis or plaque formation. This is why it’s so dangerous to eat a high-fat diet, but to also have your nightly dark chocolate bar, overdo it on the red wine, or have weekly “cheat days” with pizza, pasta, or sugar-laden ice cream.
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