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The Ultimate Guide to Ketosis

Last updated: Aug 21, 2019 at 7:03PM | - Published on: Nov 4, 2018

Written by Raphael Sirtoli, Msc

Scientifically Reviewed by Sarah Neidler, PhD

 
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What is ketosis?

Ketosis is a metabolic state. Think of being in or out of ketosis like the settings in a hybrid car; you can rely on gas or electricity to different degrees. In ketosis we rely on fat instead of carbs for energy and do so to such an extent that we start making ketones from fat.

These ketones can be used to fuel us and send many important signals to our cells. There are three different kinds of ketones: Acetoacetate (AcAc), β-Hydroxybutyrate (BhB) and Acetone.

AcAc is created first, and it can easily be converted into BhB. Technically, BhB isn’t a ketone. It’s close enough to one we still call it a ketone. Acetone is spontaneously created as a side product of AcAc. Acetone cannot be used as a source of energy but can be measured in the breath, serving as a useful but imperfect measurement of ketosis.

To know more about how to measure the depth of your ketosis check out our guide about how to measure ketone levels.

Your body is always producing a very low level of ketones, irrespective of your diet. You start producing more of them when following a diet that’s high in fat and low in carbs. For a weight stable person following a well-formulated ketogenic diet, that means about 5-10% of calories from carbs, 70-80% from fat and 20-30% from protein.

This excludes everything that is high in carbs, such as grains, potatoes, and sweets – or at the very least allows only tiny, infrequent portions of them. Low-carb vegetables such as kale, broccoli, salad, and other leafy greens can be eaten without restriction.

Nuts are also a keto friendly food given their high fat content. Macadamia nuts and pecans are very low in carbs and high in fat. Cashews on the other hand are relatively higher in carbs but still quite fatty.

Vegetables such as sweet peppers and tomatoes are ‘allowed’ but have a bit more carbs so may need to be moderated for those who are highly insulin resistant. The more insulin resistant you are, the harder is it to get into ketosis.

All meats, fish, eggs, birds and seafood are part of a well-formulated ketogenic diet. You’re encouraged to eat the fattier cuts and offal (e.g. liver). Liver is by far the most nutrient dense food.

While being in ketosis, you efficiently burn fat and use ketones as fuel. Ketosis is, therefore, a metabolic state that allows you to maximize fat burning. The amount of ketone production does however not correlate to fat loss, despite it facilitating fat loss for those who have extra fat to lose. Normalizing appetite is a big reason why.

 

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Is ketosis a natural state?

Yes, it is. Babies are born ketotic and stay so as long as they’re breastfed [1]. What could be more natural for a baby than drinking its mother’s breast milk? As soon as babies or toddlers are given fruit puree, fruit juice and other nutrient poor sugar bombs they’re of course no longer in ketosis.

A small excursion regarding “healthy” fruits: Yes, it is correct that fruits contain meaningful amounts of vitamins. But eating whole fruit is very different from the processed versions that we feed our kids.

Pureeing or juicing fruit disrupts the natural architecture of the food which leads to poor metabolic responses – abnormally high insulin and blood sugar spikes. They also concentrate an awful lot of sugar, especially fructose.

Don’t prime your kid for metabolic syndrome and diabetes so keep them away from this type of processed ‘food’. Other it’s really like they’re eating sweet treats instead of a proper meal. Even most grown-ups are wise enough not to do this.

the difference between a carb addict and a fat burner is the way the body use fats as energy. A carb addict will use carbs for energy whereas a fat burner will burn body fats for energy

Back to the question of whether or not ketosis is a natural state. It’s fair to argue that the time after birth is a special period and might not be representative of the remaining developmental stages and adulthood. So what about adolescents and adults? Is ketosis a normal state for them?

For our ancestors, dipping in and out of ketosis was the norm. Starchy vegetables were energetically costly to obtain and weren’t available the whole year round. During winter or the ice-ages, the era in which we spent most of our evolving towards our present form, we had to rely on animals that are high-fat and have virtually no carbs.

And before the invention of supermarkets food was eaten for nourishment, not boredom. After eating nothing for 24 to 48 hours, most people enter ketosis [2]. This happens even faster when you are keto-adapted.

So assuming that food was not always available in abundance, it is more than likely that our ancestors were frequently in ketosis – even tropical island populations.

Populations living further north had much less edible vegetation available for gathering. Thankfully for us, animals that lived in these areas ate the vegetation inedible to us, effectively transforming it into fatty meat we could hunt and enjoy. These people most certainly relied on high levels of fat and protein, thus likely spending most of their time in ketosis.

ketosis support brain function. Your liver breakdown fats into molecule called ketones that burn fats for energy

How to get into ketosis?

When starting the ketogenic diet, most people would like to know how to quickly get into ketosis and how long this takes. There is a short answer: The stricter you restrict carbs (or total calories), the quicker you will be in ketosis.

Except for downing a ketone supplement, nothing beats fasting for getting you into ketosis ASAP. This means eating nothing and drinking only water. Fasting will get you into ketosis within 24-48 hours. The time to enter ketosis will get shorter over time because the better keto-adapted you are, the faster and easier you enter ketosis.

Fasting aside, restricting your carb intake to 20g per day is a good heuristic (loose rule) for entering ketosis. This will get you into ketosis within a few days or a week. The time it takes varies for individuals and depends on what you have eaten in the past, your body composition and how insulin sensitive you are.

20 g of carbs represents very little carby food. Even most keto foods contain a few carbs, and it simply adds up. Many people find it easier to abstain from dairy products, at least in the initial phase. Most dairy, even the full-fat versions, have around 4g carbs per 100 ml. By not eating diary there are more carbs left for things like veggies and nuts.

After being in ketosis for a while, you may notice being able to tolerate a bit more carbs. If you so desire, gradually increase them and check for changes in your ketone levels and how you feel, look and perform (as Robb Wolf fond of saying). You could start by eating dairy products again. But beware if you’re highly insulin resistant, milk and yogurt can have enough carbs to kick you out of ketosis.

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So once you are in ketosis, can you stay in this metabolic state forever? Should that even be your goal? First of all, it is quite a challenge to stay in ketosis without interruption for a very long time. Eating out, your kids’ birthday cake and ‘hidden carbs’ are the usual suspects for leaving ketosis.

Ketosis is a sensitive state so as soon as you increase your carb intake above your carb tolerance, you’re out! You probably don’t want to continuously weigh and count your food for the rest of your life. So even if you stick to the approved list of ketogenic food, there is no guarantee that you will be in ketosis without interruption. That’s OK. Now if you’re in ketosis to manage cancer or epilepsy, that’s a different story obviously.

You may eat too much of your favorite moderate-carb vegetables from time to time (e.g. carrots, sweet peppers, parsnips) which may lower your ketones or outright kick you out of ketosis. Assuming that you are well keto-adapted, you will, however, quickly get into ketosis again.

The primary goals of the ketogenic diet for people like you and I, people living in modernity and eventually riddled with chronic disease, is to:

  • Lower insulin levels
  • Increase insulin sensitivity
  • Normalize body composition (% fat, % muscle)
  • Normalize blood pressure
  • Lower chronic inflammation
  • Improve immune function
  • Stabilize mood and mental function

Did you know?

Ketones aren’t just a form of energy, they’re powerful signaling molecules. They regulate the expression of genes and dampen inflammatory processes.

In 2015 it was found that the ketone we measure in our blood called beta-hydroxybutyrate (BhB) could ‘silence’ the NLRP3 inflammasome [2].

This inflammatory complex is involved in much of the pain and inflammation seen in rheumatoid arthritis, Alzheimer’s disease, obesity, atherosclerosis, type 2 diabetes and gout to name just a few.

This means ketones – whether produced by fasting, ketogenic diets or supplements – have actual and promising therapeutic potential.

There are no studies so far that have investigated the life-time effects of ketogenic diets in humans. The same can be said for most if not all diets, actually. They would be very difficult to realize.

The longest studies/follow-ups for ketogenic diets are about 10 years long and have shown it to be safe [3, 4, 5, 6]. Studies that carefully keep people in metabolic wards to strictly monitor food intake and biomarkers are always short because they are very costly and laborious. Moreover, most participants are not able or willing to participate for a long time in a study that supervises food intake around the clock. For these reasons, these kinds of studies are always of short duration, a few weeks maximum.

The alternative is to perform studies were participants undergo nutrition counseling, follow a specifically prescribed diet and self-report their food intake. The advantage is that these kinds of studies can be of long duration, so it is possible to study long-term effects – assuming people are actually eating what you’re telling them to. Of course, they don’t.

It’s well known that adherence to the prescribed diet is usually low and self-reported food intake is very unreliable. So there’s no way to guarantee that the participants strictly adhered to the diet. Because it requires a lot of discipline and planning to stay in ketosis for a long time without interruption, it won’t be possible to perform a long-term study that guarantees uninterrupted ketosis using old study methods. This may change soon with improved self-tracking devices.

What’s impossible in humans though can easily be done in animal studies. The downside is that animals are not identical to humans and it’s not always clear how relevant the results are.

You can find a mixed bag of studies in rodents; sometimes the ketogenic diet is amazing sometimes it’s terrible. The main reason why is because there are many kinds of ketogenic diets; what fats were used? how processed is the food and what was the method of processing? were these genetically manipulated mice or wild type? were they fed ad lib (to their hearts content), forced fed (hypercaloric) or had their calories restricted?

The only way to disentangle the results from these studies is to dive into complex study design, statistical methods and principles of physiology – a snooze fest for most of you. But if you do like that sort of stuff, check out our podcasts! 🙂

In conclusion, staying in ketosis for several years without interruption carries some risk, but relative to things like air pollution, chronic stress and a ‘normal’ diet (i.e. standard american diet), we at Nutrita consider these risks to be very, very minimal. So choose what you worry about wisely.

Ketosis is a normal metabolic state where your body CONVERTS fat into ENERGY thank to a little molecule called ketones. Well-formulated ketogenic diets provide you with the singular benefit of ketones as well as the complete range of essential micronutrients. There are three ways, the most accurate of which is blood beta-hydroxybutyrate (BHB). Breath acetone and urinary acetoacetate strips can also be useful estimates of ketosis.

 

Ketosis symptoms

One of the first things people notice when getting into ketosis is more stable energy levels. But after adopting a ketogenic diet, it might, however, take a while before you fully benefit from this dietary change.

Not sure if you’re in ketosis? Here are some of the signs and ‘symptoms’ suggesting you’ve entered ketosis:

  1. The ‘keto flu’ — The keto flu is not really a flu at all, but is more a result of carb withdrawal or temporary electrolyte imbalance. It can cause many symptoms that are similar to the flu, such as fatigue, nausea, headache, insomnia, and diarrhea. The symptoms, however, will differ in kind and severity from person to person. For example, an individual who is transitioning to a ketogenic diet from a very high carb diet will likely experience more severe symptoms of the keto flu than an individual already following a more moderately low carb diet. But it’s not all bad news — the keto flu doesn’t last forever. As your body adjusts to fewer carbohydrates, the symptoms will subside and eventually disappear.
  2. Fruity breath — While bad breath does develop from improper dental hygiene, fruity breath in the case of ketosis comes from increased levels of the ketone body called acetone. When the body is in a state of ketosis, blood acetone levels increase sufficiently for you to breath them out and thus emit its distinctive odor [7]. Breathing ketones aren’t the only way your body excretes ketones, it also secretes them in the urine.
  3. Weight loss — Typically in the first 1-2 weeks of keto, people will drop a significant amount of weight, most of which comes from water. This is because 1 g of carbs (glycogen) is stored with 3 g of water [8]. As you transition to ketosis, maximally full glycogen stores are used up which means the water is also lost and thus lowers your body weight.
  4. Keto rash — The keto rash is a rare inflammatory skin condition that occurs in some individuals who start keto. While there’s not a large body of evidence speculation on why the keto rash develops, studies have shown a correlation between high levels of ketones and its development (which is why it’s also occasionally seen during prolonged fasts). However, the keto rash may also result from other causes such as gut dysbiosis, other dietary factors changing or even the chemical irritation from coming in contact with sensitized skin. The rash presents as itchy red lesions that usually appear on the neck, central chest, upper back, lumbosacral area, and abdomen [9].
  5. Frequent urination (or more than normal) — As mentioned with the weight loss, when glycogen stores are depleted, water stored alongside glycogen is released too. When insulin levels drop from an excessive level down to a more normal one – especially following a reduction in dietary carbohydrate intake – water is lost as well as sodium from the kidneys and leads to frequent urination.
  6. Short-term fatigue — Weakness and fatigue are two well-known side effects, as well as two of the biggest problematic symptoms, associated with transitioning to a ketogenic diet. As the body has likely been running on glucose for an extended period of time, it takes the body time to adapt to a new source of fuel, which can take quite a toll on your energy levels. During the adaptation phase, the body also releases electrolytes (e.g. sodium) as already mentioned, which can be a temporary imbalance leading to weakness and fatigue.
  7. Elevated blood ketone levels — Elevated blood ketones! This may seem obvious, but it’s worth emphasizing that the ketogenic diet is the only diet that can be objectively measured to check if someone is in ketosis and to what extent. This is done by looking at blood beta-hydroxybutyrate (BhB) levels. As your body adjusts to burning fat for fuel, it produces ketones that accumulate in the blood and can be quantified using a simple glucose-ketone meter such as the one by KetoMojo. The exact line where ketosis begins is somewhat arbitrary, but generally speaking, it ranges from 0.5 or 1.0 mmol/L, to 3.0 mmol/L and above. Ketone urine test strips are another easy and affordable way to test if you’re in ketosis but their utility is limited (see our post on how to measure your ketones).
  8. Digestive issues — Drastic dietary changes may lead to digestive issues in some individuals. Constipation is one of the most common side effects experienced when making the transition to keto, which often results from dehydration. The body absorbs more water from the colon, which causes the contents of the colon to become dryer and harder. To avoid constipation, it’s important to not overdrink, not ‘force it through’ by filling up on fiber, but rather to add in a little sea salt and consume enough healthy dietary fat (e.g. coconut oil, butter, lard, tallow, fatty meats and fish, etc…).

The benefits of ketosis

As the ketogenic diet becomes more popular, more and more research is being done on the benefits of being in a state of ketosis. While there are many long-term benefits, there are a few obvious ones that often rank at the top for most people.

1. Fat loss

One of the most well-recognized benefits of following a ketogenic diet is its ability to help reduce stubborn fat, like the last rolls of belly fat. The primary reason why is because well-formulated ketogenic diets can rectify the energy partitioning away from fat storage and towards a leaner physique. It can also help normalize appetite by normalizing the hunger hormones ghrelin and cholecystokinin (CCK). Ghrelin is released from the stomach and intestines, with the highest levels occurring during a fasted state. After consuming a meal, ghrelin levels decrease in response to circulating nutrients. Ghrelin levels also increase significantly after weight loss, which is the reason why weight can be difficult to keep off — your hunger is raging! But being in ketosis helps to suppress the increase in ghrelin that is experienced after losing weight [10]. Studies have shown that a ketogenic diet leads to decreased amounts of circulating ghrelin and therefore decreased feelings of hunger.

2. Decreases insulin levels

If trying to get into a state of ketosis and insulin levels are excessively high, it will be virtually impossible; insulin suppresses the production of ketones in the body [11]. So in order to get into ketosis, insulin levels must be under control.

Chronically high insulin levels and the disrupted incretin signaling (gut derived molecules) can lead to insulin resistance over time. This means that cells are unable or unwilling to take up vast amounts of glucose anymore, and more and more insulin is needed to take up a given amount of glucose – a vicious cycle forms where more and insulin is needed over time. The point where the pancreas is no longer able to supply the required insulin, and so fasting blood sugars surpass 120 mg/dL or A1c exceeds 6.5%, is known as type 2 diabetes. With the ketogenic diet, insulin requirements are dramatically normalized and this may effectively reverse type 2 diabetes.

Following a ketogenic diet is highly beneficial for reversing hyperinsulinemia and normalizing insulin signaling. Carbohydrates raise insulin levels more than the other macronutrients protein and fat. When a meal with fast digesting carbs is consumed (e.g pasta), your liver receives aberrant signals from the gut and fat tissue. These signals cause the liver to struggle to release the appropriately moderate levels of glucose into the bloodstream. As they blood sugar levels keep getting higher and higher, the pancreas has to compensate by secreting more and more insulin to normalize blood sugar levels. This leaves the body bathing in a lipogenic environment (one that favors fat storing over fat burning) and a chronically inflamed state.

When carbs are absent or only form a small part of the diet, as on a ketogenic, insulin levels do not fluctuate as drastically as they would if consuming a higher carbohydrate diet with fast absorbing sugars [12]. The keto diet doesn’t prevent the production of insulin outright, however, but rather it decreases it enough to allow the body to produce ketones while still able to fulfill its other crucial roles in our biology

4. Improves cardiovascular health

As obesity becomes more prevalent in industrialized countries, the prevalence of cardiovascular disease has also steadily increased. Diets rich in carbohydrates, specifically with fast absorbing sugars like flour and sugar, are consistently linked with robust mechanisms to the development of metabolic syndrome, a major contributor to the development of CVD.

Studies have shown the keto diet to be particularly effective for fat-loss, but more specifically visceral fat-loss. Evidence shows that a keto diet can also be effective for improving biomarkers used to assess CVD, such as weight and body fat percentage, glucose homeostasis, A1c and lipid markers like LDL, HDL and triglycerides [13,14].

5. Mood stabilization

The switch from glucose to ketones to fuel the brain is the underlying thought as to why the ketogenic diet has so many profound neurological benefits. Many studies looking at brain metabolism support the case-reports and anecdotes suggesting keto can help with mood disorders such as bipolar disorder, anxiety, and depression [15,16]. The preeminent mechanism put forth to support these observations is that the brain improves its general redox state when in ketosis and relying less on glucose [17]. The way in which naturally occurring free radicals are produced when metabolizing ketones, as well as their inherent anti-inflammatory action, are also potential mechanisms explaining the seemingly beneficial effect of ketosis on mood disorders [18,19].

6. Improves cognitive function

Energy for the body comes in the form of ATP, which is produced primarily by mitochondria – although the brain has an unusually high need for glucose compared to other tissues. Areas of the body that need larger amounts of ATP to function have more mitochondria to supply this energy reliably. If the number of mitochondria increases sufficiently and their energetic output is improved, there is more energy for the brain to meet its high energy demands. Fasting is one way to up-regulate mitochondrial biogenesis (production of new mitochondria). Regular fasting helps to protect the brain as well as other tissues from developing cancerous cells, toxic buildup from regular metabolism and chronic inflammation derived from unavoidable environmental factors (e.g. pollution) [20].

The ketogenic diet also decreases oxidative stress, the major factor in mitochondrial damage. Chronic and excessive stress creates inflammation which is no longer helpful but damaging, in part because it can impair mitochondrial function [21]. As oxidative stress increases, so does the extent of the damage. And as the brain relies heavily on mitochondria, it is often the first to show signs of this. Compared with glucose metabolism, ketones have been shown to produce lower levels of oxidative stress, which means potentially less inflammation, better energy output, and improvements in cognitive function [22].

7. Increases metabolic flexibility

Metabolic flexibility is the ability of the body to switch between burning carbs and burning fat, or technically speaking, the capacity to match fuel oxidation to fuel availability. Having metabolic flexibility means that the body is able to use different fuel sources to power different activities. Mitochondria are the structures that ultimately turn most of food derived molecules into useable energy (ATP). So naturally, being metabolically inflexible denotes an issue with mitochondrial function.

Metabolic inflexibility can be caused by a few different things (not a complete list):

  • Dysfunctional mitochondria — Mitochondria that don’t function as they should will produce less energy than healthy mitochondria. If oxidative stress levels are high, it impairs the rate and ability at which they can produce energy.
  • Too few mitochondria — As energy is produced primarily by mitochondria, too few of them that don’t work properly severely limits the amount of energy that is produced and makes switching from carb-burning to fat-burning very difficult.
  • Insulin resistance — Insulin sensitivity and resistance are natural responses regulating how much energy a cell receives. This enables the body to ensure it doesn’t energetically underload or overload cells (just like electric circuits are built so as to avoid blowing up light bulbs). The problem is, insulin resistance can become maladaptive when constantly triggered due to damaging environmental factors (e.g. fast absorbing sugars, dysregulated circadian rhythms, air pollution…). When insulin resistant, the body has a harder time burning excess fat stores and using them for fuel, making it hard for you to seamlessly switch between fat and glucose.

The ketogenic diet, however, helps to improve metabolic flexibility via many of the aforementioned mechanisms. It improves insulin sensitivity, reduces oxidative stress and improves mitochondrial function. So long story short, when you are metabolically flexible, your body can use carbohydrates and fat for fuel.

6 benefits of Ketosis for medical conditions

One of the most well-researched areas with respect to the ketogenic diet is its ability to help combat chronic diseases. Whether it’s cardiovascular diseases, diabetes, or epilepsy, the ketogenic diets have been shown to be highly beneficial for reducing and managing symptoms as well as potentially undergoing a complete reversal.

1. Epilepsy

One of the earliest uses for the ketogenic diet was as a treatment for epilepsy. Epilepsy is a neurological disorder that is marked by abnormal electrical discharges in the brain that cause seizures. These sudden episodes can range in intensity but are generally characterized by altered or decreased consciousness, convulsions and/or involuntary movements. Pharmaceutical drugs are often the first choice for treating epilepsy, but the ketogenic diet has been proven time and time again to be very beneficial and highly successful.

While the exact mechanism remains largely unknown, several other mechanisms have been proposed [23,24,25,26]:

  • Changes in ATP production may increase neuron resiliency in the face of metallic demands during seizure episodes
  • Altered brain pH affects neuron excitability
  • Ketone bodies/fatty acids exhibit a direct inhibitory effect on ion channels
  • Altered amino acid metabolism favors the synthesis of GABA (an inhibitory neurotransmitter)
  • Enhanced mitochondrial function
  • Decreased reactive oxygen species
  • Gut microbial-derived amino acid blood levels

2. Metabolic syndrome

Metabolic syndrome is a condition characterized by high levels of visceral fat, elevated blood pressure, high triglycerides, elevated blood sugar, and elevated LDL; these symptoms greatly increase the risk of developing diabetes, heart disease, and stroke. Although LDL cholesterol was put on this list it no longer deserves its sport [27].

Studies have shown that being in a state of nutritional ketosis helps to improve markers of metabolic disease including HbA1c, lipids, high-sensitivity CRP, fasting insulin and glucose levels, and helps reduce overall body weight [28]. In turn, by improving biomarkers of metabolic syndrome, the disorder can be reversed.

3. Alzheimer’s disease

Alzheimer’s disease is a progressive cognitive disorder that slowly impairs an individual’s thinking and memory. One of the major features of this disease is a loss in the connections between neurons in the brain. While the cause of its development and progression is unknown, research shows a promising link to metabolic dysfunction as a key factor. Current research has shown a clear link between the development of Alzheimer’s disease and dementia with blood sugar regulation disorders, with insulin resistance and diabetes most strongly correlated.

Insulin resistance has been shown as a major contributor to cognitive decline. A recent study found a very clear link between blood sugar levels and neurodegenerative diseases. Researchers at the University of Bath have found that excess blood glucose causes damage to a vital enzyme — macrophage migration inhibitory factor (MIF) — involved in the inflammatory response at the early stages of Alzheimer’s through a process called glycation [29]. They found that disease progression could be linked to an increase in the glycation of the MIF enzyme.

While a few large-scale studies have been completed on the association between Alzheimer’s and the ketogenic diet, several smaller studies have shown positive results. A 2009 study of 152 patients with mild Alzheimer’s showed improvements in cognition after following a ketogenic diet for 45 days [30]. Additionally, higher blood ketones have been associated with improves in memory recall in a study of 20 patients diagnosed with Alzheimer’s disease or mild cognitive impairment [31].

Ketone bodies themselves have been shown to be neuroprotective, which bodes well as a potential treatment option or intervention for improving neurodegenerative diseases [32].

4. Cancer

Several studies have been conducted on the efficacy of the ketogenic diet as an adjunct therapy for cancer. As a cancer therapy, ketogenic diets (or fasting) reduce circulating glucose levels to starve the sugar hungry cancer cells. The rising blood ketones also serve as a good substitute fuel for normal cells who are also starved of glucose. Reducing blood glucose also helps to decrease insulin and insulin-like growth factor levels, both of which are important forces exacerbating cellular proliferation [33].

The evidence so far shows that all cancers have some degree of mitochondrial dysfunction, with some even showing a down-regulation of enzymes necessary for ketone utilization [34,35]. So when the body is fueling itself with a low glucose-to-ketone ratio (e.g. 1), there is much less fuel available for cancer to survive and replicate, but still great fuel for normal cells to survive and for our immune system to fight back.

The ketogenic diet is not a panacea though. It will not lower blood levels of the amino acid glutamine, the other fuel remaining circulating in our bloodstream beloved by cancer cells since they can ferment it for energy and ‘parts’ (e.g. new structural molecules) [36]. The ketogenic diet is part of the larger umbrella of metabolic therapies that are very promising cancer therapies.

5. Polycystic ovarian syndrome (PCOS)

PCOS is one of the most commonly diagnosed reproductive disorders among women of reproductive age. Symptoms are associated with high levels of testosterone and include irregular or absent menses, excess body hair, and infertility, as well as medical abnormalities like obesity, insulin resistance, hyperinsulinemia, type 2 diabetes, and dyslipidemia and metabolic abnormalities including elevated serum testosterone, insulin resistance, and poor cholesterol ratios [37].

PCOS can be reversed for all intents and purposes if insulin levels are lowered, improve insulin resistance is improved and hormonal imbalances are addressed. This cannot currently happen with a pill. Fat-loss is also key in reversing the disorder given that being obese increases the amount of tissue producing inflammatory signals.

As the ketogenic diet has proven successful for weight loss and improving insulin sensitivity, it may be beneficial for PCOS. In a small 12 subject study conducted on women aged 18-45 with a diagnosis suggestive of PCOS, following a ketogenic diet shower improvement in body weight, percent free testosterone, LH/FSH ratio, and fasting serum insulin [38].

6. Lou Gehrig’s disease (ALS)

Lou Gehrig’s disease, more commonly known as ALS, is a progressive neurological disorder that causes progressive wasting of muscles and leads to difficulties in speech, swallowing, mobility and even breathing.

As the ketogenic diet has been proven effective in protecting nerve cells and their ability to produce energy, it has the potential to improve symptoms associated with ALS. Research has proven that mitochondrial dysfunction plays a central role in neuronal cell death in ALS. This study looked at the effect of the principal ketone body, D-β-3 hydroxybutyrate (DBH), and how it impacts mitochondrial ATP generation and neuroprotection. While there are few human studies on the efficacy of the keto diet in ALS development, this rodent study showed positive results. It was the first study to show that the KD can alter the progression of ALS [39]. The effects may be due to the ability of ketone bodies to promote ATP synthesis by using another ‘path’ to energy production by bypassing a piece of mitochondrial machinery called complex I.

Will exogenous ketones deepen ketosis?

To get into ketosis without supplementation, you have to keep your insulin levels low. Supplementing with exogenous ketones can help get you into ketosis [40]. However, you won’t have achieved the same beneficial physiological changes as you would have from a well-formulated ketogenic diet or fasting. This is why we at Nutrita don’t recommend exogenous ketones as a substitute for a well-formulated ketogenic diet.

Long-term, your body has a lot to gain from learning to efficiently burn fat and produce its own ketones. The only way to do this is by keeping your carb intake low, doing some sort of fasting or following a ketogenic diet.

Providing external ketones will not help you with this process specifically. However, exogenous ketones can boost your short-term energy levels which can be of interest in certain medical conditions or athletic performance. What they won’t do, and what’s often claimed, is that they will ‘boost fat burning’. That’s nonsense.

What is ketoacidosis?

Many people confuse ketosis with ketoacidosis. Ketoacidosis is the state where blood insulin is so low due to a ‘burned out’ pancreas that both glucose and ketones skyrocket to dangerous levels, leading to coma and death if nothing is done.

Ketoacidosis (or diabetic ketoacidosis) occurs in uncontrolled diabetes, not in nutritional ketosis. Uncontrolled diabetics are patients that have totally lost normal pancreatic function and aren’t dosing insulin accordingly. They’re also probably still on a standard American diabetes-inducing diet when this occurs.

Following a ketogenic diet with Nutrita

Starting a ketogenic diet as easy as it should be. No wonder, doctors aren’t really trained in nutrition and science journalism is in a terrible state.

You need the right distribution of carbs, protein and fat. You also need to understand how to apply these general principles to your situation. Nutrita helps you to follow a well-formulated ketogenic diet that is nutrient dense, tasty, complete in protein and truly filling.

The keto score helps you quickly get into ketosis and stay there. The insulin index ensures you avoid the most insulinogenic junk-food items, often hidden in packaged foods, pushing you closer to diabesity with every bite. Jump right into with the app and get connected to many others who share the same questions you may have.

But is it recommended to stay in ketosis for let’s say several years without interruption? No one knows for sure, but the burden of proof is on those arguing that this natural metabolic state is inherently bad. Ketosis is as normal as not being in ketosis.

Conclusion

Nutritional ketosis is a normal metabolic state.

More and more modern science is supporting the idea of at least dipping in and out of the state for general health, whether that’s via intermittent and longer fasts or simply a well-formulated ketogenic diet. Sports science is also starting to support the notion that ketogenic diets can adequately support a range of athletic activities.

The question of whether or not it’s optimal for certain sports is still an open question.

Diabetic ketoacidosis is still confused for nutritional ketosis, a mistake akin to confusing drinking water with drowning.

Going from a standard-American diet to a well-formulated low-carb or ketogenic diet is a health upgrade. However, it usually comes with unpleasant but temporary symptoms of carbohydrate withdrawal, also known as the keto flu. This is easily addressed by using Nutrita to properly follow a ketogenic diet or simply by familiarizing yourself with basic electrolyte management.

Ketogenic diets are also being tested as therapies for a range of modern chronic diseases like Alzheimer’s, cancer and diabetes with extremely promising results. Although they’re not a panacea, it’s worth keeping an eye on given the positive trend.

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Written by Raphael Sirtoli, MSc

Raphael Sirtoli has an MSc in Molecular Biology and is a PhD candidate in Neuroscience at the Behavioral n’ Molecular Lab in Portugal. His understanding of metabolism, nutrition and clinical medicine is the base upon which Nutrita’s knowledge derives from. He loves open scientific debate, Crossfit, football, hiking, and cold water immersion.