A huge concern with the keto diet is the maintenance and potential loss of muscle mass. Many people will just think: hey, dummy, then just eat more protein. However, some research has shown that even if your protein intake remains constant, a low carb diet may promote muscle loss. A study from the Netherlands confirmed these findings. In the study, participants were given three diets (high carb, moderate carb, low carb) and moderate protein. The study found that those following a low carb diet experienced increased muscle breakdown. This is because when we eat carbohydrates, we produce insulin which promotes muscle growth. This is why athletes depend on carbohydrates (along with protein) to fuel their performance. When we eat carbs, the insulin release “unlocks” our muscles to let the protein in so it can do its job at building our muscles. So, when we skip the carbs all together, muscle glycogen stores get depleted, we lose out on those muscle building opportunities. Forget about high intensity training. A depleted glycogen store also means our workouts will suffer because we just don’t have enough oil left in the tank. This was a again suggested in the recent review looking at many ketogenic studies. The studies found that there was greater lean body mass loss in the ketogenic groups compared to the other diets being studied.
The end result of the “ketone diet” is staying fueled off of circulating high ketones (which are also sometimes called ketone bodies) — which is what’s responsible for altering your metabolism in a way that some people like to say turns you into a “fat-burning machine.” Both in terms of how it feels physically and mentally, along with the impact it has on the body, being in ketosis is very different than a “glycolytic state,” where blood glucose (sugar) serves as the body’s energy source.
Initial research has found that the diet can help maintain lean muscle mass in active women — even as they shed pounds — and may also lead to increased appetite suppression. "A keto diet is an option for people looking to lose overall weight, lower fat mass, and even build muscle. As a dietitian who focuses on sports nutrition and weight loss, I also recommend it for my clients who need a strong break from their sugar cravings, as it lessens blood sugar spikes and the cravings that can accompany high sugar intake," Nisevich Bede says.
If someone tries to tell you that the Keto diet is dangerous because of high protein consumption you can pretty much stop them right there.  The calling card of the keto diet is “Low carb, moderate protein, high fat” and the recommended protein dosage usually falls between 60-120g/protein per day depending on your weight and lean body mass.  This is not a high protein diet.  Anyone eating significantly more protein than they require is probably kicking themselves out of ketosis and is therefore not following a keto diet.
In the study, the researchers fed mice a ketogenic diet for several days and expected to find a favorable outcome — perhaps weight loss or another indication of improved health. Instead, they found that the liver began resisting insulin almost immediately and the mice were unable to regulate their blood sugar levels after only three days on the diet. (Insulin resistance, meaning that cells in the body don't respond to insulin, is a key characteristic of type 2 diabetes.)
The good news is, it is not necessary to stay on a ketogenic diet at all times to reap this benefit. Our ancestors went through fast and feast cycles and the body is designed for flexibility. We may be able to reduce cancer risk, prolong life, improve brain function, and benefit from ketosis otherwise by being in ketosis or fasting a few days a week.
Keto has become synonymous with low carb, but as you have just read, reaching ketosis is much more complex than just eating fewer carbs. Healthy, young active people are taking up ‘the keto diet’ recreationally without any clinical reason in an attempt to lose weight, drop body fat, get a six-pack, or just to follow a trend their friends have taken up.
Those following the keto diet are advised to restrict carbohydrates to just 50 grams a day at the most, although hardcore keto dieters recommend consuming just 20 grams—about the equivalent of half a hamburger bun or a single banana. Instead, high-fat foods are prioritized, like avocados, olive oil, nuts and butter. Beef and chicken, which have no carbs, are staples of the ketogenic diet, although protein should only make up 20 percent of your daily caloric intake.  
I can buy clothes off the rack. Better than being obese. My brain is sharper. I get more stuff done. I don’t sit around. I feel like I can feel the fat melting off. I have trouble sometimes eating enough. After 40 years if being very obese on and off, I think I am better off. I hope to use it when I need it after I reach my goal. The blood tests will prove it.
The keto diet is also extremely low in certain fruits, vegetables, grains, and legumes that are generally thought of as healthy. Without these foods, people on the diet can miss out on fiber, certain vitamins, minerals, and phytochemicals that only come in these foods. That has significant human health impacts over the long term such as bone loss and increased risk of chronic diseases.
I’m in ketogenesis now – 3 weeks in. Lost over 10kg. Protein shakes. Great. But what I wanted to add was that i’m Diabetic (2) and quite badly so. I was Injecting insulin twice a day – Novomix (part immediate, part slow acting). But since I went into keto, my blood sugar has been steady between 5-9, normal range. No injections needed. And no hypo attacks either – that occurs below a reading of 4, for me. This is NOT a cure of course – it’s directly related to low carb intake. But I do wonder if discontinuing insulin is partly responsible for my improvement in alertness, activity level and so on. Magnesium tabs, 1000 units twice a day, have also been helpful – I suffer leg and foot cramps due to spinal arthritis – but they had worsened until I upped the dose.
The ketogenic diet is usually something that’s prescribed by a registered dietitian. For example, Jessica Lowe, a Keck School of Medicine of USC ketogenic dietitian, said she might prescribe it to a patient who has epilepsy, since there’s research that shows it can help control seizures. There’s also growing interest in whether high-fat diets could help with brain injuries or neurodegenerative diseases, Lowe said. For the everyday dieter, Lowe said, it’s important to consult a registered dietitian.
I’ve been eating LCHF for almost a year. I’ve lost 40 lbs, feel hungry less often, reversed my insulin resistance, have lots more energy but my cholesterol keeps jumping up, not just creeping, but taking huge leaps! It’s in the mid 300’s now and my Dr wants me to go on statin drugs of which I’m very resistant, I don’t feel comfortable taking drugs. I read so often how this diet lowers cholesterol, not me! Any clue as to “why me?” 

I had type 1 diabetes for 30+ yrs; CKD/ESRD x8 yrs and did peritoneal dialysis for 5 yrs before getting a kidney pancreas transplant nearly 5 years ago. Then had a below knee amputation and a rather sedentry life since-need to lose weight. Is this a safe diet for me? I am terrified of ketosis (DKA nearly killed me when i was 12 yrs old) so anything messing with stuff like that really makes me nervous. TIA!


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The whole area of calcium supplementation is rife with misinformation. Mainstream docs assume that osteoporosis is due solely to lack of calcium, ignoring that you need to have adequate Vit D levels to absorb the calcium in the first place (and their idea of adequate D blood levels are absurdly low) as well as Vit K2. Since bone is made of calcium phosphate, you also need adequate phosphate as well. Milk contains calcium phosphate – no surprise since it is designed to build the bones of the growing animal – so dairy is your best source of calcium. You also need protein since bone is calcium phosphate within a protein matrix. To rebuild osteoporotic bone you need 1.2gm/Kg of body weight, 50% more than the RDA of 0.8gm/Kg.
There is exciting research on the role of a keto diet as a form of treatment for cancer. In one study, the use of a keto diet on patients with advanced cancer was deemed safe, and some evidence suggested it played a role in stabilizing the disease or resulting partial remission. In another study, the keto diet was used as a form of therapy for patients with malignant brain cancer. The study found that the keto diet may carry anti-tumor effects when administered in experimental animal and human brain tumors. The researchers believe this may be due to the reduction in calories, which reduces the circulating glucose needed for tumor growth. It is still unsure whether a keto diet per se plays a role in this or simply calorie restriction. All of this is to say that the research is preliminary, however still promising.
Also, be aware that, while diet can be an extremely powerful tool to regain control over many aspects of health, diet by itself remains insufficient for full health. Just as filling up the gas tank of your car with quality gasoline helps your car run well, but other aspects of your car need attention over time (change the oil, tune-ups, new tires on occasion, etc.), so it goes with diet. We must also pay attention to vitamin D and iodine status, the potential for common endocrine disruptions such as thyroid dysfunction, efforts to cultivate bowel flora, and other issues. Focus on diet as a start, not as an end.
7. I should mention ALL my health markers have DRASTICALLY improved including cholesterol and inflammation markers? My fatty liver is resolving and my cardio markers are perfect! The study where you cited there were not significant changed in diabetes markers in two months, well it takes longer! Check it out at 6 and 8 months. Most people will show a VERY different story than what you are reporting!
Can’t you take ketone supplements? No. While it is possible to elevate ketones by taking them, “without the low-carb stimulus, there is no net increase in ketone production, no decrease in insulin, and no net increase in fat oxidation,” says Volek. Don’t trust trainers or “body hackers” who say you can induce ketosis quickly without changing your diet.
Walking, stretching, or doing gentle yoga or other mind-body exercise should be fine and may even help you feel better. But when your body is already under stress from trying to adapt to a new fuel system, don’t place an additional burden on it by attempting any type of strenuous workout. Take it easy for the first few weeks and then slowly increase your exercise intensity.

This was a great read. I aim to restrict carbs always because I believe most are why the American population is obese. I would very much like to hear more about carb restriction excluding the discussion on processed meats and processed high salt content foods because I consume neither. I also don’t consume dairy or eggs. So can you provide some substance.
🙌🙌 thank you for some great info! USC just had an article about Keto, saying they don’t know the impact on bone health. So I’m not sure why all these articles are written without the documentation to prove the claims. We all know too much calcium supplementation can cause problems but every Dr wants you to supplement calcium. Most people could do a lot worse than doing Keto! The SAD will cause more problems for you than eating whole, unprocessed Keto food! Sugar seems to be the real issue along with aspartame and stressful living.
I am in the uk and a diagnosed t2d. I am also a nurse, although I am in end of life care. Up until my diagnosis I am ashamed to say the I believed in exactly th.e same things as the writer of this article. Our health service actively promotes a carb rich diet for t2d. Not an excessive amount of calories, but a “healthy” amount of whole grains, fruit, whole rice etc. It was not until I did some actual research and looked at the science that I came to see that what I had been taught and what I really did believe to be the best advice was quite simply wrong.
“It’s unhealthy and unsustainable,” they say. “How can a high-fat diet help you lose weight? It’s dangerous for the heart, increases the risk of ketoacidosis, leads to poor mineral intake and electrolyte imbalance,” they say. But the ketogenic diet has a well-established history of aiding in disease treatment. It has been used to help people with epilepsy (especially children) since the early 1900’s, and more recently, it has been used to manage type-2 diabetes (since it lowers the need for insulin therapy).1
It drastically lowers the unhealthy fat located in the abdominal cavity of the body. It helps prevent type 2 diabetes and heart disease. Surprisingly, low carbohydrate diets can also increase healthy cholesterol, also called high density lipoprotein (HDL). HDL carries cholesterol molecules back to the liver, where it can be reused or excreted. Having a high amount of HDL lowers heart complications, and is usually gained by eating more fats.
A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >
Hello everyone. I was diagnosed as a diabetic in 2010. I followed the ADA diet while taking metformin and lnsulin and could never get by glucose readings below 135. Most mornings it was at 175 or higher. In mid 2017 I had to find a new doctor. I ran out of meds in Semtember of that year but could not find a doctor due to not accepting new patients and or my health insurance. I broke my foot at work on the last workday in December. Was instructed to stay off foot for 6 to 9 months . In the mean time I finally got to see my new family practitioner on March 28 2018. Represcribed meds and ordered blood work. A1c was ar 14.1. With my new glucose meter my readings were 375. Due to basically being bedridden while my foot heals I was concerned about diabetic complications an weight gain as I was already overweight. After doing research online I learned about the keto diet. I began the diet on 3/29 /2018 along with intermittent fasting. I weighed 265#. As of 4/26/2008 I am at 245#. My glucose readings have been on average 73 to 98 and a couple of times 111. I stopped all my medication about a week ago just to see if they would increase. They have not so far and I check 4 times daily. I sleep better and do not crave sweets. I feel full . The first two weeks were tough but now I can go 2-3 days without being hungry. I am looking forward to the results of my next blood test in June. This diet fits my circumstances and I do plan on to exercise when I am able to. I want to reach my weight to height ratio also. When I achieve this goal I may tweak my diet at that time but for right now that is what is working for me. I may never be able to eat some of the things I used to but considering the complications of diabetes it is one hell of incentive for willpower to stay on the diet.I will repost again after my next blood test or if there are any significant changes.

Cutting out a whole food group (or in this case, more than one) is a dietitian’s worse nightmare. It not only makes it a really hard diet to follow, but also stresses the hell out of your body and makes it work a lot harder to keep up. In a US News & World Report’s review of 2018 diet, the ketogenic diet came in last place as a sustainable means to weight loss because of its restrictive nature.
Practicing intermittent fasting. This works wonders to help patients get into ketosis. Ideally, you’ll go 13.5–15 hours between dinner and breakfast to help your body find energy reserves beyond stored glucose. (Your body can only store reserves for about 24 hours, so if you are eating much less, intermittent fasting will allow you to drop your storage levels way down, requiring your body to burn fat instead.)

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But what does the science say? Results are mixed. In one Spanish study of 20 obese adults, participants were put on a low-calorie keto diet and lost an average of 40 pounds over four months. Another small experiment had a similar outcome. In a six-month Experimental & Clinical Cardiology study of 83 obese adults, those on the keto diet lost an average of 33 pounds, while lowering their bad (LDL) cholesterol levels and increasing their good (HDL) cholesterol.
There are various ways to practice intermittent fasting on keto, including some that are less likely to trigger side effects like fatigue or cravings. Crescendo fasting gives you a break from fasting throughout your week, but is still very helpful for achieving the benefits of IMF. Dr. Cabeca and other experts, such as Amy Shah, M.D., advise their patients to check their urinary ketone levels (using ketone strips) and to aim for testing positively for ketones about three days per week.
It is important to understand that the statement that carbohydrates are “nonessential” is not only factually inaccurate, it results in adopting a low-carbohydrate diet or ketogenic diet that increases your risk for a wide variety of chronic health conditions that may ultimately shorten lifespan, decrease your quality of life, and accelerate your risk for chronic disease.

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But there is evidence that low-carb diets may increase metabolism, according to a paper published November 14 in BMJ. Researchers found that overweight adults who lowered carbohydrates and added more fat into their diets burned about 250 calories more each day than people on high-carb, low-fat diets. The study is impressive because it's the largest, most expensive, and controlled study of its kind.
Ketones are more beneficial to the brain than glucose is.  This is great news for patients with Type 1 Diabetes, because it will not affect the brain function when you are running low in glucose. Ketosis prevent raising blood glucose levels, since you are not introducing large amounts of carbs into your system. They help in stimulating the growth of healthy brain cells.

The keto diet also calls for an increased amount of fat intake. The diet suggests by cutting carb and increasing fat, the body will begin to burn the fat. However, when the body begins to burn fat, it also begins to burn the muscle tissue as well. For those participating in the diet who have a risk of heart disease or stoke, the fat increase could be put their lives at risk.


Great article Doc! Question: One of the world top experts in high fat low carb diet, Dr Tim Noakes has stated that top level athletes actually perform better on keto, as himself an extreme marathoner , cured his type 2 diabetes by going keto. In the light of what we know today about keto, would you still assert that athletes shouldn’t adopt ketosis as their desired state?

Case in point, Steve Richert has Type 1 Diabetes and his September 1, 2015 blog The Ketogenic Diet and Type 1 Diabetes: What I Eat. He gave it the good old college try and has fearlessly came back and showed us all his results. His cholesterol increased, which just like mine, was due genetic factors, but was exacerbated by the Ketogenic Diet. So, what’s the best part of Steve’s story? He’s coming close to being right in line with what I would recommend for him! Moderation and the mediterranean diet; he’s currently trying a modified ketogenic diet or really a modified mediterranean diet. Brilliant and exactly what we all should be doing!
When in ketosis, the body begins to burn stored fats for energy, and this results in the build-up of acids, known as ketones, in your blood. A person following the keto diet aims to burn unwanted fat by actually pushing the body to rely on fat, not carbohydrates, for energy. This process occurs when there isn’t enough glucose available to burn, so the body turns to stored fats instead.

If you want to use a ketogenic diet as a health tool, it would be wise to do so for no more than a few weeks at a time, as nobody knows how long is too long. And, of course, the period of time during which ketosis is safe can vary from individual to individual. Breaking ketosis is as easy as upping protein intake or having a glass of wine or whole piece of fruit.


Increases in cholesterol levels need discussion too. We do see temporary increases in cholesterol levels often as individuals transition onto a ketogenic diet. However, when you examine lipid particle size (a more important way to look at the cardiovascular risks), the risk pattern doesn’t seem to increase with a ketogenic diet. Harvard Health has written about lipid particle size here before: http://www.health.harvard.edu/womens-health/should-you-seek-advanced-cholesterol-testing-
The problem is: it flies in the face of the way we have been taught. Our society (as an American), and our medical community, have preached for years that FAT is bad, and you should limit it. However, recent FACTS beg to differ. So many people rail against the keto diet because they just feel that it can’t be good…after all, you eat so much fat on it, it can’t be good for you! Facts are facts…they don’t care about your feelings. Fat is not the enemy. Sugar is.
“The human digestive tract is simply not well designed for digesting grains. The proteins in grain, especially the gluten, are very difficult to digest, even if you don’t have apparent gluten problems. Too much grain, especially of the highly refined kind, is behind many of the cases of food allergies, irritable bowel, chronic indigestion, and yeast overgrowth that I see every day.”

I actually clicked on the story just to see if they included anything about it’s use in managing chronic migraine. I have chronic migraine, basically intractable. Nothing has helped. I’ve tried medications, meditations, and everything in between including a bunch of dietary changes. Keto is my next consideration. I’m happy to hear it helped you! Thanks for sharing

There are occasional instances of cardiomyopathies (heart muscle diseases, heart failure) and sudden cardiac death–The immediate causes are unclear, though at least some cases are due to severe selenium deficiency. The picture is muddied by the fact that some kids were fed large quantities of corn oil in past as a means of maintaining ketosis. Nonetheless, it suggests further uncertainties with prolonged ketosis.
“The major benefit of the keto diet is that it does work so you lose weight,” says Ms. Zarabi. “But then again, it is a diet and like all diets, it is a short term solution, something you do, then you stop. It is not really a sustainable diet in real life situations. More importantly, your goal is not just to lose weight—anyone can lose weight. The more necessary goal is to keep the lost weight off.”  
Keto flu symptoms and side effects can include feeling tired, having difficulty sleeping, digestive issues like constipation, weakness during workouts, being moody, losing libido and having bad breath. Fortunately, these side effects don’t affect everyone and often only last for 1–2 weeks. (And yes, you CAN build muscle on keto.) Overall, symptoms go away as your body adjusts to being in ketosis.
Mild ketosis is a natural phenomenon that occurs in humans during fasting and lactation (19,20). Postexercise ketosis is a well-known phenomenon in mammals. Although most of the changes in the physiological parameters induced following exercise revert back to their normal values rapidly, the level of circulating ketone bodies increases for a few hours after muscular activity ceases (21). It has been found that in trained individuals, a low blood ketone level protects against the development of hypoglycemia during prolonged intermittent exercise (22). In addition, ketosis has a significant influence on suppressing hunger. Thus, a ketogenic diet is a good regulator of the body’s calorie intake and mimics the effect of starvation in the body.
While sometimes it might feel like things are getting worse before they get better, these symptoms should resolve within a few weeks to months of following the tips and program mentioned above. This is especially true if you try to remain active (walk, ideally outside, for at least 20–30 minutes daily), sleep well and decrease stress. Drink plenty of water, herbal tea or bone broth to prevent dehydration, and go easy on exercise if you’re feeling under-fueled.

Fresh fruits supply only a small fraction of the fructose Americans consume (the biggest source is sugary beverages). Sugar in fruit is accompanied by healthful nutrients and antioxidants, as well as fiber, which slows absorption of fructose so it’s highly unlikely that the fructose in even very sweet fruit could have any undesirable health effects.
When the body is first deprived of carbohydrates, usually felt at around 50 grams per day or less, the body starts with gluconeogenesis which is the body using stored glucose (glycogen) from the liver and muscles for energy. When the stored glucose can no longer keep up with energy demands, which will happen because there’s limited storage of glucose, the body turns to using ketone bodies for energy. 
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