Since our body isn’t used to using ketones, we tend to feel flu-like when in ketosis. Lots of brain fog, fatigue, headaches, nausea and poor endurance. You also get bad smelling breath, sweat and pee from the acetone (a byproduct of fat metabolism). Sexy? Not so much. Thankfully, if you are in ketosis long enough, a lot of people report that most of these side effects start to go away.


All of our cells need fuel to function. This fuel comes from three sources: fat, carbohydrates and protein, called macronutrients. Too much protein without fat puts us at risk for a handful of complications, so protein can never healthily serve as a primary source of fuel. We are left then with fat and carbohydrates as the main providers of energy – the energy that allow us to do everything from breathing and blinking as we veg out on the couch to swimming the English Channel. Our cells’ preferred fuel comes from carbohydrates, which are easily converted to glucose, which, in turn, is readily converted to energy. This is why athletes “carb load” before they compete. Peak performance occurs when the body has plenty of glucose and glycogen stores available at hand. When glycogen runs out, that’s when the body turns to fat. When there is no more blood sugar for our cells to consume, they seek an alternative form of energy. This energy comes from ketones, which are compounds our body produces from stored fat. So a ketogenic diet is one that is high in fat and very low in carbohydrates, resulting in the production of ketones to be used for fuel instead of glucose.
"We recommend against 'dieting', which is invariably a short-term solution," Dr. Gonzalez-Campoy, tells EndocrineWeb, "and since weight loss may be accomplished by a reduction in calories by any means, a ketogenic diet that restricts carbs is simply shifting the calories away from foods that typically demand insulin as in both of these studies.1,2  
Holy smokes what a great article! Thank you for such a thorough read. I have been doing a “keto diet” (keeping carb’s under 40 g/day-I use a tracker) since the beginning of January and felt “fluish” at first like you state. That passed and this past week (It is now Feb 11)my weight loss has stalled so I am experimenting with even lower carb’s (15-20g/day). This change has really interrupted my sleep the past 3 nights, hence me typing this at 4:44 in the am after deciding to do some research the past hour. Will this too pass? Or is it time for a Mg supplement? And if so can I use a pill rather than a drink? Between all the water and the bone broth I am unsure how more I will want to drink ha! But if I have to then I will, just thought I would ask. Again, thank you for all you are doing and such a fantastic read!
Depending on how you choose your fats, the keto diet can contain an abundance of saturated fat, which raises levels of dangerous LDL cholesterol and causes atherosclerosis, the buildup of fats and cholesterol in the arteries. If you decide to go keto, have a doctor monitor your cholesterol levels monthly to ensure you remain within a healthy range.
Our body needs some time to get used to ketones being elevated in the blood stream to begin using them effectively and efficiently for cellular energy.  By consuming an exogenous ketone supplement, you get the body adapted to ketones faster and using them as an energy source before the body has built the metabolic machinery to produce its own ketones effectively.
The word “keto” often has negative associations for people living with diabetes, especially Type 1. DKA, diabetic ketoacidosis, is a life-threatening condition arising when the body produces too many ketones. So how does entering ketosis deliberately through a conscientious diet differ from entering it accidentally? The answer has to do with the level of ketones, the former causing “regulated and controlled production” and the latter causing an overabundance.
By now, you've probably heard all about the ketogenic diet, the high-fat, low-carb eating style everyone's talking about. And while the benefits of keto are pretty well-known—weight loss and a suppressed appetite—the downsides are usually minimized by keto advocates. "The positive aspects of a ketogenic diet are spoken about much more than the drawbacks," says Alix Turoff, R.D., C.D.N., C.P.T., a dietitian and personal trainer.

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.)

Starting in the 1970s, when the Atkin’s Diet book was first published, low-carb diets have caught the attention of many people trying to lose weight and improve their health. The ketogenic diet (KD), which is both very low in carbohydrates and also very high in fats, has become one of the most talked-about diets in the past several years. With its rise in popularity, it’s no surprise that the keto diet has recently been the focus of dozens of research studies.
Test for allergies and intolerances. For suspected allergies and intolerances, It is best to try an allergy test and an elimination diet that removes all common allergens and intolerances (wheat, eggs, fish, dairy, nuts, peanuts, shellfish, soy, and nightshade vegetables) for a period of time (3-4 weeks). If you are noticing positive changes and want to start adding these foods back into your diet, choose one at a time and tread slowly. Take note of how you feel. If you are still feeling great, move onto the next one. If at any time you experience adverse reactions to a certain food, chances are you have an allergy or intolerance to it.
Now, I know what you are going to say, “I can take a break from the diet anytime.” What do you think happens when you take that “break”? As soon as you start consuming a normal amount of carbohydrates again, you immediately go out of ketosis or the fat burning state, and your body starts storing fat again immediately. In other words, you immediately start gaining weight. So whatever weight you lost on the diet, you gain back right away. How healthy do you think it is for your body to be in a starvation mode, then in a feeding frenzy, making up for lost time?

Ketosis is different, because, when in the state of ketosis, the brain will prefer ketones over glucose. For the dieter this is good! The body will not have to break down protein for energy. In turn the body will be forced to use its fat reserves, a.k.a. your love handles, for its energy. This is why a low-carb diet is such a good method of dieting.
Lazy keto diet: Last but not least, the Lazy keto diet often gets confused with dirty keto … but they’re different, as the “lazy” refers to simply not carefully tracking the fat and protein macros (or calories, for that matter). Meanwhile, the one aspect that remains strict? Not eating over 20 net carb grams per day. Some people find this version less intimidating to start with or end with … but I will caution that your results will be less impressive.
Check your ratios. Total cholesterol/HDL ratio is a good indicator of how long LDL is hanging around in the blood and remains the best standard assessment of heart disease risk. Another good one is triglyceride/HDL ratio, which is a strong surrogate marker for insulin resistance. In both cases, lower is better. An ideal T/HDL ratio is 1:1. I’d say 2:1 is about as high as you want to go. An ideal TC/HDL ratio is 3.5:1 or lower.

Best animal proteins are wild salmon, tuna, trout, shellfish, red meats, and poultry. The oil, protein sources will help balance your omega 3s. You only need 70 to 80 grams of protein a day, depending on your lifestyle and your body's physical needs. Protein requirements are different for everyone. Here are some good protein sources to include in your diet.
“Tremendous Results”….guess that’s why the diabetes nationwide gets worse every year, because of the stellar advice your kind is giving out. I’ve been on the virta clinic for two months and already went off insulin, Janumet and Jardiance, which I’ve been on for 10 years, with blood sugars between 80 and 150. The advice you give makes people get sick slower. The ketogenic approach deals with the real issue, carbohydrate intolerance. If you are lactose intolerant you stop ingesting lactose. Type two diabetes is simply carbohydrate intolerance. Stop eating the carbs and the symptoms go away. I think you meet to cite some of the other research out there I’ve read in other books and the work the Virta Clinic has done. In my opinion you’ve cherry picked data to suit your preconceived beliefs. 

I recently had one of my previous cooks post that she was going to do this diet and should she start with 20 grams or 30 grams. She has been a cook in the healthcare business for about 8 years so she understands the different diets but not the physiology behind them (yet. I am trying to talk her into taking the CDM course). I told her to consult the RD at her facility before she embarks on such a trend. She won’t because all her friends posted their weight loss stories.
Congratulations to you!! Keep up the good work. And, I have to say again, choosing the keto way of life as a type one diabetic is a lot easier than one would think, right?!. It is so rewarding, as you point out, and actually quite easy (lose the carb cravings and enjoy eating everything that you can!). I honestly feel more FREEDOM eating this way than I did eating the other way for 20 years and I love the normal sugars and better energy. Also the decrease in inflammation is awesome.
I totally appreciate your article. My son-in-law was just telling me a friend of his who is a bodybuilder told him that staying in ketosis for more than 4 months at a time will cause muscle atrophy in your body to eat its muscles. Well of course this concerned me, so running through the internet I ran across your article. I’m really glad to see these 10 myths that you’ve dispelled. I feel much more confident and comfortable staying in ketosis. Thank you.

I am with you! I have been a WW member and been years without going outside of my suggested guidelines. I would lose weight, plateau, go on one of their plateau breaking diets for two weeks then have to go off and slowly gained weight again. I was teaching my body to live on less. I have been down as low as 800 kcal a day and not losing. Eat more fiber so you feel full was what I was told. Try eating 800 kcal, high fiber and see how balanced your diet is. I am eating between 1800 – 2000 kcal now and dropping 10 – 15 lbs a month on Keto. Long term diuretic user, I no longer have water retention. I am salting and using fat and I am off my blood pressure medicine. I am not hungry so I am wondering why is this not sustainable? I eat mostly carbs from vegetables, I eat a variety of meats, I eat a variety of vegetables, I feel great and my blood tests are better than they have been in 2 decades. I am starting to feel that the carb revolution is because we are told by the government what is good to eat. We all know that vegetables are good to eat but the government subsidizes corn, wheat and soy, not spinach, kale and cucumbers. Do your research, follow your hearts, do what works for you.
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.
If you’re wondering about the difference between ketosis and diabetic ketoacidosis, you’re not alone. “The word ketone is scary for most people with type 1 diabetes because they relate ketones to diabetic ketoacidosis,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “But with the ketogenic diet, we’re talking about a much lower level of ketones.”
Several comprehensive studies and meta-analyses have demonstrated that after a few months or even a year of a low carb diet versus a moderate/high carb diet, there are no significant differences in the amount of weight lost (2,3,4,5).  I will say, however, most of these diets are NOT keto and are simply lower carb (i.e. 20%).  Also, long-term effects (beyond 1 year) are not often studied due to budgetary constraints, so interpret results as you wish.
Depending on how you choose your fats, the keto diet can contain an abundance of saturated fat, which raises levels of dangerous LDL cholesterol and causes atherosclerosis, the buildup of fats and cholesterol in the arteries. If you decide to go keto, have a doctor monitor your cholesterol levels monthly to ensure you remain within a healthy range.
Here’s to exciting beginnings in cancer research: While we don’t have a lot of human studies to draw on, early findings suggest that the keto diet may have anti-tumor effects by reducing the total energy for tumors to thrive. We’ve also seen animal models report successful reductions in tumor growth, gastric cancer, and prostate cancer by using a ketogenic diet.

Remember the low-fat diet craze? Back in the 1990s, we were told that swapping regular cookies and chips for those labeled "low fat" would be the ticket to easy weight loss and better health. Today, it's the opposite—a low-carb, high-fat eating plan called the ketogenic diet, or keto diet for short, is getting all the buzz. Celebrities like Halle Berry, Kim Kardashian, and Megan Fox are fans; more than 7 million Instagram posts have been tagged #keto; and upwards of 1 million people search "keto diet" on Google every month.
Great post, Abbey!! Thank you for taking the time to write this and share it with us! This diet may work in some cases as you pointed out but i find it very dangerous, eventhouh i’m not a dietician. I tried it and i felt horrible. I felt depressed, constipated, pain in my right side which i think was my gallbladder. Couldn’t sleep, terrible breath. AWFUL!!

Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show specific very-low-carb diets help people with metabolic syndrome, insulin resistance, and type 2 diabetes. Researchers are also studying the effects of these diets on acne, cancer, polycystic ovary syndrome (PCOS), and nervous system diseases like Alzheimer's, Parkinson's, and Lou Gehrig's disease.
Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.
Now, there’s even evidence that a low-carb, high-fat regimen (as the keto diet is) helps you live longer, compared to a low-fat diet. In a study by the medical journal The Lancet that studied more than 135,000 adults from 18 countries, high carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction or cardiovascular disease mortality.
Test ketones in the late morning or afternoon. Blood and urine ketones are usually lowest right after waking up. Try testing later on, preferably a few hours after eating. Even if you’re only in ketosis for a portion of the day, you’re still getting some benefits, as discussed in this talk by Dr. Steve Phinney: Achieving and maintaining nutritional ketosis.
Certain Cancers Keto may be used in combination with chemotherapy and radiation, some studies have suggested, including one published in November 2018 in the journal Oncology. (12) But ultimately more studies are needed to determine if keto can play a role in cancer therapy, and patients should not use it as a stand-alone treatment or without a doctor’s consent.
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