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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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June 30, 2008

Dear Mark: Ketosis

By Mark Sisson
114 Comments

CarbsDear Mark,

What are ketones? How does ketosis play into the Primal Blueprint? Did our bodies evolve to run on ketones? If not, why do they exist?

Ketones, to put it briefly, are compounds created by the body when it burns fat stores for energy. When you consume a diet very low in carbohydrates, the body responds to the significantly lowered levels of blood sugar by flipping the switch to another power source. The body converts fatty acids in the liver to ketones. Ketones, then, become the main energy source as long as blood sugar levels remain low.

Recently, researchers have discovered more about the unique mechanisms behind this energy “switch.” It turns out a specific liver hormone, FGF21, is essential for the oxidation of the liver’s fatty acids. Furthermore, animals who were fed a ketogenic diet over time showed “increased expression of genes in fatty acid oxidation pathways and reduction in lipid synthesis pathways.” In other words, their bodies adapted metabolically and genetically to the diet.

Ketosis was crucial to our evolution. Given the relatively minor role of carbohydrate-rich foods (even the consumption of many tubers is thought to have come later with the advent of cooking practices), our bodies were fairly frequently operating in the arena of ketosis. Add to this the fasts and famines of primal living, and it’s clear that ketones served as an essential energy source.

The Primal Blueprint recommends “generally” about 100-150 grams of carbohydrates a day, but many who follow it or the related paleo principles choose diets that fall in the realm of 50-80 grams a day, a practice (along with IF) that spurs the body to turn on ketosis as needed. These practices encourage “upregulation” of the body’s fat-burning metabolic functioning and “down regulation” of fat storing systems. For those looking to lose fat, this becomes an extremely effective tool. On the other hand, after spending a few days or weeks in a predominantly ketosis mode, it may behoove you to do an occasional higher carb day (maybe 250-300 grams) to simply readjust insulin sensitivity. This is particularly appropriate if you have achieved an ideal body composition (lean body mass and body fat) and don’t need to lose more fat. An essential part of the Primal Blueprint includes both the fat-burning upregulation and the periodic honing of the body’s systems and adaptive responses.

Finally, ketogenic diets, which are generally lumped together by critics, have gotten a lot of bad press. While experts have generally recognized their effectiveness for weight loss, very low carb diets that result in ketosis (like the Atkins) have been criticized on health grounds. The problem with these criticisms? They’re based on diets that allow for 20 grams or less of carbohydrates a day. While I believe we are not meant to run primarily on carbohydrate energy, I do believe we depend on the nutrients offered by low carb vegetables and even some low glycemic fruits. A diet of 20 carbohydrate grams simply can’t allow for the plentiful intake of nutrient-rich vegetables.

When your carb intake is low enough, say 50-80 grams a day, ketosis kicks in when it needs to. Over time, this process becomes efficient as the body “unfolds” in its genetic expression. Yet this carb intake is high enough that you can freely include copious amounts of nutrient- (including potassium) rich vegetables to offer the body sufficient nutrition, fiber, and alkalizing minerals. At 100-150 grams a day, again all from just veggies and fruits, you probably won’t hit ketosis, but you also won’t prompt a rise in insulin or fat storage.

Thanks, as always, for your questions. Look for more on low carb living this week. In the meantime, keep the questions and suggestions coming!

insearchofbalance Flickr Photo (CC)

Further Reading:

The Definitive Guide to Grains

What Happens to Your Body When… You CARB BINGE?

Act “As If” – A 30-Day Primal Health Challenge

Subscribe to Mark’s Daily Apple feeds

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114 Comments on "Dear Mark: Ketosis"

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Bill
Bill
8 years 2 months ago

That was a great post i never herd it explained in that way.

Anna
8 years 2 months ago

Sounds like the ultimate “hybrid” fuel technology, doesn’t it?

I hear and read lots of “expert” opinion that the brain needs a lot of glucose to operate properly, yet pediatric neurosurgeon Dr. Larry McCleary (& other neuro-scientists) indicate that the brain can use ketones for fuel, too. www dot drmccleary dot com

zbiggy
zbiggy
8 years 2 months ago

Great post,
I quite don’t get this “carb up day once in a while to readjust insulin sensitvity”. Sounds tempting for a low carber to be allowed to order a pizza w/ a beer every other week 🙂 but could you just elaborate more on what exactly do I expect of my pancreas to do? thanks in advance 🙂

Maya
8 years 2 months ago

Hi.
Like zbiggy, I’m interested in exactly what you mean by the “carb up day”. I am most definitely insulin resistant (since I was 9years old) and I have been low carbing since 2003. I went off-plan for about a year, gained some back, and am now on plan seriously for the duration. I tend to get cravings from eating starch/sugar so I don’t allow them at all. Do you mean “carb up” with more low glycemic veggies/fruits or actual starches/sugars?

Zoran
Zoran
8 years 2 months ago
Hey, Mark. All this low-carb and fasting got me thinking: Is it possible to be a pro, or a semi-pro athlete and still run on 100-150g of carbs with a couple of fasts per week? I have done a lot of experiments on myself with switching from high carb to low-carb&high-fat but… I never ever managed to have a good workout followed by a normal recovery with fasting. When I say good workout, I mean 1.5 hours of wrestling or weightlifting or gymnastics. Ofcourse, I have to be partially recovered for the workout the next day. If I don’t eat… Read more »
markus
markus
8 years 2 months ago

whole fruit and veg are nice and nutritious – and that’s why i eat them – but they are not unnecessary – organic outdoor naturally reared liver, eggs and whole dairy will provide almost all your mineral and vitamin needs in abundance, along with protein and fat. The only issue is vitamin c, and on a low carb diet you only need a fraction of the RDA. so a little fruit goes a long way

m

Anna
8 years 2 months ago
markus, I think you are probably right about that, but hardly anyone eats liver anymore, let alone from animals naturally raised on pasture. Now that I have some non-factory farmed source of liver, I’m trying to cultivate an appreciation for it, abut it isn’t happening overnight and especially for beef liver, requires a lot of mustard or other distraction. I was very interested to learn how sugar and Vit C compete for uptake in the cell and that a high sugar/grain diet is probably what caused scurvy on the long distance European exploration ships, not so much lack of Vit… Read more »
Darla
Darla
4 years 5 months ago

Did you know that most pirates and private sailing vessels did NOT have limes? They didn’t need them. They carried animals on board and slaughtered them as needed in addition to catching fish. You only need citrus when you eat carbs, because carbs leech it.

Adam
Adam
4 years 1 hour ago

Also spleen has decent amounts of vitamin C. There are animal sources of vit C, and VLCer’s DRI is much lower than the average (or FDA) RDI

Mark Sisson
8 years 2 months ago
Zoran, It’s probably impossible to compete as a pro athlete – or even a top age-grouper – on only 150 grams carbs a day…unless your events last less than 45 minutes and you train hard for less than 45 a day. I guess I will have to do a post just for the athletes who want to be “primal” but also want to train incessantly long and hard. Maya, zbiggy, I do mean to “carb up slightly” with some healthier choices, like yams, sweet potatoes, berries, fruits etc. Only to 250-300 grams total for that day and only once in… Read more »
LCC
LCC
2 years 8 months ago

I have heard quite the opposite regarding ketosis and high endurance athletics. It can be done.

Tommy
Tommy
7 years 5 months ago

Dear Mark and friends,

I’ve started going paleo Jen 2009, joyfully rediscovered my 6pack after years and felt better than ever 😀
..only to find that training brazilian jiujitsu 3 days/week + 2 sessions of weights + the occasional walk/sprints ate away some kgs of lean mass as well, making me gaunt!
Guess I should have eaten more carbs..

I’d love to know your suggestions for “intense trainees” like me and Zoran! Thanks again,

Tommy

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[…] Burning ketones for energy has a reputation for causing bad breath. In reality, it’s a “different” smell than […]

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[…] Dear Mark: Ketosis […]

Gary-A
Gary-A
7 years 3 months ago

Hey everyone. My girlfriend is a Type 1 diabetic and has often mentioned “going into keto(acido)sis” and “ketones”, referring to an abnormally high blood sugar level. Since ketones are produced in fasting, which implies low blood sugar, I’m seeing a possibility of contradiction in terms. (In other news, I’m trying to get her to go paleo. Health benefits, people!!)

Does anyone have any experiences with Diabetes and info on this? Thanks!

chima_p
chima_p
6 years 11 months ago

Only Type 1 diabetics can be in a state of ketosis and have high blood sugar which will lead to ketoacidosis.

In normal humans, insulin will down regulate the production of ketones in proportion to the presence of sugar in the blood, preventing ketoacidosis.

I hope that helps 4 months late.

Darla
Darla
4 years 5 months ago

Ketoacidosis is not ketosis as low carbs refer to it. You can also go into it as a type 2 diabetic, but it happens when you become so insulin resistant that even your fat can’t take in sugar. Your body starts starving to death because it can no longer use carbs at all. Your fat starts breaking down and flooding the blood. You’re talking a difference of like a 5 point ketosis vs a 250 point … major different animals. Normal humans also go into ketosis at night when you haven’t eaten!

GeriMorgan
7 years 1 month ago

Many of the complaints made about Atkins center around the extremely restrictive “induction” phase, a two-week period during which only 20 grams of carbohydrates are allowed. This is not, however, the basis of the entire diet – it is meant as a “detox” period to purge the body of carbohydrate dependence before gradually reintroducing healthy carbohydrates to the diet. The purpose of this is to determine an individual’s ability to deal with carbohydrates, as the number of grams one can consume while continuing to lose weight varies from individual to individual.

Brett
Brett
4 years 5 months ago

Might I add, that during an extreme low carb phase, you begin to crave carbs no matter what kind. As you begin to reintroduce healthy carbs after this extremely low phase, these health carbs are much more pleasing than they would be if you were still used to having tons of non healthy carbs.

to sum up, its not only physiological but also psychological.

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[…] also note that while I don’t recommend it for prolonged periods, it’s not because I fear ketosis, or that excluding plant foods will kill you; it’s because I can’t support the “unnecessary […]

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[…] Mark’s Daily Apple: Finally, ketogenic diets, which are generally lumped together by critics, have gotten a lot of bad […]

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[…] these links to help explain, both are from Mark Sisson’s MDA website. Click HERE and HERE for more […]

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[…] Sisson describes and discusses Ketosis here and here. Read these posts…and feel free to email me any questions you may […]

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[…] 3” diabetes, a disease related to insulin resistance. Truth be told, our brains can function on ketones, fat-metabolism byproducts and key energy sources in low to very low carb diets, which some say may […]

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6 years 3 months ago

[…] 3” diabetes, a disease related to insulin resistance. Truth be told, our brains can function on ketones, fat-metabolism byproducts and key energy sources in low to very low carb diets, which some say may […]

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[…] Ketosis is bad!  Atkins is bad!  Right? […]

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[…] It got me thinking about body sculptors and how they trim right down in the last couple of weeks before competition. Now I have more of an understanding about fueling your body works I can see it being not too hard to accomplish this tweak in eating before my body figure competition… Use Ketones to your advantage: Ketones […]

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6 years 1 month ago

[…] third is a link to Mark’s Daily Apple which explains Ketosis in more layman’s terms. It also talks about why “generally” consuming between 100 […]

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5 years 8 months ago

[…] reviews in the paleo/primal world.  It is used to help slim down and put your body into a state of ketosis.  After reading the forums on MDA it appears most recommend waiting for a while before attempting […]

Ashley Smith
Ashley Smith
5 years 7 months ago
My dad told me today that ketosis can kill you, and once you’ve been in it too long, it’s hard to reverse. I find this very hard to believe…is their any legitimate proof of this? I personally thinking my parents are freaking because at 5’3 and 124lbs I am by far the skinniest person in our obese family. They don’t know what “healthy” looks like unless it’s looking like an elephant…no offense to elephants. So I’m trying to prove to them that what I’m doing is healthy and better for my overall health. It’s so hard. They always come up… Read more »
Robin
Robin
5 years 5 months ago

At 5’3″ 124lbs is perfectly healthy! Even your doctor will tell you that. What’s more important than weight is maintaining a healthy body fat percentage. If you are active with a good amount of muscle 124 will be lean but not gaunt. I’m 5’5″ and 137 and often called “curvy” even at a weight closer to yours. Yet people who are overweight say I am too skinny and think I am unhealthy even though I am probably way healthier than them. Don’t let your family’s fear of change and ignorance get you off track!

James
James
5 years 3 months ago

Ketosis is just a normal body state, its ketoacidosis thats problematic, which occurs when theres an insulin deficiency, its basically uncontrolled ketosis leading to high blood sugar, dehydration, and all kinds of problems. I know about this because I used to be a vegan because it was the “heart healthy” thing to do, or so my doctors told me. Ketoacidosis happened to me on a very high carb diet though, so it’s quite a bit different from ketosis…

Tim
Tim
5 years 7 months ago
I think I may be in the midst of ketosis. As Mark indicated, I didn’t experience ketosis, even with a pure paleo diet. I think this is because I was still getting a fair amount of carbs in a day, probably at least 100 grams. Lately, I’ve been experimenting with IF. I use a combination of the Fast Five plan and some recommendations in the book “Eat Stop Eat” by Brad Pilon. (Pilon recommends not eating for two non-consecutive 24 hour periods a week). Now that I’ve been fasting, my hands and feet have become extremely cold. I also notice… Read more »
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[…] The consequences of which are a period of low energy as my body adapts back to using fat directly from its fat stores. Once that switch occurs, energy levels will rise, metabolism increases, and I’ll shed weight like a demon until I’m ready to re-introduce more carbs into my diet to offset it. More can be read about that here. […]

jo
jo
5 years 5 months ago

Please note that the Atkins diet 20 grams of carbs is what Atkins calls NET or usable carbs. Fiber is subtracted and/or not counted.
For example one of my days would have 70 grams carbs but only 30 grams net carbs.
The 20 Net carbs is only for the “induction” period of 2 weeks and some very obese people stay there longer..but in reality their carbs are closer to 30-35.
Atkins is designed for you to learn your carb tolerance with gradual increases in levels.
Please be sure you understand something before you knock it!

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[…] oxidative fallout) at relatively high outputs for very long bouts. Cardiac muscle actually prefers ketones, and the brain can run just fine (maybe even optimally) on a blend of ketones and minimal glucose. […]

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[…] than longer chain fats. They are easily digested, head straight to the liver for oxidation or ketone generation without dealing with the lymphatic system, and can be utilized by cells for energy […]

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[…] than longer chain fats. They are easily digested, head straight to the liver for oxidation or ketone generation without dealing with the lymphatic system, and can be utilized by cells for energy […]

Clark
Clark
5 years 2 months ago

I know a guy with a three year old daughter who is on a ketogenic diet to treat her severe epilepsy. It seems to work extremely well as she rarely has seizures anymore, so maybe glucose isn’t so good for the brain.

Apparently this was a much more common treatment before more effective drugs were developed.

Brett
Brett
4 years 5 months ago

epilepsy is a disease so i dont believe it should be used to show that glucose may not be good for the brain. However, fasting many many years ago used to be the main tool to help with epilepsy. Then the ketogenic diet was “invented” to mimic fasting while being able to keep the ketogenic environment that helped to reduce epileptic seizures

LCC
LCC
2 years 8 months ago

ASD – Autism spectrum disorder is not a disease, yet the same neurological efficiencies seem to apply to this (as it does to epilepsy).

Ruby
5 years 2 months ago
I’ve been transitioning over to paleo for about two months. For the last month I’ve been tracking my food and today I took my measurements. Almost no change! I don’t think I’ve lost any weight and my clothes all fit about the same. I don’t consume ANY grains. I’ve reduced even my fruit intake. When I do have it, it’s between 5-10 berries, maybe half a banana. Plenty of eggs, bacon, grass-fed beef (when I buy it for my house), vegetables, some nuts. No veggie oils. I’m guessing that I’ve increased my dairy intake too much as a result of… Read more »
ElleHad
ElleHad
5 years 1 month ago
Hi Ruby, I think I’ve gotten in to a similar habit: Upping my dairy to replace the greater evils I used to eat. You said you’ve been tracking what you’re eating, have you been looking at total fat and total protein intake each day? A few months into a primal diet, and I’ve also not been losing excess body fat as I had expected, even with starting CrossFit two months ago! But I came to realize that my protein intake was pretty low and my fat intake was high (relative to the protein). I’ve been meaning to re-read this post:… Read more »
Gai Cambel
Gai Cambel
5 years 13 days ago
i know this was a few months back, but i got this from the atkins web site. not primal, but low carb anyway: Can I drink Alcohol while on the Atkins Diet? When you consume Alcohol, it is the first fuel to burn. While that’s going on, your body will not burn fat. While this does not stop weight loss, it will postpones it until the alcohol has been used up. If you must drink alcohol, straight liquor such as scotch, rye, vodka, and gin would be the best choices as long as the mixer contains no sugar. If you… Read more »
Alvaro Coronel
Alvaro Coronel
5 years 1 month ago

I for one would love to estimate the amount of carbs I am ingesting daily. As I am having no cereals and no sugar, most of it must be from fruits… can anyone tell me how to do this, or point me in the right direction? Thanks!

Tracie
Tracie
5 years 1 month ago
I recommend using Sparkpeople.com. It’s a free site that features, among other things, a nutrition tracker with thousands of foods pre-loaded. I haven’t met a whole or natural food yet that isn’t in it. They’ll try to set you up on a nutrition plan with goals and all, and you might have to set up a profile to get to the main part, but once you’re there you can use their nutrition tracker and ignore their “goal ranges”. I’ve been using the site for a couple of years, and even though I’ve just switched to primal-eating, I’m planning to keep… Read more »
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[…] started when I began trying to then solve the plateau to “kick start” my body back into ketosis.  I did everything I shouldn’t have done on Paleo to cause me to retain […]

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[…] these links to help explain, both are from Mark Sisson’s MDA website. Click HERE and HERE for more […]

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[…] Ketosis, Mark’s Daily Apple […]

Peter
Peter
4 years 9 months ago

What about the Japanese, Vietnamese and Burmese that eat a lot of white rice? Are their bodies in ketosis or are they burning fat without ketosis? The truth is that they are still very slim even if they do eat a lot of white rice.

Rama
Rama
4 years 9 months ago

I have exactly the same question. I live in Singapore and everyday I see all these slim, slender people tuck into rice and noodles at the food courts…almost nobody cooks at home and most people eat at food courts and hawker centres. They eat a lot of rice/noodles along with lots of meat and seafood and some veggies. How do they stay so slim? They have super flat bellies!

Peter
Peter
4 years 9 months ago

OMG? Are you Singaporean also?

Karen
Karen
2 years 2 months ago

Hi Rama and Peter,
I am from Singapore too! Looking for like-minded Groks to maneuver this new life-style I am trying to embrace. Any tips will be welcome!

Peter
Peter
4 years 9 months ago

I think it has something to do with how much walking and labour they do daily. Even now, Singaporeans are starting to get fat as we start becoming more modern. I got one obese person and two severely overweight people in my family. When Singapore first became a nation, there were fat people, but very few, and there was white rice too.

amy1
amy1
2 years 3 months ago
Asians generally have a lot more coies of the AMY1 gene that controls how much amylase you can make and therefore how well you use carbs. It isn’t and can’t be the only factor because breaking down a lot of carb is not a solution all by itself. There’s the problem of glycemic index. But it shows that genetic differences may be in play. Also note that if you tried the Macrobiotic diet like I did in the 1980-90s, and read the old Japanese classics, they were advice on how to stay healthy in the “new diet” of rice and… Read more »
amy1
amy1
2 years 3 months ago
As someone who relies on on nutritional ketosis or whatever you call it today, to keep neurological disease down, let me chime in. I was delighted by the Paleo/Primal movement making high quality meat visible and available, but as NK is still the red headed stepchild of everyone except French Chefs, (if you stay away from the dessert), we still need a movement for brain and fat to be available in places other than asian or ethnic markets. That said, there are three metabolic cycles I am aware of, glycolysis, beta oxidation and oxidative phosphorilation. If you take the time… Read more »
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[…] an average of 50g per day = ketosis, rapid fat loss (ketosis is when your body switches over and uses it’s body fat for fuel. […]

Kate Kelso
Kate Kelso
4 years 7 months ago

Don’t ketones change the pH of your blood?

CMHFFEMT
4 years 4 months ago

Short answer is no.

Blood PH is maintained in a very small range by a couple different mechanisms. The largest being the carbonic acid-bicarbonate system. you can find a good explanation here: http://www.normalbreathing.com/CO2-blood-pH-respiratory-alkalosis.php

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4 years 5 months ago

[…] 3” diabetes, a disease related to  insulin resistance. Truth be told, our brains can function on ketones, fat-metabolism byproducts and key energy sources in  low to very low carb diets, which some say […]

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4 years 4 months ago

[…] all heard how w&#1077′ll suffer heart attacks, diabetes, ketoacidosis, lowered marathon performance, kidney disease, and osteoporosis […]

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[…] interested in the Ketosis Diet would probably like this article about ketosis at Marks Daily Apple Share this:TwitterFacebookLike this:LikeBe the first to like this post. Bookmark the […]

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[…] be stored, meaning they must be utilized for energy. MCTs also increase the production of ketones. These are good things, since fat is going to be your ticket through this race. In most cases, […]

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[…] – like a traditional Inuit diet – your brain will eventually be able to use fat-derived ketones for about 50-75% of its energy requirements. Most ketones are produced in the liver, but astrocytes […]

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[…] more on this check out the MDA article here. By Tom Scoble on July 4, 2012   /   Nutrition   /   Leave a comment […]

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[…] you at a normal weight. The Paleo diet teaches your body how to keep weight off by a process called ketosis. A state of ketosis is basically when your body uses stored fat for energy. So, if you are in […]

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[…] a lack of dietary glucose. As I’ve said in the past, the brain must have glucose. It can use ketones and lactate quite effectively, thus reducing the glucose requirement, but at the end of the day it […]

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[…] and glucagon is used. The process being described here is Ketosis. This is when your body produces fat burning ketones and burns fat instead of carbohydrates. A state of ketosis is when you will lose weight and get […]

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[…] an average of 50g per day = ketosis, rapid fat loss (ketosis is when your body switches over and uses it’s body fat for fuel. […]

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