You don't need carbohydrate to function. You don't need carbohydrate to be a respectable athlete. You don't need carbohydrate to be relatively healthy. A person eating primally in ketosis is going to be much healthier than someone eating a balanced diet on the SAD. However, outside of very rare outliers, no matter how healthy you strive to be in ketosis, you will never be as healthy as you are out of ketosis. Ketosis, no matter what, is always a ball and chain. It is always holding you back. Because it is almost never the state your body wants to be in. You can function well on ketosis, but you will never function optimally. It takes its toll.
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Signs of Ketosis?