Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
5 Mar

Is Constant Ketosis Necessary – Or Even Desirable?

Is Constant Ketosis Desirable? | Mark's Daily AppleEvery day, I get links to interesting papers. It’s hard not to when thousands of new studies are published every day and thousands of readers deliver the best ones to my inbox. And while I enjoy thumbing through the links simply for curiosity’s sake, they can also seed new ideas that lead to research rabbit holes and full-fledged posts. It’s probably the favorite part of my day: research and synthesis and the gestation of future blogs. The hard part is collecting, collating, and then transcribing the ideas swirling around inside my brain into readable prose and hopefully getting an article out of it that I can share with you.

Last Sunday, I briefly mentionedpaper concerning a ketone metabolite known as beta-hydroxybutyrate, or BHB, and its ability to block the activity of a set of inflammatory genes. This particular set of genes, known as the NLRP3 inflammasome, has been linked to Alzheimer’s disease, atherosclerosis, metabolic syndrome, and age-related macular degeneration. In other words, it’s in our best interest to avoid its chronic, pathogenic activation, and it looks like going into ketosis can probably help in that respect.

One thing led to another, and this paper got me thinking: once we “go into ketosis,” how long should we stay? If some is good, is more better? Is there a point where the benefits slow and the downsides accrue?

We absolutely know that ketones, particularly BHB, do lots of cool things for us. There’s the NLRP3 inflammasome inhibition, for one. There’s also the effect it has on brain health and function, particularly in the context of neurodegenerative diseases and other brain conditions.

Brain aging:

  • Whether it’s severe hypoglycemia in a live rat or direct glucose deprivation of cortical cells in a petri dish, the addition of BHB protects against neuronal death, preserves energy levels, and lowers reactive oxygen species.
  • In an animal model of Cockayne syndrome, a condition characterized by premature aging, short stature, and early death (about age 10 in most human children with it), increasing BHB through ketosis postpones brain aging.

Brain disorders:

  • Ketogenic diets are classic therapies for epilepsy, with BHB being the most important ketone for preventing seizures. The degree of seizure control tracks almost lockstep with rising BHB levels.
  • There’s also evidence that patients with bipolar — a disorder sharing certain neurobiological pathways and effective therapies with epilepsy — can also benefit from ketosis. Recent case studies show complete remission of symptoms in two patients as long as they adhered to their diets (which were fairly Primal-friendly, for what it’s worth).
  • Parkinson’s disease patients who adhered to a ketogenic diet saw improvements in their Unified Parkinson’s Disease Rating Scale scores.

Brain function:

  • Type 1 diabetics who experience reduced cognitive function because of low blood sugar see those deficits erased by increasing BHB through dietary medium chain triglycerides (the same fats found in coconut oil).
  • In memory impaired adults, some with Alzheimer’s, BHB improved cognition. Scores improved in (rough) parallel with rising ketones.
  • A ketone-elevating agent (purified medium chain triglycerides) improved cognition in patients with mild to moderate Alzheimer’s.
  • A very low-carb diet improved memory in older adults. Again, ketones tracked with improvements.

Mitochondrial levels of the endogenous antioxidant glutathione increase on a ketogenic diet; this is likely a major reason for many of its beneficial effects.

It’s quite clear why constant ketosis is attractive to people who read about (and experience for themselves) the benefits of BHB and ketosis in general: There don’t appear to be many downsides. Improved brain health? Increased antioxidant capacity? Inhibition of an inflammatory set of genes involved in the worst kinds of degenerative diseases? What’s not to love? Why wouldn’t someone remain indefinitely ketogenic?

Ketosis also activates the NRF2 pathway — a set of genes that regulate the body’s detoxification, antioxidant, and stress response systems — by initially increasing systemic oxidative stress. If that sounds a bit like hormesis, you’d be right. Ketosis, at least in the early stages, exerts some of its beneficial effects via hormetic stress. Various other stressors also activate NRF2, like plant polyphenols from foods like blueberries and green tea, potent spices like turmeric, intense exercise, and intermittent fasting. These all improve our health by triggering our stress resistance pathways and making us grow stronger for it, but they can also be taken to an extreme and become negative stressors.

Consider intermittent fasting and exercise. While the most famous way to increase BHB is to go on a ketogenic diet, it’s not the only way. Both fasting and exercise also do the trick:

  • A properly-executed fast puts you into full-blown ketosis. In healthy adults, two days of fasting increases brain BHB almost 12-fold (and almost 20-fold after 3 days). Even just an eight hour fast, AKA a good night’s sleep, will put you into ketosis and increase BHB (PDF) if you have strong metabolic health.
  • Exercise-mediated increases of BHB are a good barometer for the amount of fat a person will lose during a workout program. The more body fat you carry, the greater the elevation in BHB and the more weight you’ll lose.

What do you notice?

These are both transient states that grow problematic when extended indefinitely.

You can’t fast forever. That’s called starvation. And, eventually, dying.

Instead, you fast for 12, 16, 24, or on the very rare occasion 36 hours, and resume your normal diet after the fasting period has ended. You introduce an acute bout of food deprivation to upregulate your fat burning, trigger cellular autophagy, and generate ketone bodies.

You can’t train every waking hour. That’s called working in a forced labor camp, and it too leads to very poor health.

Instead of training 12 hours a day, you sprint, or lift weights, swing a kettlebell really intensely, or any other type of training two or three times a week. Then, you rest and recover and eat, and grow stronger, more fit, and faster in the interim.

Ketosis isn’t fasting. It’s not starvation. You’re still eating, although your appetite may be reduced (which is why many people lose weight from ketogenic diets). You’re still taking in nutrients, even if glucose isn’t among them. And ketosis isn’t anywhere near as acutely stressful as a strong training session. But I think the principle stands: these are all stressors that exert benefits, at least in part, along the hormetic pathway. And when it comes to hormetic stressors, too much of a good thing usually isn’t very good.

What does this mean for indefinite, long term ketogenic dieting?

If you’ve got a legitimate health condition that responds well to ketosis, all bets are off. There’s evidence that people can thrive on good ketogenic diets for at least five years without incurring any serious side effects. For controlling epilepsy, there’s nothing better than a strict ketogenic diet maintained long term to quell the overexcited brain. For any of the neurodegenerative diseases, like Alzheimer’s or Parkinson’s, ketogenic diets look very promising and are worth trying. It even looks promising for bipolar disorder. If you’ve got a problem that ketosis helps or fixes, go for it. It’s helping you, and there’s no mistaking that.

My personal hunch (and I’ve said this for as long as I can remember) is that indefinite ketosis is unnecessary and perhaps even undesirable for most healthy people, and that occasional, even regular dips into ketosis (through fasting, very low-carb cycles, intense exercise) are preferable and sufficient. That way, you get the benefits of cyclical infusions of BHB and other ketones without running afoul of any potential unforeseen negative effects.

Plus, cycling your ketosis means you can eat berries and stone fruits when in season, and enjoy those otherworldly-delicious purple sweet potatoes without worrying. Personally, I like food too much to go full-on keto. You may not, and that’s okay.

If you’re thriving on a ketogenic diet, and have been for some time, keep it up. No one can take that away from you, and the studies indicate it should be safe.

But if you don’t have to remain in ketosis to resolve or stave off a health condition, if you’re just doing it to do it or for yet-to-be-realized benefits, consider rethinking your stance. And if ketosis doesn’t agree with your health or your personal performance goals, then don’t do it. It’s certainly not necessary for optimal health (if such a thing even exists!).

What about you? If anyone’s been on a long-term ketogenic diet, I’d love to hear how it’s worked for you in the comments below. Thanks for reading!

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I’ve only been on a ketogenic diet for a couple of months now, although I’m planning to do it indefinitely, perhaps cycling in and out now and then. I originally started it for weight loss but really like how I feel on it. I just ‘like my brain better’ on ketosis. I have tons more energy, am hitting more PRs in crossfit, sleep great, and my mental state is more calm and centered. Am less prone to bouts of heart-clutching anxiety and my emotions don’t ‘hurt’ my physical body as much as they did pre-ketosis. (for example pangs of guilt or the sinking feeling in my stomach – they just don’t feel as bad). For that alone, the diet is worth it to me. (plus I love to eat butter) :)

    Surprisingly, I haven’t lost weight as fast as I thought I would, only about 6-7 pounds with 40 more to lose, so will be adding intermittent fasting next. Have tried a little but still get very hungry if I skip a meal, even though I’m in ketosis. I have a Ketonix and have found it to be very accurate.

    starmice wrote on March 5th, 2015
    • I have had the exact same experience (except I’ve lost more weight)! The effects on the mind and emotions alone are worth it.

      I find that once I enter ketosis, I’m rarely ever hungry. IF of 20 hours becomes natural even when I have a heavy workout day.

      Kat wrote on March 6th, 2015
      • That’s fantastic, Kat! (and inspiring). I would love to not be hungry as I often have better things to do. I’m a little surprised I’m not losing faster as normally I lose weight pretty easily if I set my mind to it. According to my ketonix I’m in mild ketosis (green6 to green8) every day. Do you mind if I ask you what you normally eat on a typical day?)
        Apologies if this is the wrong place to post this.

        starmice wrote on March 6th, 2015
        • I eat primarily very fatty cuts of meat, fish and poultry and the occasional mix of organ meats and small salad . I have some pemmican waiting for me on my desk right now, for example. I find that the fewer carbs I eat (of any kind, including vegetables), the more stable my energy is. I’ve progressed closer to a zero carb diet because the more I cut carbs, the better my gut felt and the better I felt overall. I might experiment with a zero plant food diet for 30 days to see what happens.

          I do get hungry, but only once or twice per day and if I’ve had a particularly hard workout the day before. When I do get hungry, it’s not the kind of hunger that compels me to eat right away. I don’t get “hangry”. I noticed that scale weight doesn’t drop super quickly, but the inches melt off. I fit into smaller sizes at higher weights.

          I hope this helps. Everyone is so different that it’s impossible to come up with a formula that works for everyone, but I like gathering different ideas and trying new things to figure out what works for me.

          Kat wrote on March 10th, 2015
    • Hey, keep up the good work! I have been “in and out” of Ketosis for over a year. I feel GREAT! During the summer my husband and I eat a lot of berries and fruit in season because we grow them (all organic, naturally) and then I also freeze them but we tend to eat them only once in a week during the winter. So summertime is when I use IF to control the Ketosis.
      I hardly ever experience feeling hungry any more, I don’t get stressed out. When I get up in the morning I feel alert and ready to go! I also perform super slow (body) weight training, assisted isolated stretching, and in the winter I ski (downhill/x-country) everyday and in the summer, it’s gardening, bicycling, hiking, canoeing.
      I feel I have reached my perfect weight….and it doesn’t fluctuate at all. I do not ‘miss’ or have cravings….but I do enjoy my homemade dark chocolate…..1 cup really high quality organic dark cocoa powder, 1cup organic cocoa butter and 2-3Tablespoons pure raw organic honey! YUM!!!

      Gypsyrozbud wrote on March 9th, 2015
    • Same benefit for me, I had no weight to lose, but I lose 8 pound around the belly and the hip. After 6 months of cross fit I be able to put 10 pounds of muscle!
      Now it’s been one year and a half that I’m in a ketosis state.

      Love my Ketonix to :)

      Manon gilbert wrote on March 17th, 2015
    • Matt, If something doesn’t look unnatural, it probably is. And I suspect you may detest your dietary decisions in the future. Whatever you are doing, please consult your doctor (or urologist even better) before you make this a lifestyle. Ketones have plus effects bu also minuses as well. And as a general rule of thumb, let’s not undermine doctor’s advice just because he hasn’t tried Primal or competed in sports himself. BElieve they see (a lot of) patients and cases.

      Matt Mason wrote on March 30th, 2015
    • Hi there. I’ve also had a challenge maintaining ketosis and have the Ketonix as well as the blood ketone measuring device, which is the most accurate. What I find interesting is that the breath meter isn’t really all that accurate compared to blood. It always shows “red” at night and orange in the a.m. with a range of .3 to 1.8 mm as the ketone reading in the blood. Quite a range. With that in mind you might consider using your blood reading as the most accurate. I know it surprised the heck out of me. Also if you’re still getting hungry doing IF, you’re likely still burning sugar over fat. It’s shocking how effortless not eating or getting hungry is when you’re burning fat. If you’re curious, check out Jimmie Moore on this topic.

      Starpaws wrote on April 9th, 2015
  2. For those new to the topic see also:
    FYI: Peter is no longer full time ketotic.

    Beyond just brain function, people with T1D use KD as the primary tool to manage the condition (see Richard K. Bernstein).

    No mention was made of exogenous ketones, which are available, and can raise blood ketone levels even while you are in glycemic metabolism.

    No mention was made of cancer. Some people are using KD to retard, arrest or even reverse cancers (see “Cancer as a Metabolic Disease”, Seyfried) for why it might work). Easily worth a look for someone who intends to decline rad or chemo anyway.

    Boundless wrote on March 5th, 2015
    • Hi Boundless,
      Thank you so much for that link on your post!!! That thing was an excellent read!! I am glad I have the background to understand it, and it was exactly the information I was looking for in order to help others understand what is going on as they embark on this kind of eating journey. Thank you again.

      Viola wrote on March 6th, 2015
  3. Much like type 2 diabetes is caused by overflowing your carb intake for decades, I wonder if there is a complementary disease caused by underunning your carb intake for decades.

    If such a thing existed it would be fun to think of an alternate universe where carbs got the demonization that fat did in the 20th century. Perhaps in that world they are hemming and hawing about the diseases of “chronic ketosis”.

    I despise the phrase “everything in moderation”. I much prefer “everything in context”. Carb intake (high, low and everything in-between) in context.

    Christopher Henderson wrote on March 5th, 2015
    • I also hate the “everything in moderation” mantra. You have to define moderation for it to be minutely applicable. What’s moderate for me, might be overdoing it for someone else, and vice versa. I LOVE “everything in context” because that makes all the difference. Thank you for sharing!

      Stacie wrote on March 5th, 2015
      • Ditto on hating “everything in moderation”. Nothing good in this world was achieved by moderation. Great artists and musicians aren’t moderate. Great scientists aren’t moderate. Great literature isn’t written in moderation. It takes an obsessive level of attention to detail and commitment do do just about anything really well or attain major breakthroughs.

        Clay wrote on March 5th, 2015
        • everything in modulation

          lipidphilia wrote on May 18th, 2016
      • When people tell me to take everything in moderation, I ask them if they eat poison ivy in moderation.

        Jon wrote on March 5th, 2015
        • The concept of someone eating poison ivy just gave me a good chuckle for some reason. Thanks!

          M wrote on March 6th, 2015
    • If there is such a disease, it would have probably presented in the Inuit population and the populations living in the extreme Northern part of Russia. As far as I know, no such condition was ever documented. Apparently, carbs are non-essential. Fat and protein are. Of course, your body will generate adequate glucose from protein, but it cannot generate protein nor can it generate dietary fat.

      Kat wrote on March 6th, 2015
  4. Thank you Mark,
    You mention how ketosis helps with certain types of illnesses, seizures as one of them. Have you done any recent research on how Marijuana can help. Medical marijuana oil is really in the news lately.

    Shirley wrote on March 5th, 2015
    • You must live in WA or CO! If anyone has thoughts on this, might be worth researching.

      Mark Causey wrote on March 5th, 2015
    • Go MJ We are praying in Nevada for it to pass in the next vote. Nothing beats a bowl at night to wind down before sleep.

      grndzro wrote on March 17th, 2015
  5. The acute instead of the chronic, is something I usually prefer. Then I can also enjoy my rice, potatoes and bananas.

    Troels Rasmussen wrote on March 5th, 2015
  6. I currently on Protein Sparing Modified Fast – since early January. Weight is coming off, but once I hit my goal weight I will increase my food options to include fruits and nuts, cheese and other things that are currently off limits (from either a caloric or carb type restriction). I think that will be the best for me as it is something I can stay on long term. I do feel very good overall now after 2 months.

    Dave in Arizona wrote on March 5th, 2015
  7. That’s where my 1 meal per day comes in handy. I can eat berries and still dabble in ketosis daily. With about 23 hours of fasting time per day I have plenty of time to run low on glucose and return to my basal metabolic state.

    Groktimus Primal wrote on March 5th, 2015
  8. I agree. Ketosis is an awesome tool, but I don’t see it as something meant to be used for an entire lifetime!

    Livi wrote on March 5th, 2015
    • Agree. Also, there are varying forms of a ketogenic diet, just as there are varying degrees of ketosis. Some keto diets restrict calories as well as carbs in order to mimic starvation for medical disorders. Technically, a small piece of meat, a large chunk of butter, and a lettuce leaf would qualify as a ketogenic meal, but no one can remain indefinitely on such a restrictive eating plan and hope to be healthy.

      Having administered a ketogenic diet years ago for a family member, I know for a fact that there are plenty of downsides, such as chronic constipation and copious weight loss even when weight doesn’t need to be lost. Also, some keto diets don’t provide the body with nearly enough nutrition for optimal health. (Sorry, but a handful of supplements doesn’t equate to what you get from real food.)

      IMO, extremely restrictive ketogenic diets are best used short-term for specific medical problems–not as a lifestyle for healthy persons.

      Shary wrote on March 6th, 2015
  9. In the same way ketosis has been found to prevent seizures in young patients with epilepsy, it is helpful for those with migraines. Check out “The Migraine Miracle,” by Josh Turknett, a neurologist and former migraine sufferer.

    Lisa in Northern California wrote on March 5th, 2015
  10. I try generally to stay in ketosis because personally, it works for me. The less carbs I consume the better I feel and the better I perform. Occasionally I will have a carby meal (meat and sweet potatoes with some extra veg for example) and not worry too much about getting off the ketosis train. I’m not stuck on it and I don’t panic if I can’t have a perfect meal every time, but for the most part I’ve been able to keep it the way I prefer, and truly that’s all that matters.

    Shannon wrote on March 5th, 2015
    • I’m with you on it–I didn’t lose an ounce until I got (and stayed) in ketosis. 20 lbs. later, i dared to have a small piece of Wensleydale cheese (with cranberries in it), and am now stalled. I plan to stay stalled (at this new lower weight) until spring, when I can get out and start moving again (and hopefully re-start the weight loss).

      Wenchypoo wrote on March 5th, 2015
  11. I think that real primal ketosis should follow seasons. Eat a lot of fresh fruit at summer – full on ketosis at winter.

    dXm99 wrote on March 5th, 2015
  12. Seems to be doing quite well in ketosis for the last 14 years:

    Mike wrote on March 5th, 2015
    • If you define “quite well” as big muscles….then yes…

      Texman wrote on March 5th, 2015
  13. We are designed to thrive in a variable, not static environment. Therefore exercising and relaxing (totally)…wake/sleep…fasting (even for days) and feasting…ketosis and carb loading…all on an irregular schedule…I’d like to see studies of a changing diet….In this regard “constant” ketosis may or may not be better than “constant” something else, but I’d wager it is not better than a variable healthy diet which includes ketosis sometimes, but not always. Constancy itself is the enemy. The mild stress of change is our friend.

    Jon wrote on March 5th, 2015
    • well said

      Texman wrote on March 5th, 2015
  14. I was curious why Mark did not mention migraines. I have started eating primal since May last year (almost a year) mostly to help migraines. I started by trying to be in ketosis, but have settled into a lower carb diet (a lot lower then what I was eating). I eat no grains and most of my carbs from an occational sweet potatoe and my new favorite desert, home made yogurt and berries. I have a “splurge” meal once a week (big hamburger and fries or pizza).

    Migraines have reduced. Just before going primal I would have to treat my head with abortive meds every other day (thank goodness they work). Today the average is every 5 days. Maybe if I pushed for more ketosis through fasting or lowering carbs it would help more. And by the way, I’ve lost 20 pounds as well.

    Terry wrote on March 5th, 2015
    • I’m not sure if you’ve tried this, but for me, eliminating gluten *completely* put an end to my migraines. Even a little bit now & then keeps the auto-immune response going, so you may want to choose splurges with non-gluten treats.

      Paleo-curious wrote on March 5th, 2015
      • Thanks, I’ll try that. Some of my splurges are like a gluten overload. I’m 100% non-gluten the rest of the the time. Did it take long for your headaches to go away after stopping gluten?

        Terry Haynes wrote on March 5th, 2015
        • Hi, My migraines have gone for good, after 19 horrific years when they lasted five days and came every two weeks with no meds working at all. Then I found some meds which helped a bit but had to take them nearly every day. I was referred to a neurologist who recommended a gluten free diet as an experiment. This did not help by itself, although I gather it can help a lot of people, but as soon as I came off all dairy as well, the migraines have stopped, dead. If I have any gluten and dairy they begin to reappear again. Good luck:)

          sweffling wrote on March 5th, 2015
        • It wasn’t immediate, although I did notice improvement right away. I’d say it was a few months before I really felt they were well & truly gone. I still have one every once in a long while, very possibly due to cross-contamination, but I can’t be sure. I eat as thoroughly gf as humanly possible in a household that still eats wheat. (Separate butter dish, separate cutting boards, uber-careful!)

          Paleo-curious wrote on March 5th, 2015
        • Thanks for your responses. Looks like for me it is either being more strict with gluten, or removing diary, or both if I want to be headache free.

          Terry Haynes wrote on March 5th, 2015
        • Terry, I believe that it can take up to 3 months for the inflammatory effects of gluten to subside.

          Debbie wrote on March 5th, 2015
        • Not sure if you both saw my post above. You might want to check out “The Migraine Miracle,” which address all of your questions and so much more. BTW – I do not get any proceeds from the sale of the book!! I have just had success following it’s guidelines, which are in line with a primal lifestyle. And, the author references Mark’s Daily Apple. :)

          Lisa in Northern California wrote on March 7th, 2015
        • The Migraine Miracle is what got me going on Primal. I just ate my Orange Bar for breakfast from that book. And his reference to Marks site got me here. The only problem with his book is the title. It may turn some people off with such a sensational title for such a thoughtful book.

          Terry wrote on March 9th, 2015
    • I’ve also conquered my migraines with going grain free/gluten free. The effect was immediate. I can tolerate potatoes and rice, so starch or carbs are not the problem. If the migraines continue with people who stopped eating grains, next thing I would advice is to stop drinking milk, then fermented milk products.

      If I have a single piece of bread, I feel immediate pricking in my temples.

      If you suffer from migraines, I would go 100% grain free all the time. A splurge meal with offending ingredients once a week is way too much for a migraine patient.

      Margit wrote on March 11th, 2015
  15. Awesome post Mark! I love your balanced approach to all of these issues. Keep up the great work!

    Tim wrote on March 5th, 2015
  16. Many years ago I sort of did a ketogenic thing without realizing it or knowing anything about it. Not much was available in the way of info back then.

    I mainly subsisted on coffee, green tea, lots of water and usually a light, non-starchy dinner which I sometimes skipped altogether. I’m sure there was ketosis happening but I didn’t know it at the time. I wasn’t trying to lose weight and had no health concerns. I was just in a new living situation and really was too busy/excited to eat!

    Nonetheless I lost over 50 pounds in a couple of months that year and it still hasn’t come back. I’m thinking of doing something like this again, more consciously this time, and see if I can lose about 20 more pounds (to goal weight).

    Very interesting information, especially regarding brain health. This is timely for everyone, but especially all of us aging baby-boomers.

    ShaSha wrote on March 5th, 2015
  17. Id love to hear your thoughts on how ketosis might affect a woman trying to overcome hypothalamic amenorrhea. My thoughts are that the lack of carbs/ketogenic state may actually be an impetus to health and healing in this situation. Would love to see a post on that topic!

    Kg wrote on March 5th, 2015
  18. Thanks for the post.

    I have type II diabetes and started a keto diet just over a year ago just after my diagnosis. It took about a year, but my blood glucose is now normal and I no longer see blood glucose spikes. My postprandial readings are in the 80’s and low 90’s and my last HbA1c was 4.5%. As a result I plan on staying on a keto diet for life.

    OldTech wrote on March 5th, 2015
    • That’s great! That’s inspiring to me!
      I was doing a low carb diet for diabetes, but after reading the Art and Science of Low Carb, as well as Keto Clarity, I realized I need to lower my vegetable intake and up fat! I did that, and now, have lost a little belly fat. My last hbA1c was 5.7, and I’m hoping I can lower it.

      Tenny Calhoun wrote on March 5th, 2015
  19. I kind of use the guideline and ask WWGD: What would Grok Do? Point being, there is no evidence of any race or people in the history of our planet that remained in ketosis for their entire lifespan. At the most, there would be periods of ketosis in lean times, but forever? Not likely. You could try it, but basically you’re experimenting with your life.

    Jer wrote on March 5th, 2015
    • Wouldn’t he Inuit be in long term ketosis since they ate mostly meat year round?

      Julie wrote on March 5th, 2015
      • No, not really. That’s a myth that’s been propagated over time and never really questioned. There’s a lot of research that has been done over the years and recently brought to light which refutes that.

        For starters, check out this article (among others ) on Free The Animal: “Inuit and Masai Ate Carbs and Prebiotics, Part 1”

        Jer wrote on March 6th, 2015
    • Ever heard of the Inuit? I prefer science to clever idioms that mimic religiousness.

      Rick wrote on January 11th, 2016
  20. Great post, I’d been hoping for an update on this.

    I’m curious if anyone has seen any good data on how long in heavy ketosis is required to express the genes that are expressed by ketones (particularly the anti-aging variety). In other words, is it necessary to stay in ketosis for some period of time and then intermittent ketosis is enough to maintain? Or is intermittent ketosis enough, even if it takes a bit longer for the gene influence to occur?

    I remember Steve Phinney saying something about one of the affects taking 20-25 days to occur in humans, but I wonder if several days per week of heavy ketones is enough to do the same thing, or does it just take longer , or not happen at all…Does anyone have any insight on this?

    Superchunk wrote on March 5th, 2015
  21. Where does the idea that ketogenic diet used long term / for life is “primal” come from, anyway?

    Fairy Tale wrote on March 5th, 2015
  22. After being primal for 2 years and not losing weight, I decided to try ketosis. It totally backfired. After 4.5 weeks, I lost only a lb. or two (water weight?), but the worst part was I was so fatigued it felt like I couldn’t lift my arms without great effort. I felt like a zombie – utterly emotionless – for weeks. When my mood finally crashed – in the middle of summer, not the dark days of winter – I just couldn’t make it to the 6 week evaluation mark I set for myself. I added back carbs, small amounts of starches, to recover. My mood improved, I felt energetic again, but it took a month. I also gained 5-7lbs above my pre-ketosis weight, which really hasn’t come off since. I’ve never tested positive for thyroid disease, but I swear ketosis messed with my thyroid and hormones. Never had it checked, so can’t say for sure. Just my story. I totally believe that ketosis works for some people.

    Kim wrote on March 5th, 2015
    • I had the opposite effect on ketosis. I felt great. My mind was clear and I had crazy energy. I would wake up earlier than my alarm in the morning, feeling refreshed. My mood evened out. I have a hard time sticking to it becuase of food boredom. I’m experimenting now with seeing what level of carbs I can do and still feel the benefits.

      Wendy wrote on March 6th, 2015
    • ketosis gave me a mustache and my hair started falling out. I did lose some weight, 25 lbs and have not regained it, i learned i am a better person w/o crash carbs and my face was clear, great periods like no more PMS and lighter periods too…. less cramps and mood swings…but the hair falling out and mustache…..uhh .. what do ya do?

      Angel wrote on March 7th, 2015
      • I’m not sure where, but somewhere I remember reading that being in ketosis helps some women with PCOS but unfortunately can bring on negative symptoms from women who didn’t know they had it… So i would definitely have my hormones/sugar levels checked out at ob/gyn. I hope you do not have PCOS, but I do, and have found that a primal/keto plan works best for me and minimizes my symptoms + 10 months migraine free! Good Luck.

        nicholette wrote on March 11th, 2015
    • I suppose you simply ate to much protein, to much carbs and did not suplement magnesium and potasium. Here you write about simple keto flu, entering period. If you enter ketosis properly it takes 2-3 weeks to adapt if you get enough fat, drink much water and fast ocasionally. Should have calculated your macros and stick to it for those 2-3 weeks. When you hit the wall and do not give up then the ketosis comes and you feel like newborn. It is always that way. Can’t do it any other way. Just do not be afraid of fat. It’s your friend at the beginning of the journey.

      Anna wrote on March 7th, 2015
  23. I basically eat almost no heavy carbs( like sweet potatoes) to make up for this few times I indulge while out. This might put me into ketosis I don’t know. I also do what I call broth fasts, where all I drink are meat broths for a day then maybe have a low carb dinner to set me back in track after a slip

    Julie wrote on March 5th, 2015
  24. This is interesting.

    I’ve been tuning into a lot of the ‘summits’ on line; there seem to have been a ton over the last few months, I’ve even bought some of the interviews. Pretty much all are from a paleo stance. What I’ve noted is the number of times control of blood sugar is coming up in terms of health but also particularly for women and hormone control. And for that most are talking about regular meals to balance sugar.

    I know ketosis can be regular meals (not just through fasting) but I wonder about the stress hormone response with the lacking carbs and the knock on effect that may have with female hormones, particularly the potential to imbalance oestrogen and progestrone (the real nemesis of peri-menopausal issues).

    I’ve asked Mark if he’ll review meal frequency from the female hormonal viewpoint. I’d be interested to know how many of these studies quoted above are looking at women in particular, because their response to stress hormones is somewhat different from men it seems.

    Kelda wrote on March 5th, 2015
    • I would love that.

      Angel wrote on March 7th, 2015
  25. No matter how much I read and analyze…I still eventually come back to the
    Primal Blueprint….it just seems the most reasonable path to pursue, no matter what….it just more greatly mimics how our ancestors might have lived….did some live in long term ketosis? probably but also man has survived because he can utilize a big variety of food and conditions.

    Texman wrote on March 5th, 2015
  26. When I am in a stressed state, if I try to kickstart weight loss through ketosis with either going very low carb, or intermittent fasting, my efforts, invariably result in me feeling run down quickly and my hair falls out (too much cortisol?). Usually then I gain more weight as carbs are like liquid pounds. It isn’t a good cycle.

    If I’m feeling good and generally healthy, bouts of low carb and intermittent fasting make me feel great… better brain function / emotions and steady weight loss.

    So I think for me, ketosis is a stressor that I need to use carefully. When I’m already stressed out, exercise, relaxation and good sleep with a good primal diet (not focussed on being low carb) is what I need to get me in a better place first. Weight loss just has to wait.

    Kate wrote on March 5th, 2015
    • Sounds smart.

      Martha wrote on March 5th, 2015
    • Kate, feeling run down with hair falling out is a sign that your thyroid is struggling.

      Debbie wrote on March 5th, 2015
      • Maybe, although tests have suggested levels are normal. Perhaps on top of mental stress ketosis might strain hormone regulation. It seems that women need to be especially careful with very low carb diets and fasting.

        Kate wrote on March 5th, 2015
        • What tests? I’ve heard a lot about the run-of-the-mill (just checking tsh?) being inadequate.

          Darcie wrote on March 6th, 2015
    • Kate, I started keto for healing my thyroud, adrenals after killing them with excesive cardio. Did not have my period for a year, could not sleep, I felt awful. Keto cured me. It is not a fault of keto what you write. Check your adrenals and heal them with keto 80% fat, 15 protein, 5 carbs net. You will feel like someone else, with a lot of energy etc. It took me a year but I decided to heal myself without any medications. It really works, just give yourself a try a supplement with multivitamine and B complex. Nothing more is needed.

      Anna wrote on March 7th, 2015
  27. Too bad it gives you really stinky breath! any suggestions? I’ve tried chorophyll, but it only worked a little

    Jeff wrote on March 5th, 2015
    • Water!!!

      Marilyn wrote on March 11th, 2015
  28. I go out of Ketosis a few times per year on purpose: Thanksgiving weekend, Christmas, and my birthday. Otherwise, it’s meat, organs, fatty stuff (marrow, super-fatty bacon) high-fat dairy, and maybe some herbs with the meat for seasoning. I have one small bowl of berries every week too – with whipped cream, of course.
    I’ve actually found that my weekly berry bowl at our Saturday breakfast place doesn’t kick me out of ketosis – probably because I do a big set of kettlebell swings, and down bacon and eggs before I hit the berries.

    His Dudeness wrote on March 5th, 2015
  29. I stopped going very low carb when reading about it contributing to mucus deficiency (on the Perfect Health Diet website). This doesn’t seem to have ever been addressed on this site.

    Tracy wrote on March 5th, 2015
  30. Interesting article.

    If I ever get cancer or a neuro disease, I’ll do a keto diet for sure.

    I do IF almost daily, and a 2-day fast every so often, but a keto diet messes with my metabolism. I lose a few pounds, but then when I return to eating even a small amount of fruit and starchy veg, I gain all the weight back immediately.

    I’ve found my “sweet spot” regarding exercise, carbs and those foods I have to eliminate in order for me to lose weight. (I don’t eat dairy, or nuts/seeds.) I enjoy a variety of foods, and I don’t want to restrict myself with a keto diet, unless I must. If it takes a while to get all the weight off, I’m cool with that.

    Thanks for the info. Interesting and informative, as always.

    Suzan wrote on March 5th, 2015
  31. Following a mostly primal diet put my bipolar completely into remission, for 4 full years thus far. I am in ketosis some days, but not everyday. So, from my experimentation anyway, just eliminating wheat and eating low carb is helpful in stabilizing the highs and lows of this disorder.

    Amelie wrote on March 5th, 2015
  32. I was pretty strictly ketogenic for about a year and then it felt as if something snapped. My whole system went haywire. After six months battling out-of-control hunger, fatigue, insomnia and menstrual disturbances, I have raised my carbs back up to a more moderate level (around 50 grams/day is my aim, but it’s a struggle to get that high). According to some paleo women’s websites, all of the advice I had been following was for men, and not really appropriate for women of child-bearing age. It seems my experience with long-term low carb is about par for the course for women my age. Unfortunately, I had to gain twenty pounds back before I figured that out.
    That said, I think ketosis is a great short-term hack. And I’m glad I know how to do it well in case I ever need it for disease control. I just wish I had stopped sooner or cycled out more frequently. Now the damage is done and it looks like the repairs are going to take a long, long time.

    LSM wrote on March 5th, 2015
  33. the answer is always in the basic principle: How did it go for our ancestors living in the wild? I bet they did a little of both and it was definitely seasonal, and sometimes random. Wit successes and failures.

    Having spent 3 days, and hours of underwater spear hunting in Jamaica in very rough water conditions, scoring just 1 lobster, I learned a valuble lesson of foraging: sometimes we did go days without food, and sometimes we gorged on fruit. So we may want to style our eating after that. If anything, just to be closer to harmony with nature.

    Live Primally!

    PaleoDentist wrote on March 5th, 2015
  34. Basically, there is NO ancestral society we can look at that remained in constant ketosis.

    The Inuit are pointed to, but the fact is the Inuit cannot utilize ketosis due to a genetic variation of the CPT1A gene that prevents ketosis…how is that for irony!

    The one society that should have been in ketosis…couldn’t.

    Tim wrote on March 5th, 2015
  35. I have been on a ketogenic diet for 4 months so that doesn’t really qualify as long term but wanted to put in my “two cents”. I have a neurological problem and found out about the ketogenic diet after going low carb. After the go-ahead from my neurologist, I tried it. It has made a drastic difference in my life in energy and brain concentration.
    I don’t plan to go off of it. Yes, I have lost weight, but the thing that has kept me on it is that I feel like I have gotten a portion of my life back. I will check back in and let you know after I have been on it a year.
    Great article, by the way, and very balanced.

    PrimalPenny wrote on March 5th, 2015
  36. I have found it best to stay extremely low carb (30g or less) throughout the day, breakfast and lunch, and eat a balaced meal with at least 50-100g of carbs after my heavy weight training workout.

    I have been trying this after being in ketosis for about 4 weeks and I have finally broken the plateau I had when I was keto.

    I give myself carbs when i actually need them.

    Dymon wrote on March 5th, 2015
  37. Well I didn’t understand it all, but it was interesting. I tried a ketogenic diet for about 2 months and felt pretty awful, so it’s good to hear that it isn’t something to strive for on a permanent basis.

    Mark wrote on March 5th, 2015
  38. This topic makes me so happy! My daughter never had anothe epileptic seizure after going on a ketogenic diet. She was in ketosis almost two years and still grew and was healthy. The research shows that the majority of epileptics will never have another seizure after 2 years of strict diet. We cranked it back to an almost “normal to us ” diet (80% primal).
    Any less primal, not ketogenic, she complains that she doesn’t feel right. Her neurologist said everyone would do better on a ketogenic diet. Next, let’s hear about cancer and ketogenic diets! It is all so interesting.

    Queenbolete wrote on March 5th, 2015
    • Can you tell me more about keto and seizure prevention my 19 year old had his first seizure at 17. Has had 7 more but 4 have been in the last 6 weeks.

      Jdw wrote on March 7th, 2015
      • Please check out the Charlie foundation. I can’t post the link from my iPhone for some reason. I also found amazing peer reviewed studies If you Google ketosis and epilepsy. This has changed our whole family. My daughter’s first seizure was 15 minutes long and she was going purple. In solidarity the family chucked simple carbs. The husband went from pudgy to sexy man beast, and I lost 20 pounds. Our daughter’s neurologist didn’t suggest it at first because he said no one likes to comply. When we found the good spot for our daughter we were so overjoyed. Good luck to you, I know how terrifying this is.

        Queenbolete wrote on March 8th, 2015
  39. Hi Mark!

    At the beginning of January I found a book on the ketogenic diet, and I was practically praying just to be healthy. I took off! I really felt the benefits right away and more each day. The first was that I wasn’t depressed that I’d been fighting for years. Next was the consistent energy without that 4pm lul that made me run for something sweet. I wasn’t a slave to my hunger, or cravings. I stopped craving?? Ice cream?? My muscles started to get tight and cut again, my face and athletes foot even started to clear up. My back pain decreased so much that I got off of Motrin. A client mentioned that my face looked more vibrant, not pale.

    Now the question, I am going to Mussoorie mid-May and will be living on rice and dahl for about a month, or more. I need to know if I have to come off of this ketogentic diet to prepare for my upcoming dietary changes and changes in altitude. Austin’s altitude is only about 500 ft. and the Himalayans gets up to 7,200 feet.

    Thank you

    Laura Wilson wrote on March 6th, 2015

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