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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 21, 2017

Is Keto for Everyone?—Cautions, Caveats, and Contraindications

By Mark Sisson
140 Comments

Inline_Keto_CautionsIn a few months, I’ll be releasing a book extolling the virtues of a ketogenic diet. I’m currently several months into a ketogenic experiment, which is going well. I just wrote a Definitive Guide explaining why you should consider going keto. I’m on record as stating that everyone should dip into ketosis from time to time. You’d think I’d recommend that everyone go keto. Right?

There are caveats. There are contraindications. There are very good reasons for a person not to go keto, or at least to take a few extra precautions. Today, I’m going to tell you when you should exercise particular care when considering a ketogenic diet.

If You Have Diabetes

In type 2 diabetes, the evidence is crystal clear: Ketogenic diets work, perhaps better than any other diet.

In obese diabetics, a ketogenic diet improved glycemic control to a greater degree than a low-calorie diet.

And just recently, a study came out showing that very-low carb ketogenic diet advice was more effective at spurring weight loss than conventional low-fat diet advice in type 2 diabetics.

However, the authors from the obese diabetic study recommend that diabetics going keto maintain medical supervision to avoid dropping blood sugar too low. Another typical feature of diabetic keto studies is regular and supervised adjustment of medication dosages. This makes sense. If your glucose control improves, the old dosage of the medicine designed to control your glucose might be excessive and counterproductive. Rather than eyeball it yourself, get an expert’s eye.

If You’re Pregnant

In one study, mother mice on ketogenic diets during pregnancy produced offspring with reduced growth in certain areas of the brain and increased growth in other areas. In another study, mice born to keto mothers were more resistant to anxiety and depression and more physically active than mice whose mothers ate standard diets. Maternal ketogenic diets have also been shown to negatively affect mouse fertility and slow the growth of the offspring.

Before you start slamming waxy maize in an attempt to knock yourself out of ketosis, there are some caveats to this particular caveat:

  • These were mice, of course. I trust you are not.
  • They were eating refined ketogenic chow made of oils and powders, rather than the whole foods-based ketogenic diets I recommend to humans.
  • They ate almost zero carbohydrates (just 0.7% of calories), which I’d never recommend to anyone, let alone a pregnant woman.
  • The keto chow fatty acid intakes were imbalanced, with far more PUFA than saturated fat.
  • This was an extreme diet designed to maximize ketosis. It had to be, because it’s harder for non-humans to slip into ketosis—which perhaps indicates ketosis is probably less safe for other animals than it is for humans.

Still, it gives me pause. As a pregnant woman building a human, you’ll need all the nutrients at your disposal. You don’t want to restrict anything nutritious. It’s no time to be experimenting.

If You’re Breastfeeding

Remember that little metabolite known as oxaloacetate—the protein- or carb-derived bit necessary for finishing the Krebs’ cycle and producing ATP from fat and glucose? The one where if we don’t have enough, we start making ketones? Lactating women also use it to produce lactose, the milk sugar that provides much of the nursing baby’s energy needs. That means that lactating women can eat more carbs and protein and still remain in ketosis. It also means that eating a strict ketogenic diet extremely low in carbs and protein is likely to impair milk production.

There isn’t much research, and many women report remaining ketogenic while nursing without issue, but there are a few case studies of breastfeeding women suffering lactation ketoacidosis, a dangerous condition where chronically low insulin prevents the cells from accessing blood glucose and promotes unchecked ketone production. Triggers of lactation ketoacidosis have included starvation (don’t starve yourself, or even fast, and breastfeed), twin lactation (feeding two increases the amount of lactation substrate you need to consume), and a low-calorie/low-carb/high-fat diet (bad combo).

If You’re a Competitive Athlete, and the Season’s about to Start

Becoming keto-adapted provides major benefits to athletic performance. But it doesn’t come instantly. You’re laying a foundation of dense, fat-burning mitochondria, and it takes time to put it all together. For those first 4-6 weeks, you’re in no man’s land. You’re not fully adapted to burning free fatty acids in the muscles. You’re pretty good at burning ketones, but you haven’t yet laid that dense network of fat-burning mitochondria that can really produce large amounts of energy in a short period of time on demand. The capacity for rapid energy generation just isn’t there. Glucose is still the most dependable source of high-octane fuel for intense efforts, and there’s very little of it coming in.

If you want an instant performance boost, now is not the time to begin a ketogenic diet.

If You Don’t Have a Gall Bladder

The gall bladder collects and concentrates bile, creating a “superbile” that it can unleash to digest dietary fat. Without a gall bladder, your liver still makes bile, but it’s not the super-concentrated stuff that makes short work of large amounts of fat.

Ketogenic diets tend to contain large amounts of dietary fat. You can still do keto without a gall bladder, but you’ll have to be careful. Favor shorter-chained fats, like the ones found in MCT oil and coconut, as those are easier to digest and require less bile.

If You Have a History of Kidney Stones

Kidney stones are relatively common in epileptic patients on ketogenic diets, occurring in almost 7% of subjects. This is caused by excessive urinary acidity (ketones are acidic), which increases uric acid and calcium calcium oxalate stone formation.

Luckily, potassium citrate alkalinizes the urine and prevents kidney stone formation on ketogenic diets. If you or your family has a history of kidney stones, include some potassium citrate in your ketogenic diet. A great source is lemon juice. A couple tablespoons of lemon juice, some sparkling mineral water, a dash of sea salt make for a refreshing drink. You know what? Even if you don’t have a history, still increase your potassium (leafy greens, avocado). There’s no good reason not to, and it may stave off any impending stones.

Make sure to drink water, too. Low water intake is another risk factor for kidney stone formation.

If You’re Still Growing

I don’t mean spiritually. I don’t mean “backpacking through Laos trying to find myself.” I mean: Your growth plates are open for business and you’re actively getting taller. If that describes you, a ketogenic diet may unnecessarily reduce your growth rate.

Some kids need to be on a ketogenic diet for medical purposes. But even in those cases, the diet arrests growth without reducing body weight or resting energy expenditure, probably by reducing insulin-like growth factor 1, or IGF-1. IGF-1 is extremely important in growing children and teens. It initiates the growth of bones and other tissues. The keto-induced reduction in IGF-1 has led some longevity enthusiasts to pursue keto to reduce unwanted growth (cancer) and aging. That’s fine for adults. But kids need to grow.

Other research has found that ketogenic diets don’t arrest growth in children. Still, I’d advise against taking the chance, unless you have a very good reason.

If You’re Lapsing into a Refined Food Ketogenic Diet

It’s easy to construct a ketogenic diet out of refined, isolated fats and products. A couple spoons of coconut butter here, a Bulletproof coffee there, a nibble of low-sugar dark chocolate, a coconut milk matcha latte spiked with MCT oil. Yeah, you’ll be in ketosis. Yeah, you’ll be hitting your fat requirements. But you’ll have eaten very little food in the process, and that’s a bad idea if you’re trying to lead a sustainable, healthy way of eating.

Look to the failings of the clinical epilepsy diets made of oils and multivitamins. They do a great job at staving off seizures, but they often leave patients undernourished and suffering from stunted growth, bone mineral density issues, and kidney stones.

Make sure whole foods comprise the base of your ketogenic diet.

Most of these aren’t absolute deal-breakers. There are workarounds and solutions. But it’s also proof that you don’t need to be ketogenic to be healthy.

Would I recommend ketosis for most people most of the time? No. Keto is a tool in your toolbox. I look at it as a way of resetting your metabolism once in a while to a point of greater metabolic flexibility. Some people choose to be in ketosis for years at a time. I prefer to go in and out from time to time, knowing that a few weeks in ketosis leaves my engine running smoother and more efficiently. 

What about you, folks? If you’ve ever tried a ketogenic diet with these or other conditions, how did it work?

Thanks for reading. Take care.

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140 Comments on "Is Keto for Everyone?—Cautions, Caveats, and Contraindications"

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Nicole
2 months 1 day ago

Mark, I am enjoying these posts on ketogenic diets, but I haven’t seen any comment or suggestions for those with hypothyroidism. Most of what I’ve been reading says low carb can make thyroid problems worse, but I’d like to know your opinion.

Cathy
Cathy
2 months 1 day ago

I second the above comment. Would it be possible to expand on the idea or point me in the direction of information for folks who don’t have a thyroid and are on thyroid meds and being kept a bit hypo.

Rambler
Rambler
2 months 1 day ago

Check out this article I found in a quick search. http://www.ketotic.org/2014/12/the-effect-of-ketogenic-diets-on.html
I lost my thyroid to cancer 5 years ago, and I tell you what, the lower carb I go, the better I feel. I haven’t managed to sustain ketosis for more than a day or so, just because my husband always has something tempting and delicious around that I can’t say no to, but I don’t think it would be a bad thing.

Suz
Suz
2 months 1 day ago

Also interested in advice regarding low carb and thyroid issues. I notice improvements in gut symptoms when carbs are low (under 150g, not keto!) but my free T4 and free T3 have both dropped and I’m feeling it! Not sure whether to just push though and whether this is just an adaptation phase or whether I should start including more carbs and maybe even some GF grains…

Theresa
2 months 1 day ago

Thanks for that above comment. I have hypothyroidism and I always want to know if keto will affect it negatively. I try to be low carb during the week then on weekends I’ll break down just a little, but just on occasion. Looking forward to learning more about the relationship between keto and hypothyroidism.

Angel Hix
2 months 1 day ago
My husband has been in Ketosis for 2 years, he was diagnosed hypothyroid in 2005 and has suffered and we have all suffered along with his mood swings, nasty salt sweats, sick as a dog even on his synthroid, as soon as he started reading Mark’s daily forum and recording his food intake life went from unimaginably miserable to AWESOME… his numbers at the doctors office are always way messed up and they are constantly wanting to manage his meds, they even says he is diabetic, but they are wrong, the proof is in his amazing strength, his mood, his… Read more »
wildgrok
wildgrok
2 months 1 day ago

wow nice please get the hubby to post his story one of these Fridays!
congratulations from a fellow-controlled-hypothyroid

carla
carla
2 months 1 day ago

I agree with Nicole. Keto diets and hypothyroid is not something that is talked about much. When I went keto a few years ago, my thyroid function could not have been worse.

Maxine Humpherys
2 months 1 day ago
I am hypothyroid, on desiccated thyroid, and have had hypoglycemic symptoms for most of my life (I am 74). I also have leukemia and a med I take is known to cause weight gain. I gained a few lbs since going on it last October. Have been low carb-ish for many years. Since going keto less than 2 months ago, I have no symptoms of fuzzy headedness, wanting to bite someone’s head off if I don’t get something to eat every 3 hours, or eating too much at a meal. I have not had my thyroid checked recently, but don’t… Read more »
Superchunk
Superchunk
2 months 1 day ago
What if you’re doing a lot of high intensity activity per Robb wolf’s cautions? I seem to do better with more of a carb backloading approach when I’m really active. I’d also be interested in your views on Chris masterjohn’s concerns about low insulin for too long and Paul Jaminet’s concerns about going too low in carbs creating long term immune issues. It would also be good to get your views on how keto one needs to be to get the genetic benefits. Unfortunately a lot of the current keto sources focus on rather unhealthy people or take a rather… Read more »
carla
carla
2 months 1 day ago

I also have the same question about HIIT and low carb diets.

Matt B
Matt B
2 months 1 day ago

Good question. I’d also like to know if HIIT workouts can be properly fuelled during ketosis. My swimming coach is convinced that ketogenic diets are terrible for HIIT workouts and therefore advises against ketosis entirely.

Corey
Corey
2 months 1 day ago

Fine once your fat adapted. I keto and ctisssfit and my high intensity endurance actually increased!!

Stefan
Stefan
2 months 14 hours ago

Sure. Just eat some starch (sweet potatoes, white potatoes, rice) and slightly higher amounts of fruit during your training days.

Your glycogen will be fueled by the glucose and stored in your muscles, thereby allowing you to eat more carbohydrates. Since glucose in glycogen stores is not stored as fat in the body.

Tracy
Tracy
2 months 11 hours ago

Having spent 3 years suffering from very dry puffy eyes and nasal and cervical polyps (it was only when I read the attached link I realised that it might be my very low carb diet (less than 50g per day) that was responsible), I wouldn’t go near a keto diet now. It took a good 6 months of upping my carbs to around 100-120 a day (I am a 49 year old woman) for my problems to totally clear up, which confirmed that for me anyway, low carb should only be a very short term thing.
http://perfecthealthdiet.com/2010/11/dangers-of-zero-carb-diets-ii-mucus-deficiency-and-gastrointestinal-cancers/

Cindy Jockers
Cindy Jockers
2 months 1 day ago

Thank you for this post Mark! An n=1 experiment here in which I’ve found Keto and very low carb diets to be incompatible with both pregnancy and breastfeeding. I found I had to almost double my carb intake (sweet potatoes and squashes mostly) to avoid debilitating fatigue and reduced milk supply. It’s nice to hear a reminder on individuality among all of the keto voices out there.

Grant @ Life Prep Couple
2 months 1 day ago

My wife found the same thing to be true. Her diet ended up flipping from high protein, low carb to high carb, lower protein. Her body just naturally craved more carbs and she found some of her old dietary staples like beef and eggs to turn her stomach. Her milk supply has always been on point so perhaps that has something to do with it.

Time Traveler
Time Traveler
2 months 1 day ago
Maybe I’m the exception to the rule but I manage keto fine in spite of not having a gallbladder. I use Ox bile supplement a number of times a week, but only as a mean to increase vitamin and mineral absorption and not due to discomfort. I also have Hashimoto and so far so good. Maybe because I do it intermittently and eat safe carbs from time to time. I am due for a blood test and will see if it changed for the worse or better. My guess is that Mark is studying the effects of ketosis on hypothyroidism… Read more »
Groktimus
2 months 1 day ago

Extremely well done post!

shasha
shasha
2 months 1 day ago

Dipped into ketosis without meaning to, many years ago while following the Atkins program incorrectly. I kept this up for a year or so and after stalling out on the weight loss (and beginning to feel quite unwell) I “suddenly” developed a very large kidney stone which was too large to pass and had to have a laser procedure to get it resolved/dissolved. I learned then about lemon juice, water and the importance of a whole food approach.

Jean
Jean
2 months 1 day ago

I have been trying to be ketogenic as I started chemo today for colon cancer but if I go too low with the carbs I get such a painful rash under my arms that I can’t sleep, so I am trying moderate low carb with no added sugars and as much nutrition as I can get.

English girl
English girl
2 months 1 day ago

Can I ask your ideas on people who are hyper responders and get a massive rise in LDL-P on a ketogenic diet, thought to be due to the saturated fat content. Are they generally apoE4 carriers? Switching to more MUFA rather than saturated fat seems to help lower the LDL-P, but is that beneficial to the person or do apoE4 carriers need or benefit from a higher cholesterol?

Time Traveler
Time Traveler
2 months 1 day ago

I highly recommend the “cholesterolcode” by Dave feldman!

Becks
Becks
2 months 23 hours ago

My solution for high LDL was to simply quit the high saturated fat diet. Now it’s under 100 mg/dl after dropping nearly 100 points!! Better safe than sorry. Not worth risking my health.

Joan
Joan
2 months 1 day ago

I’m wondering how long it takes to see a lowering of blood glucose on the ketogenic diet. I have been very low carb for about 2 weeks, Ketostix show mod ketones. I’ve lost 8 pounds so far, and I feel sharper mentally. However it doesn’t take much exertion, before I develop muscle weakness, and feel a little shaky. Fasting blood sugars are still running 106 to 120. Is age a factor? I’m 75 and overweight.

Jodi
Jodi
2 months 1 day ago

If I remember right from reading and experience it can take up to a month. Your body has to burn all the glycogen the first few days and then those of us with messed up metabolisms have to catch up. Maybe Mark will have time to chime in but if I remember right it took me significantly longer than the 2 weeks.

Joan
Joan
2 months 1 day ago

Thanks, Jodi. Guess I need to be patient.

Holly
2 months 1 day ago

The thing about “going in and out of ketosis periodically” is that I was nauseous with “keto flu” for almost a month when I started. I certainly don’t want to repeat that! Easier to just stay LCHF.

Kelly
1 month 27 days ago

Look up keto-ade. From experience, keeping those electrolyte levels in check have been a God-send for fighting off the keto flu. (I fell off the keto wagon and the fear of the flu is what kept me from getting back on. I wish I had learned about keto-ade earlier!)

Louise
Louise
2 months 1 day ago

Would you recommend it for perimenopausal/menopausal women?

Anne
Anne
2 months 1 day ago

I would like to know this, too. I have had autoimmune issues (Hashimoto’s, MS) for 20 years and am pre-diabetic, but nothing affected my weight as much as menopause. I gained a lot of weight at that time, and have absolutely struggled to get it off. I need to lose at least 50 lbs., if not more. Frustrating! I would welcome any advice on countering menopausal weight gain.

Sarah
Sarah
2 months 1 day ago
I am 48 and spent most of my life eating anything I want and tons of it and maintained a “thin” weight. About 3 years ago I started gaining weight (perimenopause) and then did a whole30 (x2) to lose the 20 or so pounds I gained, and now follow the primal way of eating to keep it off. I can tell you that when I add a little too many carbs I am now super sensitive to weight gain-I remember friends telling me I was lucky back in the day because they would just look at food and it would… Read more »
Anne
Anne
2 months 1 day ago

Sarah,
Thank you for your input. I agree, for some there is a very sensitive middle ground. I tried a vegetarian diet, and although I did lose some weight, I did not feel right, and even became depressed, which is not like me. As soon as I added meat, I felt better again. Too few carbs, and I am like you, feel awful. So hard to find the balance.

Jennifer
Jennifer
2 months 1 day ago

YES!! I always feel we are ignored in the primal/PaleoMagazine community. I don’t think it’s intentional or nefarious or anything like that. There’s just always an emphasis on a woman’s fertility.

Anne
Anne
2 months 1 day ago

I know, it is frustrating. Seems that it is geared towards the younger woman. Not intentional or nefarious, like you say, maybe just oblivious? Except for pregnancy, my body, overall, has never gone through such a change as it did in menopause (from hair to skin to brain, even). And solutions that may have worked years ago seem to no longer apply. We are out here, people! Please note we would like some help!

Clare
Clare
18 days 9 hours ago

I’m with you ladies – I’d like to know if this can work for 40 something ladies (like me, as a for instance). I need to shift a huge amount of fat (weight too, but I want to get back into my pretty summer dresses from 8 years ago – UK size 12) but when I try quitting eating sweets (candy), it doesn’t seem to have the same impact it had 10 years ago… Boo. I can’t face the menopause at my current size, but things don’t work as well after 40….

Martha
Martha
1 month 15 days ago

I saw my doctor for severe hot flashes – she put me on a ketosis diet because I was also pre-diabetic, and within three days my hot flashes pretty much disappeared. After I completed the diet to lose body fat my hot flashes came back so I’ve gone back into ketosis (without any weight loss goal this time) and hot flashes are gone again. Doc said she often recommends ketosis for menopause symptoms for women who can’t take hormones.

mims
2 months 1 day ago
I am prediabetic, hgA1c of 5.7, morning fasting blood sugars anywhere from 100 to 120. I have tried ketogenic diets twice for a month each….doing this one https://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/ i was weighing food, tracking macros, peeing on keto sticks and checking my blood sugars several times a day, and taking carnitine plus multivitamin. I am a 60 year post menopausal women with hashimotos. I found keto diet did NOT work for me. I felt terrible, barely, rarely got into ketosis and my blood sugars got significantly worse! I stopped the experiment the morning my fasting blood sugar was 135. WIthin a… Read more »
julia pace
julia pace
2 months 1 day ago
I can’t have 1/2 1/2 in my coffee once a day or eat very modest amounts of meat or oil or my blood sugars start climbing. My inflammation goes up too but my A1C lowers a little on higher animal protein/ low carb. Three yrs. retired from stressful job with higher AM FBS goes up to 110 or 115 when I try to eat like regular folks. Beans ,pasta and greens with a few nuts and fruit keep me around 100 in AM – Also female 70 yr. and 65% Irish – Maybe I have one APoE4 gene – 23… Read more »
carole
carole
2 months 1 day ago
My situation is similar…lchf for 8 months lost weight. felt great. Had some lab work done…fbs went from 83 pre lchf, to 98. Insulin, was 6.3, now 8. hga1c was 5.3, now 5.6. I cried all day after I got those results. I have insomnia issues for years, waking at 2-4 am..I have not tested but feel my cortisol is the culprit. Also, Mercola says to cycle in and out of low/high carbs twice a week as being in low carb too long will increase bs and insulin. Chris Kessler states he has many clients that have bs and insulin… Read more »
carole
carole
2 months 1 day ago

forgot to add…intermittent fasting also , eating window of 4 hrs. It wasnt hard and I felt great.

Becks
Becks
2 months 23 hours ago

Keto and low carb did NOT work for me either. Thyroid problems, digestive issues, high LDL, low energy, no weight loss, etc. I said F it and started eating a ton more carbs, nearly 250g, mostly whole foods though like potatoes, beans, oats, brown rice, fruits, veg and I’ve lost 30 lbs. My fasting glucose ranges from 70-80 mg/do and my last A1c was 5.3 which are both great. All other issues resolved. I feel amazing now in my 40s than before.

maria
maria
2 months 14 hours ago

I am the same way – eating less animal fats and more carbs such as veg, some gf grains and fruit lowered my blood glucose levels. I feel better.

Tiffany Yeager
Tiffany Yeager
2 months 1 day ago

I think all of these comments just go to show that you know your body better than anyone, and how important it is to listen to what your body is asking for! I say this because I know of a lot of people doing BPC with 16 hours of IF- For me this recipe does not allow me to perform optimally. I go into a state of cravings, overindulgence when I do eat! I think it is good to experiment, but important to listen to your body!

Lynda
Lynda
2 months 1 day ago
Hi Mark, I’ve been doing KETO for over two years. Was Paleo/Primal. Lost my last 20 in four months and have maintained it for two years. My secret? I log my food choices daily (I like Fitday.com), I calculate my macros. My maintenance macs are a bit higher in fat now that I’m maintaining and if I’m having a busy day I may up my protein a bit but my carbs stick around 30 – that’s my sweet spot. I’m still a Paleo girl in that I don’t do dairy or any grains – okay raw aged Vermont cheddar shaved… Read more »
Susan
Susan
2 months 1 day ago

What do you recommend for maintenance after a keto diet? I have about 40lbs to lose, about 13-14 lost so far since starting a month ago and for me, I know that this is not sustainable for life. But I started this diet not only due to being overweight but will all the issues my weight gave me. Prediabetic, irregular heartbeat, impaired fertility, border line high blood pressure. So I know a low carb type diet is something I will need to do forever but to maintain weight loss which way is best?

Karen
Karen
2 months 1 day ago

Thanks for this info. I’ve been in ketosis for about seven months now. I’ve dropped weight that I needed to lose after years on a relatively high dose of prednisone and have virtually eliminated all joint pain due to chronic vasculitis. I am, however, starting to feel like I have less energy than I should and less than I had a few months ago. I’m wondering if I should consider adding fruit back in so I can boost my micronutrient levels for a while and continue to use full-fledged ketosis as a “tune up” as you say.

Jan
Jan
2 months 1 day ago
Thanks for the information. It almost seems like everyone is pushing keto lately. I recently tried it and ended up dealing with afib that had been in remission for almost 2 years after surgery. I’m now eating more Primal and avoiding grains, legumes and processed sugar. That seems to be working okay, and my pain level from other issues seems to have significantly lowered. I’m eating this way because I definitely don’t want another surgery (had 2 cardiac ablations in 1 year) and want to avoid any more medications that wreck my energy and metabolism. Oh, and I seem to… Read more »
Laurie
Laurie
2 months 1 day ago

in a comment to “English Girl”. I am an APOE4 carrier, and my cholesterol has been high (4/4 was 362, 5/30 was 321). I, too, am wondering how to get the cholesterol into the mid-200’s and still eat a high fat diet. My fitness coach has suggested I stay away from dairy (butter, ghee, cream, etcc., all the fun stuff) and to do coconut oil sparingly. My LDL-P came in at <90 nmol/L, but I don't know if that's high or not.

Bobande
Bobande
2 months 1 day ago

Laurie and English Girl,

I am not APOE4 but I follow closely the work of Dr. Gundry who does a lot of work with APOE4 patients. My friend and mentor was a patient of his for many years. Gundry certainly recommends staying away from all dairy for APOE4s. Coconut oil depends a lot on the individual and those who can not process it may still be able to tolerate MCT oil. He recommends lots of olive oil, avocados, macadamia nuts, and occasional eggs for AP0E4s on a LCHF diet.

YMMV!

Laurie
Laurie
1 month 29 days ago

Bobande,
Thanks for your response. I just read about Dr. Gundry. I just soaked and dehydrated a lot of macadamia nuts, and have also started eating more sardines and salmon, and less meat. (Good thing the weather is hot, ’cause I don’t want to eat meat in this weather.) Thanks for chiming in with your information.

Laurie

Marilee
Marilee
2 months 8 hours ago
I am an APOE 3/4 and recently switched over to more EVOO and avocados for my fats. Also switched from a lot of beef to more fish and chicken (dark meat and with the skin). I still have some butter and use duck fat and I eat eggs almost daily. For the first time in years my cholesterol dropped – 80 points in 2 months (from over 300 to 220’s). But I also started taking Berberine (500 mg 2x day) which helps lower BS and cholesterol. It’s hard to say which one or both changes made the difference. Hope this… Read more »
Laurie
Laurie
1 month 29 days ago

Marilee,
Thank you for your suggestions. My new health care practitioner (who is quite into the problems of ApoE4.carriers) wrote up a plan whereby she mentioned that we sometimes do better with LESS red meat, coconut and dairy that would be normally advised. However she said I could still eat butter, and coconut oil. Instead of the Berberine, she suggested I eat when hungry (sometimes that’s only 2x/day) and that could help lower my blood sugar. Many thanks for your reply.

Laurie

Bob Commings
2 months 1 day ago

Having real sleep issues/insomnia. Could it be Keto

Heather
2 months 1 day ago

This was my issue as well! Changed my diet (out of ketosis), started sleeping. Changed it back (ketogenic) and the insomnia returned.

Maxine
2 months 1 day ago

This should resolve after a while.

Claudio
Claudio
2 months 1 day ago

We have no way of knowing if it would resolve or not. I doubt that it would. Boosting serotonin with 5-HTP might help offset the serotonin drop, but why even go there? Eat above keto levels of carbs but within your unique level of carb tolerance. Rob Wolf’s new book explains how to go about this.

Heather
2 months 1 day ago

It definitely did not resolve. Thanks for the book selection…it’s the ‘why’ I need to know…

Claudio
Claudio
1 month 27 days ago

Likely genetic. There is no one way of eating for everyone, especially a method as extreme as ketogenic.

But the bigger questions is why do you need to know? Even if you thrived in keto, the ketones themselves are merely a side effect of the diet. There is no ketone scorecard contest at the of the year auctioning off a new car (ie. the keto price is right :).

Rest assured, you can improve body composition while not being in ketosis. Find the mix of macro’s that works best for you.

Claudio
Claudio
2 months 1 day ago

Yes- your seratonin levels may be too low. Try Eating some carbs in the evening.

Zoltan
Zoltan
2 months 1 day ago
You say, “If you or your family has a history of kidney stones, include some potassium citrate in your ketogenic diet. A great source is lemon juice.” . Eh, no. The amount of potassium citrate that has been found effective in the prevention of kidney stones is rather high. The very study you are referencing used 2 mEq/kg per day in children – that’s 40 mEq for a 20kg (44lb) child. Adult studies usually quote 60-80 mEq of potassium citrate per day, typically administered in 3 divided doses. For reference, 10 mEq of potassium citrate equals 1080 milligrams, so in… Read more »
Rita
Rita
2 months 1 day ago
After 3 years of partial ketosis (3-4 days/wk, according to Ketostix) I have developed hypothyroidism. I didn’t need to lose weight, just went on HFLC diet—about 70% fat, 15% carb, and 15% protein for health and longevity, to get off sweets roller-coaster, and to avoid going back into metabolic syndrome. Interestingly, I eat twice as many calories as cronometer would suggest for my age/activity level and have to add a bite of coconut oil occasionally to keep from losing too much weight! I’m just wondering whether increasing net carbs from my usual 30-60/day would be beneficial or if using no… Read more »
Gordon
Gordon
2 months 1 day ago

What if you have a SNP (rs1801282) that says “watch out for high fat in diet” ?

Rita
Rita
2 months 1 day ago

I also have that SNP but 3 yrs of partial keto/HFLC diet has not increased LDL very much, HDL is almost 100, triglycerides are 60, and cardioscan shows 0 plaque score.

Barb
Barb
2 months 1 day ago

I’m following Dr. Terry Wahl’s protocol for managing auto-immune conditions. Her most strict diet plan is a ketogenic (and paleo) one. I like that her plan addresses the nutritional aspect of ketosis by encouraging high fat, as well as nutrient dense foods like vegetables. Her goal was to just barely stay in ketosis, while maximizing nutrition.

Rozska
Rozska
2 months 1 day ago
I’ve been Keto for 3+ months now. I am doing the Wahls Paleo Plus keto diet. I started it to treat my chronic migraines. I’m now down to 4 migraines or so a month, down from 12-15! I’ve been following a primal diet since 2009. And while I felt good just following a primal lifestyle, I didn’t see all the benefits from going primal that other people experience, not until I went keto. I have never felt better. However, my Free T3 has skyrocketed. Not sure what’s causing that, if it’s the keto diet or something else. Looking forward to… Read more »
Maxine
2 months 1 day ago

I have a history of migraines that last a week, maybe twice a month. I started using a Cefaly device (cefaly.com) about 9 months ago and now hardly ever have a headache, and only mild ones. It’s pricey, but well worth it to me.

Nikki Ledford
2 months 1 day ago

“I don’t mean spiritually.”

???
Good one.

Nikki
1 month 30 days ago

those question marks are laughing faces. darn interface.

Angelo
Angelo
2 months 1 day ago

Keto is awesome for Type 1 Diabetes too, in my personal experience. It’s way easier to keep blood glucose steady if you’re eating things that have slow and subtle influence on it, instead of fast high peaks like fast carbs or sugars would give.

I’ve recommended it to fellow diabetics, not everyone can work with it though it seems. One friend even got angry with his care team at the hospital for letting him stick with unsteady blood sugars for 40 years or so before finally finding this diet through me.

AK8
AK8
2 months 1 day ago

I’ve read the ketogenic diet works well for patients with severely damaged kidneys — helps them recover. But potassium is a no-no for people with kidney problems. So how do you avoid kidney stones?

Grant
Grant
2 months 1 day ago
I’m back on keto right now as well. I honestly forgot how good it feels. Body is leaner and more efficient. Clarity of mind is crazy. I also don’t buy that ketosis stunts growth in developing children. The body is not stupid (well…. okay for the most part). That doesn’t make sense from an evolutionary perspective. Maybe long term it could be detrimental? For many years with no cycling? Really, seeing all the “studies” that show cons to ketosis, and then reading the ones that show benefits or no downsides makes me realize how much we, even researchers and scientists,… Read more »
Maxine
2 months 1 day ago

” That doesn’t make sense from an evolutionary perspective.” That’s what I was thinking. Also, native peoples like the Inuit traditionally ate a keto diet, so it must have worked for the children, babies, and pregnant and nursing moms as well.

Claudio
Claudio
2 months 1 day ago

The Inuit have a genetic mutation. They aren’t in ketosis.

Melanie
Melanie
2 months 8 hours ago

I would be interested to hear more – can you expand? What kind of mutation do the Inuit have and how does this prevent ketosis? Thanks you, Claudio!

Claudio
Claudio
2 months 7 hours ago

CPT1A is the gene in question. Here’s a link that summarizes the research. You would have to dig quite a bit to pull together all of this information.

https://www.facebook.com/richard.nikoley/posts/468093786856360

David
David
2 months 7 hours ago
Maxine, I agree completely. Modern diets are the reason why people don’t do well in ketosis —too many years of habitually eating a *high* carb diet have screwed up the baseline metabolism we were born with from millions of years evolution. From an ancestral perspective, we’ve been fatty meat eaters for 3.3 million years, with very little carbs. Our meal focus was on making a kill and then feasting for several days, followed by several days of fasting (during which we were in ketosis). Along the coast, we gathered mussels, oysters, clams, but we were not out picking spinach, broccoli,… Read more »
Charles
Charles
2 months 1 day ago

What a surprise. You’ve got a book coming out.

Charles-T
Charles-T
1 month 30 days ago

I bought the PB e-book and another e-book about paleo/thyroid. Both are great books, I for one will definitely buy it. Never been overweight, always active and adapting Primal eating habits Mark suggested (i already ate a healthy diet btw) has changed my life dramatically. Mark.. Thank you !!

Pam
Pam
2 months 1 day ago
I’ve also done some reading on keto and have read there aren’t enough studies done on women and because of our more ‘complicated’ hormonal system, it can actually be detrimental. Anyone heard the same thing? There was supposedly a specific study on women done and it wasn’t favorable but they also admitted there needs to be more specific ‘women’s keto’ studies done. It’s been a few months and I don’t remember where I read it. I’ve tried the keto thing and haven’t really noticed anything out of the ordinary in how I feel. On another note, we just watched “what… Read more »
Shary
Shary
2 months 11 hours ago

The only study that really matters is the one you do on yourself. Some people thrive on a vegan/vegetarian diet; others don’t. The same is true of a keto diet. It’s easy to get suckered into eating one way or another just because somebody claims it’s healthful, but that “somebody” doesn’t inhabit the body you live in. Stick with what you know works best for you and don’t worry about what the various studies show.

Johanna
Johanna
2 months 1 day ago

Thanks for the tip for those without a gall bladder! Most of the health and fitness (and the medical) world seems to have forgotten about us.

Matt B
Matt B
2 months 1 day ago
I’m now on my second attempt to get into ketosis after the first one was scuppered by a week long visit with the in-laws – relatives who can’t even get their heads around the Primal thing, let alone a ketogenic diet. Anyway, having been Primal for three years now, keeping the carbs down has been easy. One thing I’m struggling with though is consuming enough fat. I’m tracking my daily food intake on Cronometer and always fall way short of my daily fat intake targets, even though fat is making up 70-80% of my diet. It’s proving very difficult to… Read more »
Bobande
Bobande
2 months 1 day ago

Nuts, avocado, eggs, coconut milk, make your own “candy” (e.g: coconut oil + nut butter (or nut meal) + raw cacao powder), muffins with coconut flour and almond meal.

David
David
2 months 6 hours ago

Egg yolks, bacon, liverwurst or braunschweiger (without the fillers some companies like to add), all beef hot dogs/sausages (again without the filler), mac nuts, avocado, olives, coconut cream or butter

Matt B
Matt B
2 months 5 hours ago

Thanks for the input.

Justin Robbins
Justin Robbins
2 months 1 day ago

The competitive athlete point is something I have been searching for so thanks for mentioning it Mark. It answers my query as to how long does it take to transition properly. I’m 3 weeks in and feeling fine cycling 3 hours aerobically but severely lacking in power when doing time trials.

Valéria Jacob
Valéria Jacob
2 months 1 day ago
I’ve been ketogenic for a year and a half now. I do this for my chronic migraines. I have controlled the migraines. However, I guess I pushed too hard on keto and fasting and my thyroid, which got better in the beginning, is really bad now. I know I undereat, but this was my pattern before, I was low caloric for most of my life. This in addition to a lot of stress with diseases and difficulty situations in the family lead to a loss of a lot of muscle and weight gain, which I had never experienced before. I… Read more »
Mary Congdon
Mary Congdon
2 months 1 day ago
I’ve been eating Primal for nine months. I used to be a letter carrier and although overweight, I had muscle mass. I’ve lost about 20 pounds since starting last Sept, however, I have lost muscle mass. I am 61 years old, soon to be 62 in 2 months. It’s a concern of mine, as I eat from about 11 am until 7:30 pm (window eating). I’m thinking that I should either step up my weight lifting or curtail window eating or add in more carbs. I don’t need to lose more weight. I don’t want to gain either, so I’m… Read more »
Shary
Shary
2 months 1 day ago

Mary, you don’t say what your diet consists of but you might need to eat more protein, specifically animal protein. People often need more protein to maintain muscle mass as they get older. You might also consider whey protein to see if it helps.

Mary Congdon
Mary Congdon
2 months 1 day ago
Thanks Shary. I eat protein for lunch and dinner. I do believe you’re correct though, as I don’t eat a lot period. I don’t get too hungry anymore. Maybe 3-6 oz of protein in the early afternoon and 6 oz in the evening.meal. I eat nuts and seeds for snacks, but only a serving. I do eat eggs, aged cheese. I’d say after giving up grains and any processed foods, my appetite is very small. But, I’m not tired or lethargic at all. I eat a lot of healthy fats as well. I really feel great, but once I start… Read more »
Claudio
Claudio
2 months 1 day ago

People with low levels of serotonin should avoid keto. Keto can lead to depression in these types. People with high histamine levels should also avoid keto. Keto rash (hives) is a telltale sign of an overflowing histamine bucket. I just don’t see the point in actively trying to consume high amounts of fat. You can produce ketones through calorie restriction while eating meat and potatoes. Eat fruit people. Ketones are a side effect. They shouldn’t be the goal.

Jeff
Jeff
2 months 5 hours ago

I have issues with seratonin and histamines. Only an episode of anxiety (I think caused by adrenal fatigue) keyed me in on the possible seratonin issue. I had been eating very low starch for a couple years. It’s tough, because I have trouble not gaining weight on starches, but it looks like i have no choice…

Zach
Zach
2 months 1 day ago

Lol, keto works better than any other diets for type 2 diabetes? How many cases has it cured? None. How many cases has a zero fat, high carb diet cured? Thousands. The medical literature is out there for everyone to read. I cant believe this keto crap is still being hyped. Just look at the epic failure, jinmy moore for how well keto does at healing anything.

Will Wilkin
2 months 22 hours ago
From the abstract: “The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct… Read more »
Will Wilkin
2 months 22 hours ago

Hi Zach, you might be interested in the Virta clinic, where doctors who literally “wrote the books” on ketosis (including Stephen Phinney and Jeff Volek) are using a very low carbohydrate approach to reverse type-2 diabetes:

https://www.virtahealth.com/testimonials

Robin Dodge
2 months 1 day ago

Here is some research conducted by the National Institutes of Health on the effects of a ketogenic diet, some outlined in Mark’s article. It is very therapeutic for those suffering from neurogenerative diseases such as MS, Parkinson’s, etc. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/

Maxine
2 months 9 hours ago

Terry Wahls, a physician with MS, was wheelchair bound and reversed her symptoms with a Paleo keto diet. She now does clinical trials and treats patients with her protocol.

Robin Dodge
2 months 9 hours ago

I have her book! Big fan of hers and have been following her work. Really good stuff!

Kelly
Kelly
2 months 1 day ago

I’ve heard people with thyroid issues should not do keto, but evidence seems to be conflicting. Im Hypothyroid, but take medicine to keep thyroid in normal range. Can I try keto?

Kelly
Kelly
2 months 1 day ago

Just noticed the thread below – thanks and looking forward to reading more!

Loraine Hansen
Loraine Hansen
2 months 23 hours ago
I have been eating primally 80/20 for 4.5 years. In January 2017, my husband and I started a Ketogenic diet. He has lost 35 lbs. and several inches and feels stronger and more energetic. I have lost nothing and my energy and strength have not changed. I have asked questions on a ketogenic forum but nothing has worked. I have seriously been wondering if I should go “back” to the primal blueprint way of eating. I live primally as a general rule, and love eating this way and will never go back to conventional wisdom ANYTHING. This blog post is… Read more »
Debbie
Debbie
1 month 30 days ago
I too, have SLE, with kidney involvement (32% function) and low thyroid. I am trying to eat keto, to help with belly fat and to feel better. I am a 53 year old women, SLE since I was 14. I have been on varying amounts of prednisone, since I was diagnosed. My workouts have gone downhill, since cutting out carbs, as bread, rice, pasta, and potatoes. Am weak, legs feel like lead weights, making it hard to take walks. Memory has also declined. I’m having trouble keeping my protein intake low, while eating keto. My nephrologist told me to eat… Read more »
Loraine Hansen
Loraine Hansen
1 month 29 days ago
It sounds like you are dealing with a lot. Have you tried a different medication, such as Plaquenil? I have been on that for a few years, and it has been a lifesaver. If you follow the Primal blueprint, you are not required to cut your carbs as drastically as with keto. Keto suggests less than 20/day. Primal says less than 50/day and you are in ketosis. That could possibly make your life/energy/symptoms better. You can also eat between 50-100/day and still gain many health benefits (perhaps more in your situation), and still lose a pound or two a week… Read more »
Debbie
Debbie
1 month 29 days ago

Hi Loraine. Thank you for your reply and encouragement. I’ve been on hydroxychloroquine (plaquenil) for at least 25 years. I’m sure it is helping me. Increasing my carb intake may be the answer. I will go back and read Mark’s Primal Blueprint.

Mands
2 months 23 hours ago

Im keto 4 weeks but have been lifting heavy in gym and feel nauseous dizzy and a bit “out of it” the last few days….what are the symptoms you are talking about for athletes switching over Mark? Not sure whether to up carbs or just push thru

Melanie
Melanie
2 months 6 hours ago
After 4 weeks you are not fully keto-adapted yet, meaning you don’t have the full metabolic machinery to take advantage of the ketones that your body is making. You have ketones, but you are not using them properly yet. Coupled with the low carbohydrate intake and water release from glycogen stores, you don’t feel all that good right now. But it will get better from here! I would give at least another 4 weeks, and you should see your energy and feeling of well-being return. Make sure you eat enough unrefined salt. Consider supplementing with potassium if you are not… Read more »
Becky B
Becky B
2 months 16 hours ago
Mark, lung diseases (including COPD) are seeing improvement from Keto and Paleo. diets. Nobody seems to mention them – nobody seems to research them. I am living proof – Stage 4, 20% lung function off ALL meds except 1 inhaler and doing better than I have for many years. I am not an athlete BUT I know someone who IS an athlete Stage 4 COPD and he runs marathons ( just completed London) and he is Keto. I really wish somebody would research keto and lung disease…. it could be a life saver for millions and millions of people and… Read more »
Karly
Karly
2 months 14 hours ago

What about ketos impact on gut flora? There’s a lot I love about a VLC diet, but whenever I get back into it my digestion is terrible. I become extremely bloated every night around 6p (and haven’t been able to identify a food that’s triggering it). I recently came across this info and while I don’t want to give up on keto, I think I’ll be trying this protocol (which calls for increasing carbs) to address SIBO. What do you think?

http://drbganimalpharm.blogspot.com/2013/11/how-to-cure-sibo-small-intestinal-bowel_10.html?m=1

Stefan
Stefan
2 months 14 hours ago

Hey Mark.

I can’t help but ask, couldn’t the stunt in growth in keto-reliant children BE caused (or highly enhanced) by the malnourishment in the refined keto diets used for epilepsy/clinical studies?

And that’d account for the reason that one study didn’t notice arrested growth; perhaps, their plate was full of micronutrients and polyphenols, not keto junk.

Signed, a teenager that’s trying to slip in ketosis. Any suggestions for me?

Melanie
Melanie
2 months 6 hours ago

Absolutely. But as long as there is reasonable doubt, a warning about a potential malnourishment needs to be dispensed.

Stefan
Stefan
2 months 2 hours ago

That’s the thing, though; I’m not sure this qualifies as “reasonable doubt”, not as long as the distinction between ketone production and nutrient starvation is drawn.

No sequitur can emerge from such a mishmash clusterfuck of premises. There is one variable too many to decide whether one enhances the other, whether A or B denote causation by themselves, whether it’s a synergy none alone can pull off.

Stan
Stan
2 months 10 hours ago

I’ve heard that if you are over 65 you have to be careful not to restrict protein too much. Would appreciate your thoughts on that.

PartTimePaleo
PartTimePaleo
2 months 7 hours ago
So, I still have a gall bladder but I was told after experiencing pain from it and undergoing a couple of scans, that I have a “lazy” gall bladder. I think the number they gave me which evaluates how efficient it is at doing its job is under 20%. It was recommended that I have it removed. I dragged my feet and still haven’t done so. What I find is that if I’m eating in line with MDA and the Primal Blueprint, I almost never have pain from it. When I fall back on eating pizza, ice cream, and drive… Read more »
Loraine Hansen
Loraine Hansen
1 month 29 days ago
My gallbladder was removed almost 30 years ago. It was an acute attack (while I was pregnant with my first child, no less), and it was removed in my second trimester. I still remember the incredible pain and agony it caused (worse than childbirth in my opinion). Anyway, I have not had any negative effects of having it removed that I can tell. I have been eating Primally for almost 5 years and have not had any negative experience on account of it. I switched to Keto in January of 2017, and for the first few weeks I had a… Read more »
Ontario
Ontario
2 months 7 hours ago

When I first started eating primally I was a little too strict as I assumed that was what the program required. I didn’t realize it then but now I know that I was essentially eating keto. I went from the normal SAD diet of plenty of carbs to very, very little carbs. Needless to say, I felt horrendous. I had the worst carb flu. I can only imagine how miserable I made my husband.

The point is, I realize that I absolutely need some good quality carbs in my diet for my own comfort and well-being.

Rebecca
2 months 6 hours ago

This was a very informative article. Thank you for the information, in particular about kidney stones! Embarking on the keto way to improve some health issues and don’t want to create other issues! Keep writing!

Jeff
Jeff
2 months 5 hours ago

I’m going through adrenal fatigue and I think a keto diet combined with poor sleep is what got me there. It really sucks as I gain weight when I rat starches, but my my adrenal fatigue just gets worse when I don’t eat them. Mark mentioned carbs may good for people with anxiety in another artcile, but doesn’t mention something in that realm here, I’m surprised.

Jeff
Jeff
2 months 5 hours ago

*eat

jo john
2 months 3 hours ago

Well, how about the fact that eating carbohydrates is perfectly healthy?
And the foods associated with reduced risk of mortality are whole grains, fruits, veges, legumes, and fish.

Sounds tasty, and healthy to me

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