Is Constant Ketosis Necessary – Or Even Desirable?

Inline_Constant_Ketosis_09.28.17Good morning, folks. With next week’s The Keto Reset Diet release, I’ve got keto on the mind today—unsurprisingly. I’ve had a lot of questions lately on duration. As I’ve mentioned before, a good six weeks of ketosis puts in place all the metabolic machinery for lasting adaptation (those extra mitochondria don’t evaporate if/when you return to traditional Primal eating).

But what about the other end of the issue? How long is too long?  I don’t do this often, but today I’m reposting an article from a couple of years ago on this very topic. I’ve added a few thoughts based on my recent experience. See what you think, and be sure to share any lingering questions on the question of keto timing and process. I’ll be happy to answer them in upcoming posts and Dear Mark columns.

Every 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.

A while back 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, indefinite 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. I certainly know people who have lived a keto lifestyle for years without issue.

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 consider it an obligation.

Because the goal of keto isn’t keto itself. It’s the metabolic reset that confers a potent and enduring flexibility. It’s the recalibration of inflammatory patterns along with other aforementioned benefits. How we customize our keto (or more traditional Primal) approaches should ultimately serve optimal personal health, not technically-minded dogma.

That’s it for today, folks! 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!

TAGS:  Keto Recipes

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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177 thoughts on “Is Constant Ketosis Necessary – Or Even Desirable?”

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  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.

    1. 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.

      1. 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.

        1. 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.

          1. Hi Kat, so glad this is working for you. Please forgive me for butting in.

            ‘m a professional coach in this industry, that the one thing all healthy diets around the world have in common is the inclusion of a variety of plant foods, especially the leafy greens.

            You may be able to carry this for a while depending on your personal biology, but make sure to listen to your body as a diet without any plants may not be the best thing in the long run.

            Despite some evidence to the contrary, sometimes based on an individual’s constitution, our bodies naturally require all forms of macros to thrive.

            Just trying to be helpful, plus I just noticed you mentioned trying it for, “30 days.” 🙂

          2. As a health care professional, I’m going to agree with you Pablo. We have to get our necessary vitamins and minerals from somewhere other than supplements. Green leafy vegetables should be a staple in any type of diet.

          3. I eat about 7+ cups of vegetables each day, normally with quite a wide variety of colors. A lot of people eating ketogenic diets now (and promoting them, Eric Burg, Dr. Wahls, etc.) promote eating large amounts of vegetables as well.

            I used to have low ketones levels for the first 6 months on keto with less vegetables, and now my ketone levels are strangely about double what they used to be even with a lot higher amount of vegetables.

        2. You might try upping the fat and reducing the protein in your diet. Protein can be converted to glucose via gluconeogenesis and stall/slow your keto state.

      2. Good point Kat. Definitely great for the mind and emotions. Feeling good is such a bonus.

    2. 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!!!

    3. 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 🙂

    4. 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.

      1. Good idea. My former doctor used to see me for 5 or 10 min appointments so that he could write as many prescriptions for me as he could. Not all doctors are like this, but there are enough of them that promote taking antibiotics for a cough, statin for cholesterol, various drugs for blood pressure, all with no dietary or nutritional support or advice. You could make a good case for stating that getting advice from your doctor is what will help make you ill.

      2. You should follow the health regulations as set out by those who have a PHD in diet and nutrition – they know best ! – Eat plenty of grains and breads, avoid all fats, eat healthy oils like canola and margarine, and if you get sick, just grab some prescriptions from your doctor, he knows best, don’t question him. For exercise, do plenty of long drawn out cardio sessions, and avoid short interval training and weights.

    5. 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.

    6. How many carbs a day are you allowing yourself? My wife and I did 30 carbs/day last summer . With no exercise, I lost 35 lbs in 12 weeks and she lost about 55 lbs. I have been on and off the diet since then. I usually ate eggs, bacon, cheese, and butter for breakfast. Low carb tortilla with mayo, mustard, cheese, lunch meat for lunch. Then for dinner we ate grilled chicken salads, hamburger patties, tuna, salmon, steak etc. We also survived on flavored water and coke zero.

    7. I’ve heard that you often dont lose weight on Keto while the body is still ‘healing’ and that can it take a while. Also I would stay away from fasting if you’re hungry, keto is not about eating less calories. If the body wants food it probably needs it! Especially if you’re a woman fasting might be not for you. I’ve learned a lot from the ketoforwomen podcasts but maybe you;re a guy and in that case never mind 🙂 I’ve tried fasting but even if I do it a few days a month I get issues with my period. I hope to be able to at a later stage but now i just focus on dialing in the diet, and feeling better mentally. I’ve not lost any weight yet, but I’m pretty happy where I am (+- 10 pounds) so I;m in it for the energy.

        1. Just saw this comment I made a couple of years ago and have an update actually. I cycled in and out of keto over the last couple of years – mostly paleo low carb some weeks, dipping into keto some weeks – not necessarily cycling on purpose but more just getting busy and not paying as much attention some weeks. Anyway, I’ve now lost 35 pounds! yay!

          1. Remember the old saying Starmice: “Softly, softly, catchee monkey!” Grin. Just getting on with your life, and living according to paleo principles without being obsessive has worked for me too.
            Looking back over a couple of years and noting the changes in myself has been both remarkable and reassuring. I have lost weight, true, and have kept it off, but the best thing is my emotional and cognitive state.
            I am a professional landscape painter, 75 years old. I submitted some of my recent work into the Dunedin Art Show last month, and one of my pieces was included in the Award Section as being in the top ten paintings.
            A senior citizen getting older, still improving and gaining recognition at a national level is noteworthy I think. This has happened as a direct consequence of being largely in ketosis and paleo living.

          2. Congratulations on your painting! That is truly impressive and inspiring!

  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.

    1. 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.

  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.

    1. 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!

      1. 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.

      2. When people tell me to take everything in moderation, I ask them if they eat poison ivy in moderation.

        1. The concept of someone eating poison ivy just gave me a good chuckle for some reason. Thanks!

    2. 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.

  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.

    1. You must live in WA or CO! If anyone has thoughts on this, might be worth researching.

    2. 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.

  5. The acute instead of the chronic, is something I usually prefer. Then I can also enjoy my rice, potatoes and bananas.

  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.

  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.

  8. I agree. Ketosis is an awesome tool, but I don’t see it as something meant to be used for an entire lifetime!

    1. 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.

      1. I completely agree with your first part — 100% Canola oil would technically be a ketogenic diet. But, I eat 7+ cups of vegetables each day and my diet is very healthy in my view (and in continual ketosis with no carb re-feeds).

        Chronic constipation? Perhaps for your family member and I’m sorry to hear that but for me, I used to do #2 once every three days, not it’s basically three time each day. I have largely come to view my version of keto as a cure-all since it has fixed so many things for me.

        1. Hi Todd, what’s a typical day in your version of keto? Would be great to have an idea of what you eat that’s worked so well for you.

      2. Could not agree more. Imho, you need to cycle in and out of ketosis in order to get the benefit of it. Constant ketosis may ‘work as a diet, but the benefit comes from hormesis.

  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.

  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.

    1. 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).

  11. I think that real primal ketosis should follow seasons. Eat a lot of fresh fruit at summer – full on ketosis at winter.

  12. 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.

  13. 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.

    1. 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.

      1. 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?

        1. 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:)

        2. 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!)

        3. 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.

        4. Terry, I believe that it can take up to 3 months for the inflammatory effects of gluten to subside.

        5. 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. 🙂

        6. 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.

          1. I found my way here through Migraine Miracle as well. I’ve been in full ketosis for 8 weeks, and while I had great success the first 28 days, have now had more than 20 days straight of a burning headache. Gave up all grains and sugar, and eat between 15-25 carbs daily, but still. Bad pain. Worse than before I started. I have way upped my dairy to get the fat. Maybe like sweffling , dairy is my problem as well! Thanks for this thread. Going to try knocking dairy out and see what happens.

          2. Lori – have you also investigated potential muscular issues that could be contributing to your migraines – investigate trigger point therapy, I recommend a book by Claire Davies, you may find especially if you have muscular trigger points in the neck and shoulders, theses can directly cause migraines – good news is you can easily treat them yourself, at any time, any where, once you learn the techniques. I have used these techniques to vastly improve my mother’suffering from migraines.

    2. 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.

  14. Awesome post Mark! I love your balanced approach to all of these issues. Keep up the great work!

  15. 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.

  16. 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!

    1. I know this is an old comment but I actually found that going keto healed my HA. You don’t need carbs for reproductive/menstrual health.

  17. 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.

    1. 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.

  18. 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.

    1. Wouldn’t he Inuit be in long term ketosis since they ate mostly meat year round?

      1. 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”

    2. Ever heard of the Inuit? I prefer science to clever idioms that mimic religiousness.

  19. 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?

  20. Where does the idea that ketogenic diet used long term / for life is “primal” come from, anyway?

    1. Yes, a very good question, and why the sudden obsession with “keto” from everybody.

      Just go primal, keep it simple, “keto” is just another fad.

  21. 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.

    1. 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.

    2. 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?

      1. 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.

    3. 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.

  22. 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

  23. 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.

  24. 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.

  25. 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.

    1. Kate, feeling run down with hair falling out is a sign that your thyroid is struggling.

      1. 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.

        1. What tests? I’ve heard a lot about the run-of-the-mill (just checking tsh?) being inadequate.

    2. 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.

      1. Ketosis does NOT work for everybody or for everything. Best to pay attention to how one’s own body reacts rather than follow the advice of someone else.

  26. Too bad it gives you really stinky breath! any suggestions? I’ve tried chorophyll, but it only worked a little

  27. 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.

  28. 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.

  29. 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.

  30. 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.

  31. 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.

  32. 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!

  33. 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.

  34. 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.

  35. 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.

  36. 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.

  37. 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.

    1. 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.

      1. 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.

  38. 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

  39. Another few benefits to the ketogenic diet that I noticed right away is that the sick feeling and acid reflux went away, nor do I have gas anymorure. I use to think it was dairy, but I’ve been eating cheese, cream, half & half all that I want with no side gassy effects. Also my ‘allergy’ to pecans and cashews is gone. I son’t get a facial rash from eating them, and the psoriasis patch on my back is gone.

  40. I have been on a ketogenic diet since 2002, when I accidentally invented it. Of course I didnt invent it but I had not read anything or knew anything about Atkins or paleo (did paleo even exist in 2002?). I just decided to stop eating carbs to see if it would help me lose weight. I weighed about 280lbs at the time. I lost about 100lbs in 12 months.

    13 yeas later still 175lbs or so… still in ketosis, all day every day, still alive. Now a Primal Blueprint expert too!

  41. I purchased the book Keto-Clarity by Jimmy Moore a few months ago but haven’t read it. Thanks for the reminder and motivation to sit down and dig in. I feel good when in ketosis but I find it hard to stay there. For me, ketosis equates to no more than 20 gms of carbs per day and I find it just too restrictive. Cycling works much better for me but I am very interested in learning more as I have read that’s it’s the best medicine for brain health. Check out the neurologist Dr. David Perlmutter who advocates 80% fat, 15% protein, and 5% carbs for optimum brain health.

  42. I am bipolar and have been in and out of ketose for 2 months now. It has really messed up my mind for the first time in several years so no doubt that something is going on, but beeing on medication it takes a loooong time to be sure on what you are doing because it is not something that you just play around with untill you get it right…
    I am sloooowly trying to figure out a stabil way of living with ways that will work for me long term before I dare to regulate my medication. But for sure I hope that this will help in some way. But it is a dangerous path on your own.

  43. I was keto for about 9weeks and felt pretty awful the whole time. I read an article through Chris Kresser and listened to a podcast of his on this and essentially it says it messes with the baby bearing age female hormones alot as we need carbs to make certain female hormones so he recommends not being in ketosis long term if you want to bear babies and recommends eating 30% carbs. We also need insulin (which you dont produce while not eating carbs) to change thyroid hormoneT4 to T3 which is why it is often cited as not being recommended (unless for severe neurological diseases) to be done continuously long term. Since reading this stuff I have been out of ketosis (10days), I feel more energetic, my hair has stopped falling out and am able to exercise more intensely with better recovery. And the pimples I had started getting for the first time in my life while in ketosis have cleared again (I’m in my late twenties).

    Essentially I think each person needs to find what is right for them, however women who are of child bearing age need to be careful and maybe consider trying intermittent ketosis… this is the message from both Chris Kresser and now it seems Mark, to which I agree.

  44. Every negative I have come across has a definite solution.

    Excessive Ketones? Exercise and ease up on Keto a hair.

    Constipation? Get extra potassium/magnesium. Drink extra liquids.

    Kidney stones/acidity? Take Potassium Citrate.

    There are solutions to keto problems if people look for them. It is a maintainable long term diet if you learn and know what you are doing.

  45. Greetings and peace;
    This is very good information regarding whether constant ketosis works well for everybody. I believe that constant ketosis is unnecessary for optimally healthy people, especially those with good metabolism. I’m not saying anything bad about being In ketosis at all because it is a good idea for much of the population. Much of the population suffers some sort of chronic illness due to poor metabolism and poor vascular health; so the ketogenic diet along with other healthy areas would be good for such people. You’re right about not everybody not needing to be in constant ketosis if they’re healthy. Adapting intermittent fasting, healthy eating, good physical fitness, and other healthy habits would help many restore to good health and remain that way for virtually lifetime. I’ve been reading your post for years and really enjoy much of the information here. Thanks for the great information and peace.

  46. I started experimenting with a ketogenic diet in November of 2014 for bipolar disorder that comes with a whole slew of mood shifts and being all up in my head for me that sucks.

    Much to my amazement I made over $4,000 in one month that month in my gardening business. I also had an incredibly beautiful young woman I’ve secretly had the hots for for over a year be attracted to me because I was confident, grounded, on purpose and focused in my life! She just came right up to me and leaned in.

    That is enough for me to continue on with the ketogenic diet because my ability to make money and pursue women/romance has been so hard. This showed me what is possible and also that working with a mentor to resolve trauma and emotional abuse is important because that is surfacing. This is the only other thing that actually worked and gave me any significant traction other than diet.

  47. Ketosis is the only thin that keeps my fasting blood glucose below 90. Isn’t there health benefits to that?

  48. My other half has had epilepsy for 10 years. After a horrendous experience with side effects from meds, we asked to try the Ketogenic diet. It’s been 6 months and although it hasn’t been a cure, life has actually returned more or less to normal and he’s able to work and enjoy life again. I believe it really ought to be offered as a treatment much earlier for epilepsy patients. AEDs have life altering side effects, and neurologists should be more forthcoming about that, and not focus solely on seizure reduction but rather on quality of life, which is what ketosis has given us. We haven’t figured out how to do 80% fat minus dairy, since double cream is just the easiest go-to for keeping the ratio high without high protein. Thanks for a great article Mark, we plan on continuing for a few years before going back to Primal.

  49. Hi Mark,

    You asked for comments about personal experiences with KETO eating – I just lost my last 20 in about 4 months doing about 1350 calories – 75% fat, 70% protein and oh about 35 carbs – I make a “Daily Bowl” which is basically eggs, greens (cooked spinach/broccoli – whatever is fresh at my Co-op), meat, fish or chicken – my homemade mayo – nibble all day – never hungry – now that I am maintaining I add some sweet potato and bump my carbs to 50-80 and up my fat so I stop burning my own…I feel energized. No plans to quite any time soon…Pale/primal got me off grains and healed life-long respiratory stuff but I ate too much protein and fat so never lost. This is a breeze and my foundation is solid – oh right, dairy – not so much except a bit of raw aged cheddar once in awhile. I’ve been maintaining my loss for 8 months – a major miracle for me. I do my Max eliptical three times a week 20 minutes and lift heavy water bottles twice a week – yes stretches in the midst. Really it’s all good for me with KETO – 🙂

  50. Hi Mark

    Thanks for your service

    I’ve always relied upon your opinion regarding health & diet

    All the best!

  51. I am a 46 year old mom of two kids

    I’ve tried for nearly 3 years now (breaking in between more than once for 1,2 months) to become keto adapted without much success.,
    To improve general health.,

    I’ve tried 24 hours water fast a few times

    Now I’ve thought of trying IF in a more regular basis.,

    I cook too much of carb delicacies at home in a regular basis which is too much of a temptation to try to remain in Ketosis all the time.,

    Thanks for sharing the fruits of your research

    Good day!

  52. I was hoping for the miracle in ketosis for my chronic migraines. Once I became keto-adapted, I had the most amazing 28 days of my life. Not a single headache. A total record for me. Energy was off the charts. Mental clarity. All of the good stuff. Then the wall fell. I’m now at 20 days straight with a burning headache that starts at the base of my skull. I went to a doctor of integrated medicine this week and am waiting on blood test results, but my blood pressure has gone up from 120/60 to 125/75, I’m bruising like mad, have lost too much weight (didn’t need to lose to start). She thinks I took the diet too far and that I definitely need more protein and carbs. (I’m at less than 20 carbs a day). I’m torn, because I see all of these people having such amazing luck with ketosis, and fear adding in more carbs will make it worse. Perhaps I need to find the right balance, and maybe for me, it will be cycling instead of staying steady. Curious if anyone else has had the same experience and how they fixed it. Thanks for the podcast! Feeling quite torn at the moment.

    1. Hi lori,

      Please read this article by Sarah Strange over at Robb Wolf’s site:

      I have been in nutritional ketosis for 2 years straight, since I was 21. I have enjoyed its benefits alongside intense strength training. However, last December I began to notice stark differences in my mood. I started adding in a serving or two of paleo starches on a couple of workout days (I train 4 times a week), with an additional high carb PWO on Saturdays. My hormonal profile has improved and I feel like a meta-human. Increase carbs very gradually. I took 6 weeks to increase them slowly…

  53. I have been eating on the borderline of ketosis for a few years, with some excess fruit, with great results in weight maintenance and energy levels. Recently I started taking a ketone supplement that has exogenous ketones and this has boosted my energy levels even more. When I was telling a friend about it, she asked this very question. Is staying in ketosis bad for you? Thanks for this article, I don’t think it definitively answer sthe question, but it does point to the research saying tha long-term ketosis is not harmful. So I’m going to keep on taking the supplement and eating well.

    Thanks again,
    Dr. Brad

  54. constant ketosis may not be necessary. but it creates trouble for me whenever i am trying entering into ketosis after being out of ketosis even for few hours or a day or two..

    It takes for me about a day to reach from 0.2 millimolar to say above 1 millimolar. But during this process of getting into ketosis again , i feel little unusual with little headache , constipation , little muscle cramp(not always). Ok , i can solve it by taking little more salt , magnesium , more fluid etc.

    Due to this reason i think that the constant ketosis for me is better if i want to stay in ketosis due some hormonal and even genetic advantages what i am reading now -a-days.

    Otherwise i can still be a fat burner without being in ketosis at all. what is your opinion??

  55. Been on Keto since 2015
    I just got my blood test today: (I fasted) it reads: March 2017 Cholesterol: 284 (ref range: none) HDL: 47 (ref range: >40 mg/dL) LDL, Calc: 208 (ref range: <100 mg/dL) Triglycerides: 112 (ref range: <150 mg/dL) Testosterone1109, (ref range: <193-740 mg/dL) Glucose (fasting): 94 (ref range: 65-99 mg/dL) The rest is normal… should I be worried about my liver? or how my cholesterol and glucose have increased a lot in the last months? December 2016 Total cholesterol: 258 HDL: 51 LDL: 182 Triglycerides: 98 Glucose 72 (fasting) Testosterone 766

  56. I think the key in your article is the term “Healthy.” There are millions of people in the U.S. that have hidden diseases and disorders caused by the standard American diet and don’t even know it. None of the research I have found is contraindicated for staying on this way of eating for life.

  57. I’ve been doing a calorie-restricted, ketogenic diet for about 10 years now. I do have a “cheat” day every Saturday to satisfy my cravings for carbs which knocks me out ketosis for a 24-48 hours; therefore, I cycle in & out of ketosis every week as a result. I also lift weights & run a 5K 5 nights a week. I don’t ask others how old I look because I’m not that vain, but people routinely tell me that I look 30-35 yrs old after picking their jaw up off the floor when I tell them I’m 50 yrs old. I think I am one example that cycling in & out of ketosis every week is perfectly fine. Also, it’s possible to have your cake and eat it too! Even if it’s only on your cheat day.

  58. I’m going on 1.5 years in full ketosis (other than one small break) and the beneficial changes have been nothing short of remarkable. What I don’t understand though is why people refer to the sense of restriction on keto — I have never enjoyed food as much since being on keto, but then again I eat a ton of vegetables.

    I’m not sure that I need to add winter squash to my diet in order to stop from missing out. Still, the point underlying the article is that even if long-term ketosis is working for you now it will still likely cause you some type of metabolic of hormonal damage later on. Not exactly what I consider a balanced position although you’ve obviously put in some effort to try to do so.

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  60. I am in and out ketosis since four years now on the Wahls Protocol (paleo and keto). This lifestyle improved my severe symptoms due to spms. For women it is better to get adequate protein as you reduce carbs. This will prevent hormonal problems. I am now in ketosis over 9 months doing great. Getting my cognition in the best shape ever.

    1. forgot to tell that I do not eat very high on fats. for I want to burn bodyfat. my macro’s are acording to OKL (facebook) 26 carbs, 100 protein and 90 fat.

  61. Have we discovered any long run consequences of long-term keto?

    And is there any reason to really say we NEED carbs?

    1. Yes, you need carbs. A lot of people seem to think “carbs” are limited to sweets and grain products, but most other foods contain carbs too. Carbohydrates such as vegetables, fruit, and various other healthful foods contain vitamins, minerals, and antioxidants that the body absolutely needs for optimal health. Eliminating all carbs means subsisting on nothing but protein and pure fat.

      1. Doesn’t meat have these vitamin and minerals, at far higher rates, than vegetables and fruit?

      2. Yes, but they all go to glucose, and your liver can make all you need by GNG. Don’t discount nutrition from foods rich in protein and fat. These (eggs, liver, steak, etc) are some of the most nutritious foods available and they pass the evolutionary filter with flying colors.

  62. Thanks for this I really needed to hear it! I am one month into a 3 month cycling trip through Europe and since arriving in France I simply CANNOT pass up the croissants!!! Back home in Canada I haven’t eaten any grain based products for 2 years, but here….well we will see what happens. I am cycling an average of 50 kms/ day, pretty well every day. I took one day off after riding 800 kms and went for a 8 km walk that day. I am still having a bulletproof coffee (coconut oil and butter) every morning with my croissant…and I haven’t put on any weight yet! Other than that and a daily dose of an ounce or two of dark (85 percent) chocolate, I don’t eat many carbs…lots of olives, cheese, meat, avocado, sauerkraut, lettuce, cucumber.

  63. I’m underweight. How can I maintain or body mass with low insulin and slightly questionable ability to digest fat?

      1. Honestly, just eat more food. There are a few very good podcasts and resources about gaining muscle while on Keto. My favorite is The Ketogenic Athelete, I found it because MDA’s own Brad Kearns was on it!

  64. Been doing keto off and on for about a year. When our carbs are really low, we have deep joint pain and can’t sleep well (around week 2). We do bone broth, Real Salt, potassium and magnesium supplements. I don’t like it for those reasons. Why does that happen?

  65. Hi! I read a site called, by a vegan, Dr. Greater, and he says there that ketosis is wrong, and he cites 1160 studies that, he says, proves ketosis is not a good choice.i wonder what’s your opinion on that. Thanks!

  66. After reading Mark’s posts and suggestions about Keto, which I was curious about, I decided to follow his advice and try it for 6 weeks. I’m on week 7 now, and wow! Talk about results! I’m down 8 pounds (at the bottom of my goal range and on my way to my dream weight) and have easily lost visible body fat all over.
    But the big success has been in my blood sugar (I’m a controlled diabetic, whose numbers have been drifting upward on Primal), which initially went up slightly on Keto (no idea why), but since I dropped all fruit entirely, have been steadily falling and are now often in the normal zone.
    I had labs and an A1C yesterday, excited to see the results.
    If the numbers are as good as I suspect they might be, I’ll stay on Keto so long as I continue to feel good, but experiment with keto real foods that mimic those I’m missing (glucose testing them one at a time) for variety and to see how I feel with them. And I’ll probably throw in a ‘feast day’ once a month or so, see how that sits.
    I’ll keep you posted!

      1. Thank you Mark, you’ve had a major positive impact on my health and my life. I really appreciate your advice.

        BTW, blood test back today:
        A1C: 5.6 !!!!
        Down from a high of 6.8. Lowest since 2002.
        Thanks to Primal and Keto, I’m no longer diabetic nor pre-diabetic! Finally in the normal zone! High five!

          1. A follow-up to the follow-up, LOL!
            Let me Grok this thing another couple of months, have some recipes, exercise adjustments and ideas to try out, n=1.
            (Sidenote: for some reason I’m not getting email notifications of replies, even though I checked the box… Hmm, but I didn’t check my spam. I’ll let you know if I find anything there.)

          2. Exactly, Barbie. Nothing wrong with a 2nd follow-up! I’ll check into the notification question. Thanks for sharing that.

        1. Nice work Barbie. Are you T1 or T2? If T2, are you off oral meds completely or still taking some? I’m T2 and had gotten my a1c down to 5.2 with mainly primal eating but was taking both Metformin and Tradjenta. I’m giving keto a shot and have already quit taking the Metformin because my bs was getting too low. We’ll see if I can come off the Tradjenta as well though I probably won’t be doing keto indefinitely so I’m not sure how going back to Primal w/o meds will effect my sugars.

          1. Got a notification! Thanks, Mark!

            John P. , I’m T-2, 16 years. Got off meds when I went Primal years ago, but couldn’t get my numbers all the way down where they should be. At one point my A1C climbed, even eating Primal. That’s what prompted me to try Keto.

            From my perspective today eating keto, I’m blaming fruit. Getting rid of it entirely dropped my numbers immediately. Sweet potatoes and butternut squash, too, though I only ate them occasionally. I used Robb Wolf’s morning glucose testing method on them and got huge rises, as well as a stomach ache.

            With your low A1C, you should be able to get off meds, I would think.

            Good luck and Keto-Grok-On!

          2. John et al
            I was diagnosed with T2 about 2 1/2 years ago. Both my blood glucose and A1C were really high so my Doctor put me on metformin. I have worked out religiously for 4 decades and I was shocked about my blood sugars, particularly because all my other numbers (Cholesterol, triglycerides) were off the chart great. Even though my Doctor thought it genetic (which it wasn’t) I realized it was stress. So at the end of September when my blood sugars were back at 200, I was sent to a nutritionist who wanted me to go low sugar and low carb diet. In particular, my sugars were not to exceed 10 grams a day and I confined my carbs to lettuce, kale, bok choy, celery, cucumbers and occasionally mushrooms and black olives. Because I work out so much, the nutritionist recommended that I consume a pound and a half of protein per day. After 3 days of discomfort, my body adapted and I felt it was easy to adhere to this. One week after being on this regiment, I took my blood glucose and it was 122–all in one week. Two weeks ago I thought I would give a try to the 5:2 diet confining caloric intake to 600 calories two days a week. The first time was a bit of a challenge but this past week it was easy. Three weeks ago, after consulting my doctor, I cut my metformin dose in half and a week ago yesterday, I stopped taking it entirely. Why? Because the two times this week I tested my blood glucose, it was in the 90’s both times. More importantly, I love the feeling of feeling so focused, grounded, and clear headed. Next, I am not hungry and do not have cravings. I will admit ice cream was the greatest thing invented and I ate it every day but now sugar free popsicles do the trick. There are just so many benefits to this life style and it really is easy. I had to lessen the intensity of my weight training but only for the first two weeks. I welcome any questions anyone might have.

  67. I’ve been keto for 1.5 years. I so this for my severe chronic migraines. I also discovered that due to the huge amount of analgesics I’ve taken, I have a leaky gut. This added to addrenal fatigue keep me doing keto. I don’t mind. I really feel better and safe while in ketosis. I’ll keep this way of eating for the rest of my life. Maybe enjoying some seasonal fruits and potatoes sometimes.

  68. Since when did this whole “Keto” diet become such a thing – I have just been following the primal plan for a few years – is that Keto ?, and seriously, why would I need to obsess about whether I am “keto”or not ?

    Grok didn’t know what Keto was, he just ate real food and avoided poisons, and had random intervals where he went without if the hunt had gone bad, or the season was bad. There was no planned dieting, it was random.

    If your planning your diet, you already missed the whole point of primal.

  69. Beautifully written, well-backed, and down-to-Earth. This post reminds me of Richard Nikoley’s post, “The Hormesis Files: Chronic Ketosis and the Case of the Missing Glutathione.” Yes, Mark, you are right about too much of a good thing being not very good. I believe all phenomena occur in waves or pulses. The same can be said for ketosis. Believe it or not, heavy metals exert hormesis in small doses too. Could this be why we have seen an increase in those with very, very high-functioning autism with the dawn of mercury-laden vaccines…hmmmm…perhaps. I don’t know, but I digress.

  70. My husband is a paleo/keto success story (he went Paleo three years ago, and he’s been keto for six months now). He has always been rather fit, but I’d summarize his impressive results this way: he lost body fat, built muscle, cured his athlete’s foot, cleared up the chest acne he had had since his teenage years, no longer has dental problems, is better focused, and sleeps better. Mark, you changed his life for the better, and now he is helping my parents and me do the same. My mother was just diagnosed with cancer last week, and now she is listening to him attentively as we are praying that keto will help her regain her health. I have to admit that at times, I have clashed with my husband over his diet as I don’t always experience the same benefits and worry about his excessive consumption of fats, but generally speaking it has been a blessing to take back control of our eating habits and our lives. It’s very empowering, so thank you for your wisdom. 🙂

    1. Gigi, thanks for your note. I’m happy for your husband’s turnaround in health and the benefits you both have gained from the lifestyle changes. I’m sorry your mother is facing this diagnosis, and I wish her all the best as she takes next steps. Best to you and your family – Mark

      1. Thank you so much, Mark! It means a lot to me, and my husband will be tickled to know I reached out to you. He is a tremendous fan. 🙂

  71. Hello my name is Thomas Karol , my husband was suffering from liver cancer, and the doctor’s told me that there is nothing they could do to save my beloved husband life. Then a friend told me about hemp oil , i told her that my husband liver cancer was in the last stage that i don’t think the hemp oil will be able to help, and she persuaded me to try, for the love of my husband, i decided to give it a try. I did some research and i found a doctor who helped me with the cannabis oil to cure my husband liver cancer and he assured me that after 3 months the liver cancer will be gone, and For the past one year my husband is perfectly okay and he is free from cancer, if you know any one who is suffering from cancer you can save his/her life by contacting Dr. Brown Nelson via his email : ([email protected]) it worked exactly as the doctor prescribed. Thanks to Dr. Brown Nelson for taking away sorrow in my life. God will bless Dr. Brown Nelson for helping me with cannabis oil and for his support and care, i will keep on help you to fight cancer in the World, all i have to say is THANK YOU LORD.

  72. i came specifically to your site to find out about ketosis. but this article missing a paragraph on what ketosis is. 🙂 or i might go look for another article. but i dont have time!

  73. I want to eat something sweet so badly. I have been on Keto for 5 months now and I don’t cheat. I have dropped 31 lbs and I am terrified to eat something sweet, and all I want is some chocolate. Do you have any suggestions on what I can eat to satisfy a chocolate craving?

  74. i have had no single serious life threatening health condition, but a myriad of health issues that improved since im keto.
    the most important is that my exhaustion is gone, and so is my chronic flatulence and pain in stomache, as well as the dizzy feeling in my brain whcih resulted in carbohydrate rape of my brain and which i accepted for my entire life as being normal and unchangable.
    i never liked bread and all that sweet stuff anyhow i just kept on eating it because everybody else does but these days are over and i have no desire to change it EVER.
    plus i stay very well in keto with under 50g of carbohydrates, that means i CAN eat some tasty fruits or drink some fruit juice, just not too much,

  75. i Just got your books—now to sit down and read them, right? I’m on day 20 of Keto diet. Im 50, dealing with hormonal issues…. my weight has been creeping up. I love the food on Keto and especially Paleo, except I like cheese occasionally cheese. I just listened to a podcast saying paleo is really unhealthy, My husband is a university wrestling coach and former Olympian, so I’ve seen and tried many different weight loss programs, At my age I’m more concerned with health and energy, (I would like to lose 5 lbs), how do you know what research to trust? I do feel better than I did on weight watchers a month ago.

  76. This diet is extremely popular and has surpassed diet trends. Every other person struggling to lose weight resorts to a keto diet.

  77. The first 100 days on the Ketogenic Diet was a life changing experience for me– my energy level, mental clarity and overall sense of well-being improved. I also did intermittent fasting (IF) and unwanted pounds were coming off. I delayed my first meal of the day until late morning. For several weeks in a row I fasted from Saturday until lunch on Sunday. Just after crossing the 100 day threshold, I hit a brick wall and felt terrible– I started experiencing bouts anxiety and depression. From what I’m reading, the concept of ‘cyclical’ ketosis is important because our bodies were designed to have the metabolic flexibility to use both glucose and fat for fuel. It was easy to minimize the importance of carbs while experiencing the transforming effects of being in ketosis. Dr. Mercola mentioned that the ‘metabolic magic’ in the mitochondria actually occurs during the carbohydrate refeeding phase. This is something I should’ve paid attention to. The closer I got to my ideal weight, the more I felt the need to increase the amount of carbohydrates in my diet and fast less often. My downward trend occurred right after fasting– the day after I broke my fast I was blindsided with a wave of anxiety. I don’t think there’s a consensus on the frequency of refeeds or a definitive rule on how long someone should stay in ketosis or a formula on how often one should fast. Listening to what my body is saying is key

  78. I’ve been on the diet for about six weeks. I love eating what’s allowed and while I miss ice cream, cheese Danish, and fruit, I’ve been very strict with carbs (<20 gm/day). I use the Carb Manager app and have been under all my targets. I use Nurse Hattie urine test strips but never get above 0.5. This morning it even showed “negative “ ketones. Any thoughts?

  79. Before the 1950’s, EVERYONE was on a ketogenic diet. There wasn’t the proliferation of cheap, sugary foods around as in today’s society. Mom cooked with bacon fat. Only the rich could afford candies. Who had freezers for ice cream?
    But, if a naysayer says that the low carbohydrate diet is bad then you have to ask yourself – is the HIGH carbohydrate diet GOOD for you? Well, America and all the nations that follow the American diet are now suffering from OBESITY with all its’ attached medical problems. So, what do you think? Were great grandpa and grandma healthier than the tons of funs walking around nowadays? Great grandpa and grandma COULD WORK A HARD DAY IN THE FIELDS OR FACTORIES. Today’s lard-butts get winded walking to the refrigerator for another beer or cheesecake.

  80. The statements above in reference to the length of time to maintain a Keto diet are unclear. I started over 3 months ago and lost the desired 12 lbs. I feel and look great. I have inspired others. However, I believed this is the way I would be eating the rest of my life. Is this not true?

  81. I was on a very low-carb diet for about ten years, following a diabetes diagnosis. I managed to keep the diabetes under control (mostly at pre-diabetic levels). Finally, two 36-hour fasts over a six month period put an end once and for all to the diabetes. My blood sugar is no normal, no matter what I eat. I remained on the low-carb diet until I developed atrial fibrillation (i.e., an irregular, “fluttering” heart beat). I found out that long-term low-carb diets can cause fibrillation, so I stopped. The atrial fibrillation went away, and the blood sugar is still normal. But I have gained weight back, rapidly, so I am experimenting with intermittent fasting.

  82. I did well on staying in ketosis for about 3 months. But now seems I’m hungry all the time and not fasting as I should. Only staying in minimal tomoderate stage on stick test. Is it harmful in any way just to stay at this level until I’m able to get back to fasting? Have bern consumed with updating house to sell, so having trouble staying on fasting routine.

  83. Hi,

    Great article!
    But what I don’t understand and can’t find an answer to is the following;
    I read and hear some people stating they are in ketosis 95% of the time. I started testing my blood and will be at 1.7 or 1.8 at a certain time of day (a while after my bulletproof coffee), but doing several tets throughout the day will always show several moments (after I eat usually, even if it was 0 carbs) where the reading will show something like 0.3 or even 0.2.
    Does this mean I’m only in ketosis from the coffee until I eat? Or am I getting a false ketosis reading because of the bulletproof coffee? Or does everybody have this, and getting a high reading like 1.7 means I’m aa much in ketosis as one can get??

    Thanks for giving me your view on this!