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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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October 09, 2017

Dear Mark: Is Keto Ancestral, Ketone Breath, and Keto for Lupus?

By Mark Sisson
24 Comments

Inline_Dear_Mark_10.09.17For today’s edition of Dear Mark, I’m answering some questions about keto (hey, you folks keep asking!). First, is being on a ketogenic diet actually congruent with our ancestry? Is there historical precedent? Next, is bad breath really a reliable indication of being in ketosis? And finally, could going keto help treat the autoimmune disease lupus?

Let’s take a look:

First, Ryan asked:

My understanding and experience with Ketosis as a state, is that it is not necessarily hard to get into, but is difficult to maintain for any period of time. By “difficult” I mean you have pay very close attention to everything you are eating, or you will easily slip out of Ketosis…

So, my question is this. From an evolutionary perspective, is long term Ketosis something we “should” be aiming for? Assuming long term ketosis was optimal, it seems that we would have evolved to easily maintain it under a number of circumstances, and not easily slip out of it, instead of the opposite.

Thanks for all you do!

Ryan

Interesting question, Ryan. I dig it.

I’ve written about whether or not we need to be in long-term ketosis, coming to a similar conclusion. It isn’t necessary for most people, and it’s probably not optimal, either.

Why ask folks to go keto for 4-6 weeks then? That’s not “long term,” but it’s longer than “transient.” Paleolithic hunter-gatherers wouldn’t have gone that long without food, nor would they have consciously avoided carbohydrates if they were available. There’s no evidence of long-term wholly ketogenic populations.

But that doesn’t mean they weren’t producing ketones on a regular basis. Before everyone had constant access to cheap food without having to work for it, ketosis was more common. It wasn’t a constant state of being, but it was always in the vicinity. The food situation was ketotic in three main ways:

  1. Glucose wasn’t as plentiful as it is today. The starchy tubers you could access came packaged with a ton of fiber. That reduced the amount of digestible glucose and increased the amount of tuber a person could eat and still produce ketones.
  2. Constant snacking wasn’t tenable. There was no fridge to open when you were bored. You couldn’t just dig through a non-existent pantry. The kind of constant low-level eating that keeps glucose topped off and inhibits ketone production—snacking—just didn’t happen very often. A lot of time elapsed between meals, which was very conducive to fat-burning and ketone production.
  3. Obtaining food required physical activity. Exercise, in and of itself, stimulates ketone production by increasing energy expenditure and reducing energy availability. If you have to physically work for your food, you will produce ketones. And sometimes the hunt comes up short, AKA you train on an empty stomach.

You’re correct that extended, protracted ketosis probably wasn’t the norm for our hunter-gatherer ancestors. Rather, they spent most of their time in what I call the keto zone, where one slips easily into and out of ketosis. The Keto Reset offers a way to emulate that ancestral metabolic environment by condensing it into a shorter time frame, to make up for the lack of lifelong dalliance with transient ketosis and the enhanced fat metabolism it creates.

Just a quick question, Mark. Does being in ketosis cause bad breath? My daughter has an unusually acute olfactory sense and swears I have keto breath. Am old, sedentary, 25 lbs overweight (belly) and trying to slim down via intermittent fasting and carb restriction.

Yes, ketone breath is a common indicator of ketosis.

All signs point to “yes.”

Just wondering about something. Has anyone suggested anything about Lupus, an autoimmune disease. I’ve had Lupus for 27 years. After going on low carb I am in remission. Not sure, but it has to have something relevant. No longer on any of the medications. Thankful!

There’s reason to believe going low-carb or ketogenic can help lupus and other autoimmune diseases.

For one, many of the foods known to trigger or exacerbate autoimmune diseases are higher in carbs, like grains. Going low-carb necessitates their elimination. The Primal eating plan, whether ketogenic or not, also eliminates refined foods in general and industrial seed oils in particular, both of which are inflammatory and can contribute to autoimmune flareups.

Two, ketogenic diets may directly affect the inflammasome involved in lupus. Inflammasomes are the mediators of inflammatory pathways in the body, and their activation is linked to many different diseases. Activation of the NLRP3 inflammasome in particular is a critical mechanism in the progression of lupus—and ketogenic diets are known to inhibit it.

Three, “fasting-mimicking diets,” or ketogenic diets, have been shown to improve outcomes in rodents with autoimmune encephalomyelitis, a type of brain and spine inflammation. They do this by actually regenerating immune cells damaged by the progression of the autoimmune disease. All the rodents improved their symptoms and 20% entirely reversed them.

Four, it’s working for you! This is the most convincing piece of evidence that it helps, at least for you.

That’s it for today, folks. Thanks for reading. Be sure to chime in down below with your own input.

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24 Comments on "Dear Mark: Is Keto Ancestral, Ketone Breath, and Keto for Lupus?"

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Shary
Shary
4 months 13 days ago
I agree with Mark’s idea of slipping in and out of ketosis (which I have done off and on) versus trying to maintain permanent ketosis. Thing is, there aren’t any hard and fast carb/protein amounts for maintaining ketosis. It will vary somewhat from person to person and from one day to the next, depending on genetics, the state of one’s health, the pull of the moon (tongue in cheek), and who knows what else. Even a nutrient-poor (and therefore sub-optimal) zero-carb approach won’t necessarily produce ketosis in everyone. The Keto Zone makes sense. It takes all the stress and struggle… Read more »
NaturalGirl
NaturalGirl
4 months 13 days ago

Great input.

Petra
4 months 13 days ago

Primal let’s you slip into ketosis, without the stress of being perfect.

Because it is not about being perfect, it’s about making the right choices most of the time.

Shary
Shary
4 months 12 days ago

Exactly. Some people actually will be in ketosis on a primal diet without trying very hard or paying much attention.

IMO, tracking everything constantly is way too much trouble, but for some people maintaining ketosis (or strict Paleo, for that matter) is more about the numbers than anything else. It’s possible to get so caught up in the process itself that one can lose sight of the fact that the results might not be as expected.

Vince
4 months 12 days ago

Agreed. I know many people who hate having to constantly track food. For them, the requirement to do so would prevent them from ever being successful with a given diet or approach.

Elizabeth Resnick
4 months 13 days ago
Great stuff here…especially about the lupus! That is so exciting and completely makes sense. And I totally think Keto is ancestral, when you look at the Keto diet the way Mark presents it. Our ancestors weren’t running around checking their urine or their breath to see if they were in ketosis, but they often went long periods of time without eating, and certainly didn’t have unlimited access to carbs like we do. And I’m sure there were times when they stumbled upon honey or berries and had way more carbs than usual. But for those of us looking at this… Read more »
Mike
Mike
4 months 13 days ago

I think keto was ancestral for some populations but not all or even necessarily most. European/north Asian/North American would have had longer periods of prolonged dependence on animal proteins and fats relative to the unavailability of other food sources. Southern Asian and African populations would have more fruits, tubers, berries, vegetables, melons etc available to them for longer periods of time, lessening the amount of time they were wholly dependent on hunting or scavenging to provide the bulk of their caloric needs.

Margaret
Margaret
4 months 13 days ago

Had the opposite experience with Hashimoto’s (just low carb, not keto). I had been doing nicely on levothyroxine for years without a change in dosage. Not long after starting LCHF, my TSH skyrocketed and all my hypothyroid symptoms came back. I tried to stick it out, but very low carb just didn’t work for me. Maybe not all autoimmune diseases are created equal?

Kimber
Kimber
4 months 13 days ago

I have hashimoto’s and have only had my numbers drop since I went LCHF.

Playpus
Playpus
4 months 13 days ago

So then for someone with hyperthyroid would the opposite be true? Go Keto to raise TSH. Interesting. Paul Jaminet talks about carbohydrates and thyroid function.

Mike
Mike
4 months 13 days ago
Obviously, all of our Paleolithic ancestors did not universally eat a diet that resembles today’s Keto diet. They ate whatever was available to them specific to the region they inhabited. Closer to equator meant a larger variety of edible plant species that were available for longer periods, hence less dependence on animal fats and proteins. Farther from equator equates to shorter growing seasons and less edible plant variety, resulting in longer periods of greater dependence on animal fats and proteins. Even though they were not themselves farmers they would not have been averse to consuming the wild grains that were… Read more »
Shary
Shary
4 months 13 days ago

Survival mode is an apt description. I think our Paleo ancestors ate whatever they could get their hands on that was remotely edible. When food was abundant, they may have eaten significantly more than we do for the cushion it gave them against times when a meal was hard to come by. No doubt everything was harder then, including just staying alive. Nowadays there’s not much need for an extra layer of fat.

Martin
Martin
4 months 13 days ago
Any new book on the ketogenic diet should not just repeat what Phinney & Volek and others wrote years ago but address specific problems some people have. Two most intriguing ones: 1. I’ve been on a paleo/low-crab diet for 9 years now, and on keto for ~5 years. Everything works, I can skip breakfast and go hiking/climbing/trail running for hours at moderate intensities, I have no sugar cravings But my fasting blood glucose is around 100-110. I was never diabetic or pre-diabetic but apparently I’m getting there. Before going low-carb my fasting BG was in the 80-90 range. 2. Some… Read more »
Lina
Lina
4 months 12 days ago

Yes, he addresses both of those (not Jimmy Moore by name but the question of metabolism).

Martin
Martin
4 months 12 days ago

Thanks, apparently I have not reached that section yet. So far all I’ve read is a very well written summary of what has been known and written down for years, also on this site. Looks more like a beginner’s guide.

David
David
4 months 12 days ago

Martin, Physiological insulin resistance may be why your fasting blood glucose readings are high despite being low carb / keto. Dr. Naiman has a great info graphic explains HOMA-IR as a better metric for measuring insulin resistance for low careers.

Suzanne
Suzanne
4 months 13 days ago

Happy Thanksgiving to all my fellow Canadian groks!

Sarah
Sarah
4 months 13 days ago

don’t forget to add testosterone replacement to get a body like marks

Vince
4 months 12 days ago

That’s fascinating about the differences in food between now and the Paleolithic era. Modern food has had so many more impacts that we ever truly account for.

Renee
Renee
4 months 11 days ago

I have had Tourette’s all my life. The theory is that it is caused by brain inflammation, or P.A.N.D.A.S. A doctor I went to who treats P.A.N.S. and P.A.N.D.A.S. patients had a treatment that addressed any latent brain infections, but it would cost me $19,000 out of my pocket, and there is no guarantee it would work. I have decided, after following marksdailyapple.com to go fully Primal and Keto, as a means to get this under control. More will be revealed!

Phil
Phil
4 months 10 days ago

I would like to know how you get on with that as I am convinced that most neurological issues, not just things like MS and Alzheimers, are affected by the processed foods we eat, and wouldn’t be present if we ate more naturally. Please keep me informed 🙂

Carol
Carol
4 months 11 days ago

After going low-carb (eliminating grains) my lupus immune antibodies fell to zero, and have been zero ever since. All lupus symptoms have disappeared as well. I am a believer. I am now following a low-carb paleo diet. Probably I am in the keto zone, sometimes in ketosis, sometimes not. No hypoglycemic brain fog, no sugar shakes. My weight is now remarkably stable, without even trying.

lisa
lisa
3 months 26 days ago

i have lupus and have gotten the same results!!!! I am on the low carb paleo, but have the occasional beer, wine, pizza on vacation (I do pay for it in inflammation), but I’m pretty good otherwise at home and as long as I dont cheat, i’m symptom free!

rachel
3 months 25 days ago

It was nice to see some research about keto and lupus.
I have both lupis and sarcoidosis and my disease progression for sarcoidosis went off the charts during my year on keto.
I’ve been trying to find some information that might explain it, but sarcoidosis isn’t well researched in the health and wellness Community. I love being in keto, it manages my alopecia, food addictions and depression. But despite a very careful supplement routine I experience an increase in Sarcoidosis symptoms.
I’d love to find out if there’s any information at all about it!

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