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

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!


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.

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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25 thoughts on “Dear Mark: Is Keto Ancestral, Ketone Breath, and Keto for Lupus?”

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  1. 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 out of what and how much to eat while also allowing the body to benefit from the vitamins and minerals of extra plant food part of the time. I see this as being more realistically primal as well as healthier in the long run.

    1. 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.

      1. 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.

        1. 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.

  2. 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 as a long term lifestyle and not a quick fix, that’s pretty realistic too. Eating high fat/low carb (no idea of my actual carb count, etc) for years now, I feel great and it’s very easy to maintain. But that doesn’t mean I don’t enjoy the occasional dessert. Or several glasses of wine. It’s all about balance.

    1. 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.

  3. 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?

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

    2. 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.

    3. Did you adjust your medicaments?
      Sometimes when your body is healing, but you stick to the same dose of medicaments, it can be detrimental.
      I see it in people with Diabetes 2, who try low carb without reducing the medication, and of course, they report hypoglycemia (the meds are working hard to take the glucose from blood, and they are trying a diet with low glucose, so…) Just a thought.

  4. 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 available to them. Being in survival mode would be more descriptive of our ancestors than being in Keto mode is.

    1. 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.

  5. 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 people on a keto diet lose body fat initially but after some time their bodies adjust and start storing fat again E.g. Jimmy Moore. Mark, you talked to him on his podcast and asked about the daily caloric intake, he said 2500 kcal. With his body height and weight he should be in extreme deficit. You suggested going down to 1800 kcal. But why would 2500 be too much, again considering his size?

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

      1. 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.

    2. 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.

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

  7. 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.

  8. 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 to go fully Primal and Keto, as a means to get this under control. More will be revealed!

    1. 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 🙂

  9. 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.

    1. 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!

  10. 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!