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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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June 21 2017

Is Keto for Everyone? Cautions, Caveats, and Contraindications

By Mark Sisson
142 Comments

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

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

If You Have Diabetes

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

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

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

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

If You’re Pregnant

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

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

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

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

If You’re Breastfeeding

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

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

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

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

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

If You Don’t Have a Gall Bladder

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

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

If You Have a History of Kidney Stones

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

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

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

If You’re Still Growing

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

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

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

If You’re Lapsing into a Refined Food Ketogenic Diet

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

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

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

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

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

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

Thanks for reading. Take care.

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142 thoughts on “Is Keto for Everyone? Cautions, Caveats, and Contraindications”

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

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

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

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

        1. Everyone, thanks for your feedback. Commentary on keto and thyroid issues is in the works! It’s a more nuanced picture than I was able to include in this post. Look for more soon….

          1. Great news, Mark! Thing is, very low carb diets can cause reverse T3 levels to skyrocket in susceptible individuals, and once elevated, they are a bitch to bring back to normal levels. Which is bad news as reverse T3 will occupy the T3 receptors in your cells, causing your cellular metabolism to tank.

          2. I am interested in Keto diets and hyperthyroidism as well. Also, is there any affects known on antibody counts? Please include in your discussion when you post on the topic! Thanks Mark!

          3. I’m curious about the antibodies too. I’ve read several reports that ketosis is helpful to those with autoimmune conditions. But there are are a few who disagree.

          4. I have hypothyroidism. I tried to go keto about 6 weeks ago. After 3 weeks I started getting a really achy thyroid, and was feeling very low energy. After some research what I understand is that insulin is required for conversion of T4 to free T3. (someone correct me if I’m wrong). With low carbs you don’t have a lot of insulin. So I have upped my carbs from 50g to 100 g per day and the ache is better. I couldn’t think of a reason to stay keto after this so I don’t think I will mess around. I also don’t have a gall bladder but was having success using digestive enzymes. (an issue here is that if you take enzymes the supplement will likely include protease, amylase, as well as lipase and you don’t want your pancreas to start getting lazy about producing what and when it should). I’m thinking about rotating on and off enzymes.

          5. I second this. I have had thyroid issues for 15 years or more. When I went Keto for 4 weeks, my thyroid symptoms increased, my gut issues got worse, and it caused me secondary amenorrhea. I would be willing to try it again, possibly with more guidance. I am still trying to bounce back from it and this happened back in May!

          6. Mark, I was wondering if you can address (the related to hypothyroidism) anxiety/mood swings and if someone who uses eating to deal with it can benefit from going ketogenic.

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

    3. My husband has been in Ketosis for 2 years, he was diagnosed hypothyroid in 2005 and has suffered and we have all suffered along with his mood swings, nasty salt sweats, sick as a dog even on his synthroid, as soon as he started reading Mark’s daily forum and recording his food intake life went from unimaginably miserable to AWESOME… his numbers at the doctors office are always way messed up and they are constantly wanting to manage his meds, they even says he is diabetic, but they are wrong, the proof is in his amazing strength, his mood, his stamina.. everything about him now is a completely positive change to the person he once was which was sickly and miserable. He has gone from 220lbs to 165. He also fasts daily eating at 8 or 9 am and at 4 or 5 pm only. (just twice daily). I recommend at least trying it because it has changed his whole outlook on life. BUT BE WARNED MOST DR’s WILL NOT APPROVE. His doctors are always telling him he is not on enough synthroid now and they want to raise the dosage, but he gets so shaky and sick when the dr’s mess with his meds. He no longer needs heart burn meds and he is off of his high blood pressure meds too. 🙂 we LOVE Mark.

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

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

    5. I am hypothyroid, on desiccated thyroid, and have had hypoglycemic symptoms for most of my life (I am 74). I also have leukemia and a med I take is known to cause weight gain. I gained a few lbs since going on it last October. Have been low carb-ish for many years. Since going keto less than 2 months ago, I have no symptoms of fuzzy headedness, wanting to bite someone’s head off if I don’t get something to eat every 3 hours, or eating too much at a meal. I have not had my thyroid checked recently, but don’t feel more tired. If anything, I have more energy. I have lost the lbs I gained and am starting to lose more, which I need to do. This is such a blessing, to not be a hostage of food the way I was before. I will never go back.

  2. What if you’re doing a lot of high intensity activity per Robb wolf’s cautions? I seem to do better with more of a carb backloading approach when I’m really active. I’d also be interested in your views on Chris masterjohn’s concerns about low insulin for too long and Paul Jaminet’s concerns about going too low in carbs creating long term immune issues. It would also be good to get your views on how keto one needs to be to get the genetic benefits. Unfortunately a lot of the current keto sources focus on rather unhealthy people or take a rather extreme view so your more balanced mentality will be welcome

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

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

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

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

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

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

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

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

  4. Maybe I’m the exception to the rule but I manage keto fine in spite of not having a gallbladder. I use Ox bile supplement a number of times a week, but only as a mean to increase vitamin and mineral absorption and not due to discomfort.

    I also have Hashimoto and so far so good. Maybe because I do it intermittently and eat safe carbs from time to time. I am due for a blood test and will see if it changed for the worse or better.

    My guess is that Mark is studying the effects of ketosis on hypothyroidism and will update us soon.

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

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

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

    1. I highly recommend the “cholesterolcode” by Dave feldman!

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

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

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

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

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

  10. Would you recommend it for perimenopausal/menopausal women?

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

      1. I am 48 and spent most of my life eating anything I want and tons of it and maintained a “thin” weight. About 3 years ago I started gaining weight (perimenopause) and then did a whole30 (x2) to lose the 20 or so pounds I gained, and now follow the primal way of eating to keep it off. I can tell you that when I add a little too many carbs I am now super sensitive to weight gain-I remember friends telling me I was lucky back in the day because they would just look at food and it would go right to their hips. Well now that I’m perimenopausall, sadly, that’s me. If I eat too little carbs, I feel awful-insomnia, excess thirst, too many I gain weight quick-the key is that there is a VERY sensitive middle ground that I will have to stay at now. I think that’s the key to menopause-finding that specific small range of carb intake, with attention to sleep, stress and exercise. Wish I would have appreciated my metabolism more back in the day.

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

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

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

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

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

  11. I am prediabetic, hgA1c of 5.7, morning fasting blood sugars anywhere from 100 to 120. I have tried ketogenic diets twice for a month each….doing this one
    https://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/

    i was weighing food, tracking macros, peeing on keto sticks and checking my blood sugars several times a day, and taking carnitine plus multivitamin.

    I am a 60 year post menopausal women with hashimotos. I found keto diet did NOT work for me. I felt terrible, barely, rarely got into ketosis and my blood sugars got significantly worse! I stopped the experiment the morning my fasting blood sugar was 135. WIthin a week after gong back to a much lower fat, higher carb (still lower than average: 150 grams per day) by numbers went back to normal for me.

    I think people vary in their ability to handle fat and to switch over into fat burning. My ancestry is slavic and irish, I seem to be more suited for carbs. Also, my waking and mid mornign cortisol levels (measured by DUTCH testing) are double what they should be…..which likely explains my elevated blood sugars (all my postprandials are normal). I am beginning to think years of working out in a fasted state and intermittent fasting has stressed my adrenals unduly.

    would love to hear more about how older folks can create T2DM from this elevated cortisol in mornings, exacerabated by fasting exercise.

    Different strokes for different folks.

    1. I can’t have 1/2 1/2 in my coffee once a day or eat very modest amounts of meat or oil or my blood sugars start climbing. My inflammation goes up too but my A1C lowers a little on higher animal protein/ low carb. Three yrs. retired from stressful job with higher AM FBS goes up to 110 or 115 when I try to eat like regular folks. Beans ,pasta and greens with a few nuts and fruit keep me around 100 in AM – Also female 70 yr. and 65% Irish – Maybe I have one APoE4 gene – 23 and me gave data on only one copy so I have APoE3/ APo? I can’t understand how anybody trending towards DM2 would get better on a lot of fat either.

      I always eat a little before I exercise, otherwise my blood sugar goes up (probably caused by elevated cortisol)

    2. My situation is similar…lchf for 8 months lost weight. felt great.
      Had some lab work done…fbs went from 83 pre lchf, to 98. Insulin, was 6.3, now 8. hga1c was 5.3, now 5.6. I cried all day after I got those results.
      I have insomnia issues for years, waking at 2-4 am..I have not tested but feel my cortisol is the culprit. Also, Mercola says to cycle in and out of low/high carbs twice a week as being in low carb too long will increase bs and insulin.
      Chris Kessler states he has many clients that have bs and insulin increase with hflc…..
      Using seriphos and gaba for sleep issues and will retest in 4 months.
      I am 63, 114 lbs.
      Its a journey.

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

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

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

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

  13. Hi Mark,

    I’ve been doing KETO for over two years. Was Paleo/Primal. Lost my last 20 in four months and have maintained it for two years. My secret? I log my food choices daily (I like Fitday.com), I calculate my macros. My maintenance macs are a bit higher in fat now that I’m maintaining and if I’m having a busy day I may up my protein a bit but my carbs stick around 30 – that’s my sweet spot. I’m still a Paleo girl in that I don’t do dairy or any grains – okay raw aged Vermont cheddar shaved in my salad once every two months because duh, I live here but that’s it for dairy (Kelly Gold unsalted butter is not dairy to me LOL) – My fats are butter, olive oil and coconut milk (I don’t buy into to MCT oil, sorry…:)) Anyway – good luck with your book and as we say: KETO ON…:) Martina’s FB site is a great source – check it out: https://www.facebook.com/groups/Ketodietplan/

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

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

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

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

    1. Laurie and English Girl,

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

      YMMV!

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

        Laurie

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

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

        Laurie

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

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

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

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

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

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

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

  18. You say, “If you or your family has a history of kidney stones, include some potassium citrate in your ketogenic diet. A great source is lemon juice.”
    .
    Eh, no. The amount of potassium citrate that has been found effective in the prevention of kidney stones is rather high. The very study you are referencing used 2 mEq/kg per day in children – that’s 40 mEq for a 20kg (44lb) child. Adult studies usually quote 60-80 mEq of potassium citrate per day, typically administered in 3 divided doses. For reference, 10 mEq of potassium citrate equals 1080 milligrams, so in order to take 60 mEq, you’d need to ingest nearly 6.5 GRAMS (almost a quarter of an ounce) of pure potassium citrate every day. There’s no way you can drink the amount of lemon juice required to meet these requirements. (Plus, the ACTUAL amount of potassium citrate an individual needs to avoid kidney stone recurrence can only be determined by way of careful monitoring of urine pH and supersaturation – and you’ll need a good nephrologist for that.)
    .
    Last but not least, solid potassium salt preparations/supplements can have some pretty serious side effects such as gastrointestinal ulceration or bowel obstruction. The majority of people will never experience any of these, but if you are unlucky, you may end up being one of the few who do.

  19. After 3 years of partial ketosis (3-4 days/wk, according to Ketostix) I have developed hypothyroidism. I didn’t need to lose weight, just went on HFLC diet—about 70% fat, 15% carb, and 15% protein for health and longevity, to get off sweets roller-coaster, and to avoid going back into metabolic syndrome. Interestingly, I eat twice as many calories as cronometer would suggest for my age/activity level and have to add a bite of coconut oil occasionally to keep from losing too much weight! I’m just wondering whether increasing net carbs from my usual 30-60/day would be beneficial or if using no iodized sodium for 3 years has caused it. I used only himalayan pink salt the first 2 yrs, and mix ½ himalayan and ½ celtic sea salt for the past year. I also have eaten ¼-1/2# of raw cabbage/day in my salad but have recently begun microwaving it 1-2 min with coconut oil before adding spinach, etc. I take kelp now—any other ideas on where to start treating hypothyroidism or what to ask my Dr. to check?

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

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

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

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

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

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

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

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

  25. I’m back on keto right now as well.

    I honestly forgot how good it feels. Body is leaner and more efficient. Clarity of mind is crazy.

    I also don’t buy that ketosis stunts growth in developing children. The body is not stupid (well…. okay for the most part). That doesn’t make sense from an evolutionary perspective. Maybe long term it could be detrimental? For many years with no cycling?

    Really, seeing all the “studies” that show cons to ketosis, and then reading the ones that show benefits or no downsides makes me realize how much we, even researchers and scientists, have no real clue what’s going on inside our bodies. It’s all educated guesswork….. which is funny when you think about it. We think we’re so much more advanced and knowledgeable that people hundreds of years ago. Which we are. To a tiny extent. But it the grand scheme of things we know NOTHING.

    I am super interested in your thoughts on thyroid hormones and keto, though.

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

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

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

      2. Maxine,
        I agree completely. Modern diets are the reason why people don’t do well in ketosis —too many years of habitually eating a *high* carb diet have screwed up the baseline metabolism we were born with from millions of years evolution. From an ancestral perspective, we’ve been fatty meat eaters for 3.3 million years, with very little carbs. Our meal focus was on making a kill and then feasting for several days, followed by several days of fasting (during which we were in ketosis). Along the coast, we gathered mussels, oysters, clams, but we were not out picking spinach, broccoli, kale, peaches, avocados and pears. Modern diets are what cause all these thyroid, t2d, and migraine problems.

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

  26. I’ve also done some reading on keto and have read there aren’t enough studies done on women and because of our more ‘complicated’ hormonal system, it can actually be detrimental. Anyone heard the same thing? There was supposedly a specific study on women done and it wasn’t favorable but they also admitted there needs to be more specific ‘women’s keto’ studies done. It’s been a few months and I don’t remember where I read it. I’ve tried the keto thing and haven’t really noticed anything out of the ordinary in how I feel.
    On another note, we just watched “what the health” movie. Pretty compelling evidence for veganism. Is it really true inflammatory markers are elevated immediately when eating meat, even if it is pasture raised, local etc.? Have been advocate of Paleo for a few years. Know some of the movie was slanted, but was just curious because they seemed to also have some pretty compelling studies to back up what they were saying. Thoughts that are based on evidence? I know larger amounts of meat don’t always agree with me and I always feel much better on lots of veggies. So many opinions.

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

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

  28. I’m now on my second attempt to get into ketosis after the first one was scuppered by a week long visit with the in-laws – relatives who can’t even get their heads around the Primal thing, let alone a ketogenic diet.

    Anyway, having been Primal for three years now, keeping the carbs down has been easy. One thing I’m struggling with though is consuming enough fat. I’m tracking my daily food intake on Cronometer and always fall way short of my daily fat intake targets, even though fat is making up 70-80% of my diet.

    It’s proving very difficult to get enough fat, whilst still eating “real” food and staying within the limits for carbs and protein. I don’t particularly want to be guzzling down spoonfuls of oil just to get my daily allowance. That’s not much fun and seems like it shouldn’t be necessary.

    (As a side note, I also realised I was eating waaaayyyy too much protein. Cutting that back has also been a huge adjustment because, well, I love meat and fish).

    Any tips on this from anyone would be greatly appreciated.

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

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

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

  30. I’ve been ketogenic for a year and a half now. I do this for my chronic migraines. I have controlled the migraines. However, I guess I pushed too hard on keto and fasting and my thyroid, which got better in the beginning, is really bad now. I know I undereat, but this was my pattern before, I was low caloric for most of my life. This in addition to a lot of stress with diseases and difficulty situations in the family lead to a loss of a lot of muscle and weight gain, which I had never experienced before. I don’t blame ketogenic diet for that, I know it is a great diet and I believe it is the solution for my problems. I just think I shouldn’t have pushed so hard and restricting so much. I am seeing a endocrinologist now that is helping me with my hormone problems (testosterone and thyroid) and I am already seeing visual results, not in weight for now. I hope you talk more about thyroid and how other hormones can play a roll even in ketosis.

  31. I’ve been eating Primal for nine months. I used to be a letter carrier and although overweight, I had muscle mass. I’ve lost about 20 pounds since starting last Sept, however, I have lost muscle mass. I am 61 years old, soon to be 62 in 2 months. It’s a concern of mine, as I eat from about 11 am until 7:30 pm (window eating). I’m thinking that I should either step up my weight lifting or curtail window eating or add in more carbs. I don’t need to lose more weight. I don’t want to gain either, so I’m concerned about implementing more carbs. Any suggestions would be greatly appreciated.
    Thanks.

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

      1. Thanks Shary. I eat protein for lunch and dinner. I do believe you’re correct though, as I don’t eat a lot period. I don’t get too hungry anymore. Maybe 3-6 oz of protein in the early afternoon and 6 oz in the evening.meal. I eat nuts and seeds for snacks, but only a serving. I do eat eggs, aged cheese. I’d say after giving up grains and any processed foods, my appetite is very small. But, I’m not tired or lethargic at all. I eat a lot of healthy fats as well. I really feel great, but once I start eating, I do get full pretty quickly, but still eat what I’ve put on my plate. I can’t attribute it all to my age as I’ve only retired a year ago and I had muscle mass. I appreciate your suggestions.

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

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

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

    1. From the abstract:

      “The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results…”

      The whole article is worth your time:

      http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext

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

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

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

  35. I have been eating primally 80/20 for 4.5 years. In January 2017, my husband and I started a Ketogenic diet. He has lost 35 lbs. and several inches and feels stronger and more energetic. I have lost nothing and my energy and strength have not changed. I have asked questions on a ketogenic forum but nothing has worked. I have seriously been wondering if I should go “back” to the primal blueprint way of eating. I live primally as a general rule, and love eating this way and will never go back to conventional wisdom ANYTHING.

    This blog post is supporting my consideration of switching back to Primal, since my gallbladder was removed several years ago. I was also diagnosed with SLE years ago. I’ve been seriously wondering if perhaps my body is working so hard to keep itself in balance that weight loss is it’s very last concern. None of my doctors have answers for me as to why the weight hasn’t moved. I also am striving for more energy, strength, stamina and general well being.

    I am a 54 year old woman, and follow the Primal Blueprint Fitness program. Generally, I live Primally as much as possible, including playing, using my mind, avoiding toxins and poisonous things, eating Primally, getting enough sleep, etc. I have considered becoming a Primal Health Coach, but cannot do so until I get positive results that I can share with others. I can’t sell something that hasn’t worked for me. True, there are a few things that are better in my life as a result of Primal living, but until it’s obvious and truly works, I can’t do it.

    Anyway, that’s my experience doing Keto for 6 months. Any advice or suggestions would be most helpful.

    1. I too, have SLE, with kidney involvement (32% function) and low thyroid. I am trying to eat keto, to help with belly fat and to feel better. I am a 53 year old women, SLE since I was 14. I have been on varying amounts of prednisone, since I was diagnosed. My workouts have gone downhill, since cutting out carbs, as bread, rice, pasta, and potatoes. Am weak, legs feel like lead weights, making it hard to take walks. Memory has also declined. I’m having trouble keeping my protein intake low, while eating keto. My nephrologist told me to eat 25-30 grams of protein. Not much left to eat other than fat and vegetables. I may have a rash on my back, since I cut my carbs. I read something about it being a side effect of low carb eating, but I’m over 60 grams.

      1. It sounds like you are dealing with a lot. Have you tried a different medication, such as Plaquenil? I have been on that for a few years, and it has been a lifesaver.

        If you follow the Primal blueprint, you are not required to cut your carbs as drastically as with keto. Keto suggests less than 20/day. Primal says less than 50/day and you are in ketosis. That could possibly make your life/energy/symptoms better. You can also eat between 50-100/day and still gain many health benefits (perhaps more in your situation), and still lose a pound or two a week if you need to. If you don’t need to lose any more weight, you can eat as much as 150/day. He has created a nice little chart outlining that. You can find it on his blog.

        Good luck. I hope you find a sweet spot for your issues. Being sick is not fun. We are too young to be this debilitated. I hope something works out for you. It certainly can’t hurt to try something different.

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

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

    1. After 4 weeks you are not fully keto-adapted yet, meaning you don’t have the full metabolic machinery to take advantage of the ketones that your body is making. You have ketones, but you are not using them properly yet. Coupled with the low carbohydrate intake and water release from glycogen stores, you don’t feel all that good right now. But it will get better from here! I would give at least another 4 weeks, and you should see your energy and feeling of well-being return. Make sure you eat enough unrefined salt. Consider supplementing with potassium if you are not already doing this. Increasing your carbohydrates would delay (or at the worst prevent) keto-adaptation. You are soo close!

  37. Mark, lung diseases (including COPD) are seeing improvement from Keto and Paleo. diets. Nobody seems to mention them – nobody seems to research them. I am living proof – Stage 4, 20% lung function off ALL meds except 1 inhaler and doing better than I have for many years. I am not an athlete BUT I know someone who IS an athlete Stage 4 COPD and he runs marathons ( just completed London) and he is Keto. I really wish somebody would research keto and lung disease…. it could be a life saver for millions and millions of people and their families.

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

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

  39. Hey Mark.

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

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

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

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

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

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

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

  41. So, I still have a gall bladder but I was told after experiencing pain from it and undergoing a couple of scans, that I have a “lazy” gall bladder. I think the number they gave me which evaluates how efficient it is at doing its job is under 20%. It was recommended that I have it removed. I dragged my feet and still haven’t done so. What I find is that if I’m eating in line with MDA and the Primal Blueprint, I almost never have pain from it. When I fall back on eating pizza, ice cream, and drive through dinners as a regular part of my diet, it comes back.

    So the question is: Does using ketosis (and paleo/primal eating generally – higher fat, lower carbs) affect, improve, or worsen gall bladder function? Anyone have experience with that?

    1. My gallbladder was removed almost 30 years ago. It was an acute attack (while I was pregnant with my first child, no less), and it was removed in my second trimester. I still remember the incredible pain and agony it caused (worse than childbirth in my opinion).

      Anyway, I have not had any negative effects of having it removed that I can tell. I have been eating Primally for almost 5 years and have not had any negative experience on account of it. I switched to Keto in January of 2017, and for the first few weeks I had a lot of uncomfortable bloating. I asked advice on a keto forum about it and was told it could be a number of things I was eating. When I eliminated them from my diet, nothing changed. I eventually adjusted some of the medications and supplements I was taking, and the bloating is now gone. So, I do not think the bloating issues was on account of having no gallbladder.

      When I had it removed, I was told by my surgeon that by removing the gallbladder, I would be able to eat anything I wanted to without problems. By keeping it, I would have to restrict my fat intake and have a stricter diet. Since it was an acute attack during my pregnancy, I really had no choice but to remove it, but I have not had any serious or obvious dietary issues since.

      I love eating Primally and will never go back to SAD. When I have “cheated” and had something from the SAD diet, I typically get bloated and gassy and feel more lethargic, so I don’t do that very often. I am very content with my lifestyle and feel better than I did when I was younger. I just keep feeling better and better.

      I am at a point where I am focusing more on the Primal Blueprint than keto. I still eat keto meals, but am focusing on incorporating more nutrient dense foods, moderate protein and fat. And I definitely follow the Primal Blueprint Fitness program and overall lifestyle. It’s the perfect solution for me. I fight Systemic Lupus as well, and I believe that if I didn’t live this way, I would digress, possibly quite quickly. It’s a very empowering and enjoyable lifestyle and I am so grateful that I found it and that Mark Sisson is so willing to spend so much time and effort sharing it with the world.

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

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

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

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

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

    Sounds tasty, and healthy to me

  46. My doctor recommended a keto eating plan to me this past year due to health problems I’ve had related to chronic Lyme disease. I seriously love eating this way and do it along with frequent intermittent fasting.

    My hunger pangs are gone and I’m better able to concentrate…Of course it’s hard to know if that’s from the IF or the keto but I’m encouraged and will continue.

    Thanks for another great article, Mark!

  47. I don’t get the whole hullabaloo about keto. Great for you once in awhile like our ancestors when they couldn’t find enough food. Why not just fast for 2-3 days a couple, to a few times a year? Especially if you are already a fat burner like most Primal folks are! Seems like a lot of folks on here are burning out their thyroids and messing up other bodily systems. And why are folks doing this if they don’t even know how to do it correctly. I mean really, are there women out there doing this while pregnant? Crazy!

  48. My problem with keto diets is hypo-brownie-ism. Dang, they look good. The other problem is when I convince myself that beer has no carbs.

  49. Hi Mark, love your posts, Over the last few year I have really improved my diet (less sugar, less wheat)the main thing I have noticed is that my immune system is really on top of things. I cannot remember the last cold I had. I am a long way from starting a ketogenic diet but I am giving it plenty of thought. Cheers Pete

  50. Best thing I’ve ever done is go keto. This, on the heels of following your Primal Blueprint for years. I am lean, no brain fog, look literally years and years younger than I am and am multo healthy. BUT, when I don’t eat real food, fat loss sticks (or weight even goes up!!!) and I feel like crap. Heavy into weights and HIIT a couple times a week. I will never eat any other way.

  51. Hi Mark, what about with adrenal fatigue? I have read yeas and no!

  52. Would digestive enzymes and/ or other supplements make a keto diet safer and more effective for individuals that have had their gallbladder removed?

    1. I hear you Tonya. I don’t have a gall bladder and it’s very difficult getting any good information re what to eat, high fat or low fat. A friend with her gall bladder removed does very little fat on recommendation from her doctor and is doing well with her eating plan and my doctor said eat what I like including fat. I haven’t had any problems so far eating LCHF and lost about 20kg and although I’m not skinny I’m not fat either.
      What to do when you want to try keto?
      I think I will try an n=1 experiment on myself with digestive enzymes and see if there is any difference as I do worry about high fat eating with no gall bladder and the possible strain on the liver to produce enough bile over the long term, like over 2+ years without a gall bladder.
      Would one have to supplement for the rest of one’s life?
      You would think there would be more info around when thousands of people each year have their gall bladder removed.

      1. I just wrote a reply about my experience having no gallbladder for almost 30 years with no negative consequences. I’ve been eating Primally for almost 5 years and keto for 6 months. Although I was bloated for about 7 weeks at the first of keto, it has subsided without a change in diet, so I don’t believe it’s on account of having no gallbladder.

        My doctors/surgeon informed me that by removing my gallbladder, I would be free to eat whatever I liked, but to keep it, I would be forced to restrict fat and have to incorporate other dietary restrictions. My circumstance didn’t give me choice, so the gallbladder had to go in order to save both my baby’s and my life, and I’ve suffered no ill effects as a result.

        I’ve eaten what I want to (basically conventional wisdom, the SAD diet), for many years, with no problems. And I do feel better eating Primally. Just my 2 cents.

  53. Mark, thanks for the info on not having a gallbladder. I have several issues, including no gall bladder, hashimoto’s thyroiditis, MS and celiac disease. I just read grain brain and, though I have been gluten free since 2005, I do love my GF snacks and green smoothies with fruit. I’m about to start a Keto diet and will keep an eye towards the MCT oils. I have been using Cholacol by Standard Process to help with digesting fats and it seems to work for me. I also just read your article on leptin from several years ago and I guess I need to skip the fructose laden fruit from now. I really appreciate your thoughtful and thorough articles.

  54. In addition to the concerns about keto if you’re hypothyroid (which I am) what about if you have a candida overgrowth problem? I recently got back some blood work and all three candida antibody markers were high (IgG, IgA, IgM). I read on Chris Kresser’s website that keto could be problematic in these cases because the candida can feed on ketones. What are your thoughts?

  55. I’m always curious how diets affect women as most of the research seems to be done on men. Is there any research on keto diets and women specifically?

  56. I don’t have my gall bladder and have been on ketosis for a month now. I haven’t noticed any changes for me. I eat butter,cheese, MCT oil, bacon, fish everything and I feel great and don’t seem to have any issues