The Definitive Guide to Keto

ketogenic diet, 3D rendering, text on metalI use my Los Angeles surroundings as a barometer for changes in the mainstream approach to health, and it holds up quite well. Silicon Valley can claim to be the cradle of technology, but L.A. is definitely the cradle of diet and fitness trends; and the latest is most definitely keto. At the local cafe where every species of Malibu fitness enthusiast gathers to gossip and fuel up, I’m seeing fewer gels and energy bars, and way more butter coffees and discarded packets of the new powdered ketone supplement products.

Sure enough, keto is entering into mainstream health consciousness everywhere. Google searches for “ketogenic diet” are at an all-time high. The stream of keto-related email queries and comments I receive has seen a major uptick. And early this year, a major publisher approached me with a keto book proposal, which I accepted. I dove headlong into a total Small_Keto Reset Diet by Mark Sissonimmersion/participatory journalism experience where I walked my talk, and pricked my finger for blood tests enough times to get a little scar tissue going, for the past several months. The book is called The Keto Reset Diet and it’s coming out October 3rd. This is a comprehensive presentation to educate you on the science and benefits of ketone burning and to give you step-by-step guidance to go keto the right away, avoiding the common setbacks that happen when many adopt an ill-advised approach to something as delicate and rigorous as nutritional ketosis. You can pre-order a copy from major retailers right now. We are also filming a comprehensive online multimedia educational course to give you a guided immersion experience that will be available in 2018.

Meanwhile, it’s definitely time to do a Definitive Guide….

To understand ketogenic diets, you must understand the conditions that promote ketosis. And to do that, you must understand how our bodies beta-oxidize fatty acids for energy.

  1. Fatty acids are broken down into acetyl-CoA.
  2. Acetyl-CoA combines with oxaloacetate.
  3. The acetyl-CoA/oxaloacetate duo starts the Krebs cycle.
  4. The Krebs cycle produces ATP, the body’s energy currency.
  5. Congratulations. You’ve just turned fat into energy.

Where Does Ketosis Come In?

If the supply of acetyl-CoA exceeds the supply of oxaloacetate, the liver converts any excess acetyl-CoA into ketone bodies. These ketone bodies are an “alternative” energy source for the brain and body. 

Both carbohydrates and protein provide oxaloacetate to the liver, so both carbohydrates and protein can prevent ketone production or knock you out of ketosis. Carbohydrates also elevate insulin, which blocks the release of body fat and reduces the amount of fatty acids making their way to the liver for conversion into ketones. A ketogenic diet, then, is one that limits carbohydrate and, to a lesser extent, protein.

Ketosis occurs in certain instances without any dietary change at all:

  • Extreme physical exertion that depletes liver glycogen (total around 100 grams) and depletes around half of stored muscle glycogen (total around 400-500 grams)
  • Fasting for significant time period (at least 24 hours for most people)
  • Starvation or significant restriction in total calories for a signification time period

In all of these conditions, there’s a common ketogenic thread: liberation of body fat in excess of that which we can beta-oxidize. Any fat that isn’t beta-oxidized for energy will convert to ketones.

In one sense, ketosis is a stop-gap solution for situations where you’re burning huge amounts of body fat, like during a famine. Why would I want to mimic abject starvation if there’s all this food around?

Grocery stores are an evolutionary aberration. The constant drip of glucose into our blood is a modern luxury. For most of human history, if we wanted carbs, we had to climb a tree and extricate a bee’s nest, spend hours digging tubers, or wait around for the wild fruit to ripen. We are adapted to periods of low food availability, and, especially, low glucose availability.

Plus, humans are remarkably good at slipping into ketosis. Whereas for most other animals ketosis is difficult to achieve, a human will be mildly ketotic just waking up from a full night’s sleep. Heck, breastfed babies spend much of their time in ketosis despite drinking nutritionally balanced breastmilk. We’re clearly meant to produce and utilize ketones from time to time, and it’s safe to assume that mimicking this ancestral milieu provides adaptive benefits.

Let’s go over some of the major ones.

Adaptive Benefits of Ketosis

Treatment for Major Disease States

The ketogenic diet first emerged as a tool for clinicians to treat their patients with epilepsy. It was—and remains—the only thing with the consistent ability to prevent seizures. Whether it’s Thai kids with intractable epilepsyScandinavian kids with therapy-resistant epilepsy, or adults with refractory epilepsy, ketogenic diets just work.

Ketosis improves epilepsy via several mechanisms.

It increases conversion of glutamate into glutamine into GABA, reducing neuronal excitability.

It increases antioxidant status in the neuronal mitochondria, improving their function.

It reduces free radical formation in neurons, a likely cause of seizures.

These effects on neuronal function and health, along with the ability of aging or degenerating brains to accept and utilize ketone bodies, also have implications for other brain conditions, like Parkinson’sAlzheimer’sbipolar disorder, and many psychiatric disorders.

Ketogenic diets aren’t just beneficial for brain disorders, though.

A Spanish ketogenic diet (keto with wine, basically) cured people of the metabolic syndrome and improved health markers of non-alcoholic fatty liver disease. Over 92% of subjects improved their liver health; 21% resolved it entirely.

In cancer patients, a keto diet preserves lean mass and causes fat loss. Many researchers are exploring the use of ketogenic diets in preventing and treating cancer, although results are very preliminary.

Cognitive Function

Since ketosis can help with major brain disorders, many have wondered whether it can improve cognitive function in otherwise healthy people. Unfortunately, researchers haven’t studied the nootropic effects of ketogenic diets in healthy people—yet. They have looked at people with “milder” cognitive deficits, though, finding some promising effects.

In mild cognitive decline, a ketogenic diet improves memory.

In type 1 diabetics who experience reduced cognitive function when their blood sugar is low, increasing ketone production via medium chain triglycerides (found in coconut oilrestores it.

In adults with bad memory, adding ketones improves cognition. The higher the serum ketones, the better the scores.

In older adults, a very low-carb diet improves memory. Again, higher ketones predicts bigger improvements.

Anecdotes abound of people with intact cognitive function going on ketogenic diets and experiencing huge benefits to their mental performance. I’ve been experimenting with more protracted ketosis for some time now, and I can add my hat to the pile. What could be going on?

It may clear up brain fog, that enemy of clear thinking, by clearing ammonia from the brain and upregulating conversion of glutamate into GABA.

It definitely increases brain energy production by increasing mitochondrial biogenesis in the brain. More mitochondria, more energy production.

It tends to produce a sense of euphoria. If you can parlay that into productivity instead of getting caught up in the sensation, your mental output will increase. A cup of strong coffee helps here.

Physical Performance

Being keto-adapted has several advantages for anyone interested in physical performance.

It increases energy efficiency. At any given intensity, a keto-adapted athlete burns more fat and less glycogen than a sugar-burning athlete. Long-term elite keto athletes can burn up to 2.3 times more fat at peak oxidation and 59% more fat overall than non-keto athletes, and they do it at higher intensities. They remain in the predominantly fat-burning zone at 70% of VO2max, whereas non-keto athletes switch over from predominantly fat burning to a spike in sugar-burning at 54.9% VO2max.

It spares glycogen. Glycogen is high-octane fuel for intense efforts. We store it in the muscles and liver, but only about 2400 calories-worth—enough for a couple hours of intense activity at most. Once it’s gone, we have to carb up to replenish it. Keto-adaptation allows us to do more work using fat and ketones for fuel, thereby saving glycogen for when we really need it. Since even the leanest among us carry tens of thousands of calories of body fat, our energy stores become virtually limitless on a ketogenic diet.

It builds mitochondria. Mitochondria are the power plants of our cells, transforming incoming nutrients into ATP. The more mitochondria we have, the more energy we can utilize and extract from the food we eat—and the more performance we can wring out of our bodies. Ketosis places new demands on our mitochondria, who adapt to the new energy environment by increasing in number.

Fat Loss

Although keto is not a classical weight loss diet, it can certainly help a person lose body fat. After all, to generate ketones without eating ketogenic precursors, you have to liberate stored body fat.

But that’s not the main mechanism for ketogenic fat loss. Ketosis isn’t “magic”—it doesn’t melt body fat away. Instead, it works for many of the same reasons a standard low-carb Primal way of eating works: by reducing insulin, increasing mobilization of stored body fat, and decreasing appetite.

Ketosis suppressing appetite may be the most important feature. The overriding drive to eat more food is the biggest impediment to weight loss, and it’s the reason why most diets fail. When people attempt to eat less food despite wanting more, they butt up against their own physiology. Few win that battle.

Ketogenic dieting avoids this issue altogether, suppressing the increase in hunger hormones that normally occurs after weight loss.

Ketogenic diets are especially effective for massive weight loss. If you have a ton of weight to lose, aiming for ketosis could help you lose body fat. Again, not because of any inherent fat-burning quality of the ketones, but because in order to make ketones you must liberate stored body fat.

Many diets work in the short-term and fail in the long run. Weight loss isn’t worth anything if you can’t keep it off. Ketogenic diets appear to be good for long-term maintenance of weight loss, at least compared to low-fat diets.

How to Do It Right

I’ll have more details in The Keto Reset Diet book, but there are right ways and wrong ways to do keto. What’s wrong or right is contextual, of course. It depends on several factors.

If you’re part of a small group that uses keto to keep seizures at bay, or treat serious neurological diseases, you’ll want to diligently maintain high blood ketone levels. That means sticking to very-low-carb (5-10% of calories) and low/moderate protein (10-15% of calories). But even then, modified ketogenic diets with slightly higher carbs and relaxed protein intakes are also effective against epilepsy.

If you’re doing keto for general health or weight loss, you can handle more protein and still remain in ketosis. Protein will help stave off the muscle loss, and, because calories are reduced, you can handle a bit more protein without interfering with ketosis. An older ketogenic diet study in obese subjects shows that 50% protein diets are highly ketogenic as long as calories are kept low. And in another study, subjects eating a weight-maintaining ketogenic diet ate up to 129 grams of protein without leaving ketosis (129 grams is fairly high).

If you’re trying to lose weight, artificially boosting ketones won’t accelerate the process. Higher ketones do not enhance fat loss, but they may indicate it’s taking place.

How to Make Keto Work

Ketogenic dieting is a big jump for some people. You’re literally switching over to a new metabolic substrate. That can take some getting used to. Make sure you are well-prepared with a Primal-aligned eating pattern in place for ideally several months before you ponder a journey into nutritional ketosis.

Make a minimum commitment to six weeks of nutritional ketosis. The first three weeks will be the most difficult as you transition to new fuel sources, but then you can expect breakthroughs. Some serious athletes may experience a temporary performance dip in the early weeks, but then will come back strong after 4 weeks and beyond. Once you get to the six-week mark, the metabolic machinery is in place, and it’s hard to reverse the adaptation. Extra mitochondria don’t just disappear.

Get plenty of electrolytes. You’ll want lots of sodium, magnesium, and potassium. Try 4.5 grams sodium (about 2 teaspoons of fine salt or a little under 3 teaspoons of kosher salt), 300-400 mg magnesium, and 1-2 grams of potassium each day on top of your normal food. Going keto really flushes out water weight, and tons of electrolytes leave with it.

Eat fat, but don’t be crazy about it. Just because a ketogenic diet is a high-fat diet doesn’t mean you should eat ungodly amounts of fat. Being ketogenic is more about not eating carbohydrates than it is eating as much fat as you possibly can.

Eating extra fat in the first 4-7 days can accelerate keto-adaptation by increasing AMPK signaling. Dial it down after.

Lift heavy things. A common criticism of ketogenic diets is that they cause loss of lean mass. This isn’t totally unfounded. If your ketogenic diet reduces appetite so much that you undereat, you might lose muscle. If you’re on a super-low-protein ketogenic diet, you might lose muscle. Lifting weights prevents these issues by sending an anabolic signal to your muscles and allowing the consumption of more protein without hampering ketosis. 

Do lots of low level aerobic activity. Walk, hike, jog, cycle, row. Keep things in the aerobic HR zone (under 180 minus age in heart beats per minute), and you’ll increase your utilization of body fat, which will speed up ketone production and adaptation.

Eat vegetables. The vast majority of vegetables are keto-friendly. Not only do they provide important micronutrients and phytonutrients, they provide negligible amounts of carbohydrates.

Eat berries. Raspberries, blackberries, strawberries, and blueberries are all quite low in glycemic load and extremely high in phytonutrients. While eating a flat of strawberries isn’t very ketogenic, a large bowlful won’t knock you out.

Eat fiber. Many people on ketogenic diets tend to ignore or malign fiber. That’s a mistake. First, fiber doesn’t digest into glucose. It doesn’t “count.” Second, fiber feeds your gut biome, providing fermentable substrate for your gut bacteria to turn into beneficial short chain fatty acids and to provide support to your immune system.

How to Know if You’re Ketogenic

You can test your blood, urine, or breath ketones. There are drawbacks to each, and unless you have a medical condition necessitating a specific level of ketones, obsessive testing may be unnecessary/unwise/expensive. Forget the inexpensive urine strips, as they measure only what you excrete, not what you are making and burning.

Once you’re keto-adapted and naturally good at burning fat, the ketone measuring devices might not put up impressive numbers. That’s because, after weeks in ketosis, you have built enough metabolic machinery in your muscles that they run extremely well on free fatty acids and don’t require much additional fuel from glucose or ketones. You’re still making ketones, since your brain can’t run on fatty acids and needs them to offset the glucose that isn’t coming, but your muscles no longer require them. Many people who have been in long term ketosis can get by quite nicely on 20-30 net grams of carbs a day and might only show .4 or .7 millimolar ketones on a blood test, but they have plenty of energy from burning free fatty acids and maintain muscle mass on relatively fewer calories than when they were dependent on carbs. Few people understand this, but it’s a major benefit of keto-adaptation. You might even say that ketogenic diets are ultimately about becoming free fatty acid-adapted.

Instead of objective numbers, I prefer to go by symptoms and signs. Since you’re trying to divine what works best for you, relying on the subjective signs and symptoms you experience is perfectly legitimate. These include:

Reduced urge to snack: Being ketone-adapted means you’re less reliant on outside calories.

Steady energy: When I’m feeling full of relaxed energy, calm but not sleepy, I know I’m in ketosis.

You may have heard talk about the dreaded ketone breath, caused by the presence of the metabolite acetone (the breakdown product of the ketone bodies acetoacetate and beta-hydroxybutyrate). A sweet and fruity odor to your exhalations is a reliable indicator that you are in a state of ketosis, but it’s also a likely indicator that you are not yet super efficient at burning ketones. Don’t worry, that will come in short order.

So, are carbs out forever? What if you want to incorporate carbs for high intensity performance while maintaining the benefits of ketosis?

First of all, it may not make much of a difference if you’re just strength training. A series of recent studies looked at the effects of introducing carbs into a ketogenic diet in resistance trained adults, finding little to no benefit.

Carbs likely will help certain populations, namely CrossFitters, sprinters, and anyone else engaged in intense glycolytic work. But even then, being keto-adapted reduces the amount of glycogen you’ll use for a given intensity —so err on the side of fewer carbs and eat only as many as you actually earn.

There are two basic ways to construct a ketogenic diet that includes carbs: with one big weekly carb load (the classic CKD) or multiple smaller carb loads adjacent to training sessions (often called the targeted ketogenic diet, or TKD).

On a CKD, you spend the majority of the week and your workouts in ketosis and devote a day or a pair of days to eat lots of carbs. You might be ketogenic Monday through Friday, exercising all the while and capping the work week off with a really intense glycogen-depleting training session, then go high-carb, low-fat Saturday through Sunday to refill your depleted and newly-insulin sensitive muscle glycogen stores.

On a TKD, you spend the majority of your time in ketosis but selectively eat carbohydrate before, during, and/or after your workouts. Most people seem to benefit most from pre- and peri-workout carbs. These aren’t large carb loads — 15-30 grams of relatively fast-absorbing, simple carbs. If you don’t want to opt for dextrose or other powders, a baked potato works well.

Whatever option you choose, you’ll need to deplete glycogen if you want to include carbs in a ketogenic diet. As long as you have a glycogen debt, any carbs you eat will go toward restoring those glycogen stores and won’t interfere with ketone production.

Final Thoughts…

Also: Ketosis doesn’t have to be for life.

Going ketogenic can be refreshing. You’re not hungry like before. You’re euphoric. You have steady, even energy levels. Your brain works better. You’re leaner. You start thinking: Why not do this all the time?

A recent study of long-term (5 years) ketogenic dieting in patients with glucose transporter 1 deficiency syndrome found no apparent downsides. Bone mineral density, which can be a problem for growing kids on long term ketogenic diets for epilepsy, was unaffected.

Yet, I’ll admit to being a bit leery of long-term, protracted ketosis in people who aren’t treating a medical condition. It just doesn’t seem necessary. After all, while humans are unique in our ability to slip into ketosis and there are clear evolutionary precedents for being in ketosis, Grok wasn’t starving all the time. He wasn’t living through famine after famine.

Not everyone needs to be on a ketogenic diet. Even fewer need to be on a ketogenic diet for life. But I do think that everyone should try it for a few or (even better) six weeks, build and install some new mitochondria, remain long enough to get really good at burning free fatty acids in your muscles, and then return to a ketogenic state on a regular basis to keep your capacities topped up.

That’s it for me today. Have you recently tried keto, or are you hoping to? Maybe you’ve done it for a while. I’d love to hear your tips and questions. Thanks for stopping by, and have a great week, everyone.


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.

If you'd like to add an avatar to all of your comments click here!

199 thoughts on “The Definitive Guide to Keto”

Leave a Reply

Your email address will not be published. Required fields are marked *

  1. I got a very important question. In terms of standard, not ketogenic, low/moderate carb diets I’ve read where you shouldn’t count low calorie green veggies considering most of their glucose is burned during the digestion process. This method has worked for me very well, when I count carbs I think of fruits, tubers, berries, honey, etc., not broccoli and kale. But if I were wanting to experiment with ketosis should I count broccoli, kale, spinach, and other green veggies? Or does the same method apply in ketosis?

    1. Hi Jackson, I’ve been doing keto for 5+ years… I too have scar tissue on finger tips from daily (sometimes hourly) finger sticks to test ketones… To say the least, I’m obsessed with ketosis.

      I’d say that the green veggies won’t make much of a difference… they’re just too high in fiber and way too low in carbs to impact ketosis. So I’d suggest to keep doing what you’re doing… include the green leafy veggies and broccoli… you probably won’t get more than a few net carbs out of them.

    2. That’s a really good question.

      I’ve always counted the carbs in my greens. I figure it can do no harm to add them in, and after a while the mental addition is automatic. Last night I had salmon + 300gms green cabbage (9 net carbs) + 300gms pumpkin (18 net carbs) = 27 carbs. The difference hardly seems to matter but if you’re trying to stay safely below an upper limit, say 50, it could give you peace of mind to know your position with more exactness. As I said, pretty soon the calculation becomes automatic anyway.

  2. Never heard of this diet before Its very interesting what got me confused was that I have always read that making your body in a ”starving feel” if i’m understanding right it’s basically the purpose of this diet your body lowers your metabolism as your body is scared that there is no food. But this diet is saying it helps you lose weight which contradicts with what i just said. I am no nutrition expert by all means if anyone could explain to me if what I said is basically a myth or why this diet works different I would be really grateful heck il even give it a try and see how it goes haha :3

    1. I’m not understanding your reasoning, but a severe ketogenic diet (that mimics starvation) will definitely cause weight loss unless you eat enough fat to counter that effect.

    2. it’s basically a myth. your body will go into starvation mode if you don’t EAT. not if you don’t eat carbs ( which keto is based on – very few carbs ). Besides, going into “starvation mode” after a a week doesn’t make evolutionary sense – if we went into that after a few days of low calorie intake and got tired, low metabolism, sleepy – we wouldn’t make the effort to go out and find food. we’d go to sleep and starve to death. This is why Americas Biggest Loser contestants put on all weight or more once they get off their crazy diet – they starve themselves and lower their metabolism, then go back to eat same amount of food they did before the contest = weight piles back on quickly.
      Keto is not low calorie. Just low carb although you will eat less because of no sugar spiks that cause massive insulin spikes, over compensating, lowering blood sugar too much and making people tired and cranky until they load up on more carbs.

    3. The key element in this concept is that you must already be “fat adapted” before you start on the whole keto thing. Mark explains this in the article and it means you must already be using fat as your primary fuel rather than carbs. We all have the ability to use both but most people have lost the ability to use fat because of the constant carb consumption. This is where most nutritionists are clueless because they are scared of healthy fats. Fat is a much healthier and cleaner fuel for our bodies to run on and stops all the inflamation which is rife with the low fat nonsense. Try one of Mark’s books or go to the Mercola website for more info.

    4. Well, because you aren’t starving. Keto reduces hunger and cravings, so you will most likely eat less. Which is to say, not an over abundance like many do. You still eat enough calories depending on your goal – more for bulking, less for cutting – but not to the extent of “starvation”. Your metabolism will slow if you go down to 500 calories, but being keto isn’t about that. You still eat enough calories for your body depending on weight, gender, etc. but it is consumed in fats and proteins instead of carbs. So your body still has plenty of energy to run on, including your own stored fat and ketones. Hope this helps, and definitely try it! It is amazingly beneficial!

    5. Keeping the protein optimal prevents the lowered metabolism associated with so many low calorie diets. Phinney and Volek, 2 experienced researchers in ketogenic diets, recommend 0.7 g – 1.5 g protein per pound of one’s ideal or recommended weight for sex, height, and frame. Extreme athletes, body builders, pregnant or lactating women, the elderly, and those recuperating from serious injury, surgery, or illness, needing to ingest amounts closer to the higher end. They say that puts most adults needing between 90-125 grams protein per day.

    6. Just because you lower carbs in a keto diet, does not mean you are lowering calories as well. If you eat less carbs you up your fat intake. And don’t forget the protein you’ll eat too. It is not a calorie restricted diet at all.

  3. This is great to see – I’m excited to read it. Congrats!

    One thing that I think is important to cover, and just about every resource on keto seems to omit, is who keto does NOT work for. Speaking personally, the simple act of adding a Bulletproof coffee several times per week spikes my lipids in an extremely bad way. So would be great to cover that somehow – how to know when keto and/or moderate to high-fat diets are just not in the cards for you.

    1. Mike, thanks for your feedback. I’ll absolutely be talking more about these issues in the coming week. Look for more in next Monday’s Dear Mark and the following weeks’ articles. Grok on!

      1. Hi Mark, and even more importantly, is worth mentioning form the start that nutritional ketosis is of limits (dead dangerous) for those with diabetic type 1; right? As someone who made the switch about a year ago, I am thrilled to see you covering the subject and I look forward to reading some more. What’s working for me is cycling in and out depends on my activity. But I do admit that I find the simplicity of cooking and eating that way endearing 😉

        1. Quite the opposite. you are mistaking nutritional ketosis with ketoacidosis. Ketosis helps type 1 diabetics to regulate their blood sugar easier , needing less insulin. That’s the only thing I can think of might be dangerous – taking the same amount of insulin as on SAD diet. but it’s easily controlled with blood glucose meter and adjusting your insulin dosage accordingly.

        2. Type 1s do extremely well on a ketogenic diet if they work closely with their physician on insulin doseage. They will need far less insulin when reducing their carbohydrates to ketogenic levels. Ketogenesus is a MUCH lower level of ketosis than the ketoacidosis of diabetes.

          1. Sorry for the above. I must have been feverish when I wrote it. In particular, since I am very familiar with the work of Dr Peter Attia (he is type 1) and others on the subject. By the way, I have Hashimoto (combination therapy of synthroid and cynomel) and lacking a gallbladder and yet I manage the diet (~75% of calories from fats) quite well but that doesn’t mean that it will work for others in the same manner. Thanks!

          2. Unless he’s been hiding the fact, Peter Attia does not have Type 1 diabetes.

          3. Sorry about that. I must have been feverish when I wrote the above. In particular since I am very familiar with the work of Dr Attai, Dr Fung and others. By the way, I manage quite well with ~75% of calories from fats (I use chron-o-meter), despite of having Hashimoto and lacking a gallbladder. But what works for one doesn’t mean that it will work for the other.

          4. Time Traveler
            you should really look at an NDT to replace Synthroid /Cytomel , a very informative book.
            The Paleo Thyroid Solution:
            I have been hypo for 20 years.. been on NDT for about 15 years

      2. Looking forward to it. I’ve read that if you are even slightly hypothyroid, low carb is not a good idea. I’d like to understand this a bit better.

        1. I second this! Low carb is apparently bad for thyroid issues and I’ve read that it can have a negative impact on women in general. Most low carb articles/books seem to be written by men.

          1. I’m a woman, in fact, I’m an elderly woman and I’ve been ketogenic for 9 months. I have lost 119 lbs. and have improved my thyroid function since I started on this program. Lots of myths going around with no truth to them. It is too many simple sugars and grains that destroy thyroids, not ketogenesis.

          2. Sharon,

            Congratulations on your success. Would you share a couple days food plan with me and do you do snacks and if so tell me what you prefer.

            Also, how old are you to classify yourself “elderly,”

            KarenJoin the discussion

          3. I rarely snack, even at our weekly dominoes game night. I drink water instead, sometimes with flavored stevia drops.
            I am going to be 75 years old this summer.

            Day 1 Breakfast @7:30 AM: 3 tablespoons shelled hemp heart seeds, a half ounce of chopped walnuts, a small pinch of sea salt, an ounce of chopped strawberries, moistened with three tablespoons of a vanilla Premier protein shake (drink the rest).
            Prefast meal @ 1:30 PM: Three to four ounces grilled fish with steamed broccoli and a 1/4 cup cottage cheese with salted radishes and cucumber slices. A Premier Clear protein drink.

            Day 2 Breakfast @7:30 AM: Premier protein shake, 2 eggs on a bed of spinach with hollandaise sauce and 2 slices of Canadian bacon or an egg, beaten with cream, scrambled in a little butter, and served with 2 or 3 slices bacon.
            Prefast meal @ 1:30 PM: Three one-ounce slices of Boar’s head sliced meat or poultry wrapped around an ounce of cheese divided into 3 strips and spread with 2 teaspoons creamy horseradish sauce. A third cup of tuna salad made with boiled egg, celery, onion, no sugar added pickle relish, and mayonnaise served on a romaine lettuce leaf. A third cup of cottage cheese. A Premier Clear protein drink.

            I have trouble eating a lot of denser foods, so I do rely on protein supplement drinks to bring my macros in line with Phinney and Volek’s recommendations.

        2. Completely depends on why your’e hypothyroid… for instance, if you’re hypothyroid because of stress / cortisol dysfunction, then chances are that your reverse T3 (rT3) has been upregulated thus displacing free T3 (at the cellular level) in an effort to slow you down and get you recovered. Same thing happens when you get sick, or get the flu but with chronic stress, it’s never ending which is why hypothyroid is common here. Going low carb / keto could be disastrous because keto is another stress.

          On the other hand, if you’re vitamin A and/or D deficient (like most people), this can prevent T3 from activating your cell. Or, if you have a selenium or iodine deficiency, conversion of T4 to T3 (active thyroid hormone) issues can arise. In these cases, going keto is probably not going to hurt but it’s obviously more important to fill the nutrition gaps to support one’s thyroid.

          Do you know why you’re hypothyroid? Do you know your free T3 and free T4 and rT3 numbers? Cortisol is important too but you’d need a 24 hour saliva test to know what’s going on here.

          In summary, keto is not categorically bad for people with hypothyroid issues… but it could be… it just depends.

          1. Great reply, Liver King. I just got out of 12 weeks ketosis due to decrease in my thyroid functions and need for substantially more medication. I regularly take Iodine, Selenium, Magnesium, Vit. D/K, A, C. I am hypothyroid (not autoimmune) and it runs in my family.
            ketogenic diet was my way of N-1 experimentation. I am post-menopausal, notmal weight, fit and eager to partake in the benefits that the ketogenic diet that many other people experience.
            I hope that Mark will approach the subject of ketogenic diet in hypothyroidism.

          2. I am also (non-autoimmune) hypothyroid and have no idea what the root cause is. Have been low carb for about 4 years, starting before the hypo set in (although that could just be coincidence). Am on synthetic thyroxine and feel better … BUT just can’t lose the extra 10 lbs … would LOVE to hear advice/ personal experiences from the Primal community (esp women) on whether Keto or other approaches have helped with weight gain. I am a 45-year old otherwise healthy and fit woman.

        3. I have experienced this firsthand, Nicole. I have been doing cycling (in and out of ketosis) for at least a year. I have noticed my goiter has enlarged in recent months AND on the last 3-day ketosis/low carb cycle, I suffered for the first time ever, a horrific gallbladder attack. I seem to have thrown my liver/gallbladder/pancreas balance out of whack and am now taking some “heavy” supplements to try to get the balance back! (bile salts, beet root, HCl, digestive enzymes). Everything is suddenly sluggish but functional post-meal so I am limping along, eating more carbs in the form of beets, carrots, root veggies, veggie soups with root veggies & sweet potatoes and trying to be patient. it is discouraging! I feel so awesome when ketogenic! I am a 57-year-old post-menopausal woman/moderately active/normal weight (and not trying to lose any). I think it is critical to maintain excellent and consistent hydration while ketogenic, keeping up with salt and other electrolytes. I suspect I got a little complacent for a couple of days and paid dearly for it. That’s my theory, anyway…

          1. Jeanne. I’m curious about your goiter because I’ve always understood it to be caused from lack of iodine in the diet. Are you taking kelp pills or something similar that will resolve it? Hope you feel better soon!

        4. My lower functioning thyroid has improved since I started the diet 9 months ago. Because of my 119 pound fat loss, my primary physician tested my thyroid, worried that it’s function has declined. It is normal!

          1. I’m a woman, in fact, I’m an elderly woman and I’ve been ketogenic for 9 months. I have lost 119 lbs. and have improved my thyroid function since I started on this program. Lots of myths going around with no truth to them. It is too many simple sugars and grains that destroy thyroids, not ketogenesis.

          2. Sharon Burress, I would love to be successful in the application of ketogenic diet. I love good fats and my 12 weeks of keto diet were full of delicious meals. Alas, my thyroid functions went down substantially and the unpleasant hypo symptoms reappeared. So, no myth here just disappointment that keto did not work for me.
            I would love to go back to it and experiment some more but would like to know how to avoid this decline in my thyroid functions. I am a health nut and have been hypothyroid for most of my life.

          3. I hate to hear of your experience resulting in such disappointment. I am no expert, certainly, and I’m sure many factors exist of which I am in no position to know. I have read that inflammation from grains and glycation from insulin insensitivity and hyperglycemia can cause thyroid dysfunction, but I’m sure those are not the only reasons. We can find online abstracts from studies that may deal with thyroid and ketogenesis that might be worth your time. The book by Phinney and Volek The Art and Science of Low Carbohydrate Living has an excellent citation list to give you guidance. I pray you find a way to live in this most natural state.

          4. Thank you, Sharon. I will research some more before I embark on another keto adventure. I did come across a study of children with epilepsy many of whom after 1 year on keto diet became hypothyroid. I heard Volec on a podcast. He mentionned that more studies need to be done in this respect. .. Well, I am glad that you are getting benefits. Be well!

        5. My short two cents here:
          I am hypothyroid (partial thyroid removal like 50 years ago) and I function very well with low carb (around 80 to 100 grams daily). I take synthroid daily, but I do it just for the numbers: I don’t have hypothyroid symptoms other than slightly lower body temperature and some sensitivity to cold

        6. I have heard the same and Leanne Vogel goes into this a bit. She recently released a book on Keto and she has a great podcast. You may want to check her out to get a woman’s perspective.

      3. Thanks Mark! Don’t forget about the ladies. (You used to seem to forget about the ladies a bit more. I have noticed it;s getting better a little bit.) It would be great to see all these covered:
        -Women through all life stages and ages (kids, teenagers, adulthood, peri-menopause, menopause, and post menopause.)
        -Pregnant women
        -Newly breastfeeding women
        -long term breastfeeding women
        -and if you can, pregnant and breastfeeding. It happens.

        It’d be great if you can get even more specific about ketosis impacts on fertility and menstrual cycles.

        Hey, it’s not our fault our biology is always in a state of flux! But this information would be greatly appreciated.

        1. I would LOVE a primal guide/source for menopause. I feel with all (what I perceive to be) emphasis on fertility that women “of a certain age” get a bit overlooked. If anyone has any reads…..please please share!

          1. Agreed! Perimenopause – transitioning…. I’m worried that I am following general online advice that’s only research with men. Tried keto and cycle started up after being dormant 4 months.

        2. I second Caitlin’s request! I’m currently pregnant and I have gone off the rails and gained far too much weight already at 24 weeks. I had previously lost 60 pounds after my first child was born using the Primal Blueprint. As soon as I got pregnant I lost control and allowed far too many cheats, and it shows. I am getting back on the wagon now, but it would be nice to know if keto was safe for pregnancy. Thanks!

          1. Hi Zora,
            Purely anecdotal but I maintained my ketogenic diet throughout my pregnancy with no ill effects on myself or the baby. Lots of eggs, meat, cheese, and veggies!

        3. Just an important note that might be obvious. I had hyperemesis during all my pregnancies in the first trimester (severe morning sickness to the point of not being able to eat) and was tested for ketosis throughout as my physician/midwifes told me it was dangerous to the baby to be in ketosis. (And maybe this is because I was in ketosis because extreme deficit of calories?)

        4. You may want to check out Leanne Vogel. She is a gal that does Ketogenic diet and discusses hormonal imbalances and such for women. I’ve been listening to her podcast and have really enjoyed getting a women’s perspective on this subject. She’s recently released a book on keto as well.

      4. Hi Mark- a couple areaa you may want to touch on in the book: The first is people with lower levels of seratonin- keto may be a bad fit them. At least not for long term. Secondly, people with naturally high levels of bodily histamine may want to avoid keto as well (the loss of water in the body exacerbates high histamine types, and many of the common keto foods tend to higher in histamine). Both of these areas were issues for me. I’m doing much better now with a moderate amount of carbs.

      5. Hi Mark
        I am about 40lbs. Overweight. I drink about 10 cans of Dt. Mt. Dew a day. I just can’t seem to stop. I am totally addicted. I would like to start this program. What do you recommend about the soda. Thank you.

        1. Roxy – try Mountain Zevia (it’s made with Stevia instead). I love all the flavors of Zevia. Totally satisfying

      6. Mark- maybe I missed it in the reading above, how many carbs a day allowed on the keto diet? I do weights, body weights, occasionally running/spring, and dog walking.

    2. I’d love to hear more on this as well. As someone who has at least one APOe4 gene, I’m a bit concerned about increasing my fat intake.

      1. Yes, I agree. Although I saw the link for Alzheimer’s benefiting from a Keto diet in the article, I’ve always read that people with APOe4 would do worse on this type of diet. I’d love an explanation or some clarification. Thanks, Mark!

    3. I would guess that your bullet proof coffee is made with saturated fat (butter or coconut oil). For me, lots of saturated fat takes my already high (well above above 100) HDL and pushes it sky high. That’s good,. However, it takes my LDL scary high as well – and not proportionally high. However, a high fat, lower saturated fat diet doesn’t do that and I get the HDL benefit with out the LDL issues. I’m probably a saturated fat hyper-responder, So no more gobbling fatty meats daily, pounding dark chocolate and spoon fulls of coconut oil. Keep my fat sources focused on nuts, eggs, avocado, olives/olive oil, some dairy, and plenty of lean meats ( skinless chicken and turkey mostly.)

      1. Interesting, I was discussing saturated fat hyper responders last Saturday day during our seminar (local WAPF chapter). It seems you’re doing the best thing. Did you noticed if your triglycerides went up substantially as well? For hyper responders and/or people with pre-existing heart disease we usually recommend more omega 3 fatty acids. Instead of fish 2 or 3 times a week we recommend 5 times a week. This lowers the triglycerides and c-reactive proteins thus negating any inflammatory response which might cause LDL oxidation. Also getting either wild game or grass fed ruminant meat will give you more stearic acid. Stearic acid is a particular saturated fatty acid which converts into oleic acid upon consumption and lowers cholesterol. Palmitic acid and myristic acid are the saturated fatty acids to avoid. You do this by lowering the amount of butter, cream, whole milk, and grain fed meat in your diet. Also try putting turmeric on all your foods. Turmeric up regulates your LDL receptor activity. Finally, you may just need more carbohydrates in your diet, depending on how low you are. Mark’s carb curve is fantastic, however some people (especially folks with hypercholesterolemia) need at least 600 to 800 calories from natural paleo friendly carbohydrates. I.E not grain, things like yams, sweet potatoes, fruit, berries, winter squashes, etc.

      2. Giving up dark chocolate would be tough for me Clay. 🙂

      3. Clay,
        Check out Dave Feldman’s N=1 experiments as a hyper responder. He clearly shows that as a hyper responder, his blood lipid results are inversely correlated with the amount of fat consumed in the five days prior to the test. Others have followed his protocol and gotten the same inverse correlation results.
        Makes you wonder why Big Pharma recommends blood lipid results be measured while one is fasted
        (Google Dave Feldman cholesterol)

  4. Thank you for this information. For many of the health benefits you list, I’d like to get into ketosis for a time. But I do NOT want to lose weight. I don’t have any pounds to spare. The past couple of times I’ve tried this diet it was hard for me to maintain my weight. I have no fear of healthy fats like lard, butter, heavy cream, etc, but it was still hard to eat enough. Any advice for us skinny guys and gals who want to get into ketosis without losing weight?

    1. Eat a lot more healthy fats. My son was on a ketogenic diet for seizure control years ago. He was losing too much weight very rapidly and was put on “ice cream” three times a day. I made this with oil, heavy cream, and a non-sugar sweetener–all weighed and measured according to a custom-formulated medical “recipe.” It worked like a charm.

      Contrary to a popular internet meme, fat will absolutely make you fat if you eat enough of it. In the case of maintaining ketosis, sufficient fat will likewise stop unwanted weight loss. Experiment to find out what amount is sufficient for you. Also look into gradually increasing portion amounts of protein and higher-glycemic vegetable carbs, until you find the point where you are still in ketosis but not dropping weight like crazy. Keto sticks can be useful for finding that point if you are winging it without professional assistance.

    2. if you eat enough protein, like the article states, you will keep your muscles. which is what you don’t want to lose. unless you want to keep body fat? 100 grams of fat is 900 calories so you need perhaps 150-200 grams of fat which should be pretty easy if you cook veggies in fat and go for fatty cuts of meat and perhaps a bullet proof coffee, 100 grams of protein ( 400 calories ) and 50 grams of carbs ( 200 calories ) which ads up to around 2000-2300 calories which should be enough for a male. a bit more protein if you work out and you are good to go.

        1. Mark, 100 grams of protein is definitely not too much for a male that works out. He wanted to keep his weight intact and I assume he meant muscle mass, not fat. Depends on his height, current weight etc. I think general rule is 0.5 – 1 gram per kg of body weight. a 200 gram steak for dinner, some cheese, a few eggs and that gives you enough protein. I went keto and am quite fit with little body fat. Added dinner to dinner fasts twice a week and my DEXA scan showed i still lost 2kg of fat but put on 2 kg of muscles at the same time which shocked me as i was never hungry much and thought i was undereating. Stayed in ketosis all the time with TKD around workouts ( beetroot juice 🙂 an hour before workout)

  5. I agree that very few people need to be in ketosis permanently or even for long, extended periods.

    That first month or so to adapt is such a huge benefit, though. You can freely shift in and out of ketosis and enjoy both sides once you have that set.

    As long as you remain primal of course 🙂

  6. I am attracted by the benefits of keto, but if it depletes water and electrolytes that much, I probably shouldn’t do it. I have Postural Orthostatic Tachycardia Syndrome, and I already have to supplement with water and electrolytes to increase my blood volume (and keep at bay fatigue, lightheadedness, dyspnea, tachycardia, and a few other symptoms). Keto might be a bad idea for me. Any POTSies here who have ever tried keto?

    1. My mom for 35+ years has been working with all the heavy hitters in POTS research at Mayo Clinic so I asked her your question 🙂 Now I am not a physician, and this is not a prescription or medical advice, I’m just sharing with you her opinion:
      Her response:
      “If you have POTS and you “Get plenty of electrolytes, sodium, magnesium, and potassium at 4.5 grams sodium (about 2 teaspoons of fine salt or a little under 3 teaspoons of kosher salt), 300-400 mg magnesium, and 1-2 grams of potassium each day on top of your normal food,” there should be NO worry about depletion of volume with that!!
      She said: “I have never heard of any diet ‘no’ no’s for POTS patients other than in regard to not getting their salt and potassium and other electrolytes.
      Physical conditioning is first and foremost with POTS patients, and they are the hardest people to convince they need to power through it, because they feel lousy doing anything!!!”
      I hope that helps 🙂

  7. I’ve had great results going keto, but one thing concerns me: I’ve heard that ketogenic diets can cause false positives on drunk driving breathalyzers. Anyone have any information on this?

    1. I had heard that too and had heard to insist that they take you down to the station for a blood test rather than a breathalyzer test.

    2. This is only true for very old breathalyzers but you can always request a blood test.

  8. This is all new to me Mark and I love learning new things! Going to start dropping hints to the kids now that I’d love the Keto reset diet book for Father’s Day! 😉

  9. I have started using a keto diet to help combat dibilitating migraines. I am about 20 pounds over weight so I am hoping it helps there and with my insulin sensitivity as well. This is great info I can trust! Thanks Mark!

    1. I stopped getting migraines when I cut out wheat, dairy, preservatives, sulfites, and nightshade vegetables. Everybody’s different, but Ketosis doesn’t make a difference for me. Just my 2c.

    2. It worked for me and was the reason I started Primal, then Keto many years ago. After too many of those migraine buggers, it was a god-send. The only downside was, as Mark wrote about, that I became too adapted, too satiated and got to a point where I ate too few total calories and didn’t keep an eye on my loss of muscle mass. Never having done that, nor had an issue with eating, I was blind to it and the pendulum swung too far the other way.

      You will really likely love the benefits to your migraines and one day realize you haven’t had one in ages. :-). Just keep a close eye on your satiety and know how to adjust smartly.

  10. I did keto for about 6 months, I saw NO increase in energy or clearer thinking. I am 46, hashimoto’s, non classic congenital adrenal hyperplasia, most likely pre menopausal.

  11. OK, I’ll do it. I’ll be more strict about the Primal Blueprint until July 4th, then try keto for six weeks. I am training for the Chicago Marathon on October 8th, though. Is there a conflict between keto and endurance training?

    1. If you want to fail at your marathon, go keto 🙂
      Seriously for high performance in sport, especially endurance, it’s a no go. If utltra endurance athlete are usually low carbs, but not keto on a daily basis.
      Moderate your carbs during training, do some workout fasted / with glycogen stores depleted, and you’ll get all the metabolic benefits. And load up on carbs before the race.
      That is, if you want to perform at your best.
      Eat good quality carbs though 😉

      1. Carlos Dones – ultra marathon runner. Ran 170 miles keto. Like Mark said, when doing crossfit or sprints, you’re more likely to want a small carb boost. Not endurance.

        1. You can run for a long time sure, but you wont run fast 😉
          No world class athletes are keto. If you want to perform at your best, you need carbs.

          1. By “fast”, I mean “at your best”. So it all depends if you want to optimize your race and set a personal record.

    2. Not really! Many endurance runners use nut butters, coconut oil packets and/or salt capsules to keep energy and electrolytes up, but you’re body has roughly 40,000 calories stored in fat at any given time, where glucose is about 2,400. So you won’t hit that “wall” when your glucose stores run out and your body switches to burning fat. You may see a decrease in performance the first few weeks, when your body is adjusting to a new fuel source. That is where you’ll want to take it a little lighter on workouts, and increase back to your normal routine after a few weeks. Good luck on your marathon!

    3. It’ll actually be the following Monday, after my brother-in-law’s wedding. I can squeeze six weeks in before the total solar eclipse, which I expect to involve a lot of carbohydrates. It’ll give me another six weeks before the marathon itself, @Mathieu, so I’m not currently planning on doing the event keto unless the experience sways me. @Tom, I’m about halfway through. I’ve been that far through for a while, training with the H7. It’s time to explore the remainder of the book. @Shanna, after reading Mark’s “Cognitive Effects” post (linked), I’m interested in foul-tasting Esthers during a long run. What do you think of that? Thanks for your replies, everyone!

  12. I would like to have more examples of what a day in the life would be for ketogenic diet. Grams and percentages make it hard to visualize what a person actually eats. Walk us through actual meal examples for different people (Male/Female, Maintain/Lose weight, etc.)

    Also, for someone who can’t tolerate dairy, what are other examples of fats to include besides coconut oil?

    1. Can you tolerate Ghee? Regardless, I’d recommend Avocado Oil or Beef tallow/ Duck fat as well.

    2. Hey Angela, I consider myself to be “borderline” keto. I don’t measure anything, but feel amazing and energized and find it really keeps cravings at bay. Here is a typical day…I am up super early (5 am) and have coffee blended with unsalted butter and mct oil. Sometimes add collagen for the skin benefits, but think I get hungry sooner with the added protein. Later in the am I’ll have another coffee made the same way, usually decaf. I might not get hungry till 12 or 1. Lunch is usually something like sardines or grass fed burger and veggies, plenty of olive oil or butter added. Dinner kind of like lunch. Avocado and berries thrown in there somewhere. For a non dairy person, avocado oil and olive oil are great. And some meals I skip the animal protein and have avocado and some other veggies. Hope this helps!

      1. But Elizabeth, you are the collagen queen! If not in your morning coffee, when do you recommend to consume collagen? (Thanks for the real life food examples!)


      -Wallaby Organic / Grass fed yogurt (2 cups or 150g)
      -NOW Brand MCT oil (1-2 tablespoons; up to 30g- dose to tolerability)
      -Organic raw virgin coconut oil (2 to 3 tablespoons or 30 to 45g)
      -Organic almond butter (2 tablespoons or 30g)
      -Organic unrefined red palm oil (1 tablespoon or 15g)
      -Grassfed Collagen / Gelatin (10-20g)
      -Himalayan sea salt — 1/4 tsp (2g)
      -Organic cinnamon — 2g
      -Organic / Grassfed vanilla protein powder (1 scoop)
      -Organic banana (optional)
      -Organic / Pasture raised raw eggs (4 to 6 large eggs)
      -Organic raw milk (1 cup or 150g)… raw is best but you can sub any type of milk

      This shake takes me about 15 to 20 minutes to make… It’s super convenient… and, it’s down right delicious. If I don’t make a shake, I will have a bunch of pasture-raised eggs (8 or so) that are smothered in butter with a side of avocado, nitrate-free, sugar-free bacon and a dollop of sour cream.


      -Homemade Bone Broth Soup
      -Serving or Kimchi
      -Organic Avocado
      -Grass fed butter or Ghee (2 tablespoons)
      -Organic unrefined red palm oil
      -Dark leafy greens w/ 2 tablespoons of organic, fresh pressed olive oil and sea salt
      -Grass fed beef/organs (9 – 12 oz ground peleo, organs, birds, beef or steak)
      -Organic almond butter (2 tablespoons) mixed with organic raw coconut oil (2 tablespoons) and a tablespoon of grassfed vanilla protein
      -Organic banana (optional)
      100% Cacao block for dessert

      I generally carb reload on the weekends with plenty of sweet potatoes, raw local honey, the occasional sorghum and various in-season fruits. I also do a 24 hour fast on Sundays. As I’ve mentioned previously, I blood test ketones and glucose every morning… Once you’re fat adapted, ketosis becomes your default (your homeostasis).

      I should also add that most people won’t want to consume as many calories as me… maybe cut the servings by 1/2 or so. Been in keto for 5 + years… never felt better… never looked better 🙂

    4. Angela, a ketogenic diet isn’t necessarily full of weird components. Just stick with meat/fish protein, eggs, low-glycemic veggies, and healthy fats. Macadamia nuts are okay in moderation. Skip grain products, legumes, sugars, and starchy veggies. Limit or temporarily eliminate most fruit. A strict keto diet often limits portion sizes as well, although hunger is seldom a problem.

      Ketogenic diets are currently “in.” However, a true keto diet is a fairly drastic departure from normal eating patterns and therefore not easy to stick with. Unless you have a specific reason (such as a medical condition or needing to lose a lot of weight), such an extreme approach to food is unnecessary. A low-carb diet (versus VLC or ketogenic) usually produces excellent results for most people.

      As someone else indicated here, healthy fats would include fatty meats, lard, bacon fat, nuts, and avocados. Be aware, however, that while they are a healthy addition to the diet, avocados do contain carbohydrates.

  13. I was fairly keto for a lot of last year and lost quite a bit of weight pretty easily. I tend to do well for a couple of months and then offroad a bit. I’d been supplementing with exogenous ketones when I go on vacation or drink alcohol, figuring that my brain could still use the exegenous ones even if I temporarily stopped making my own. Seems to work but not sure if this is healthy or not.

  14. Is there any evidence to indicate that being keto long term has any harm? I’m currently about 10 months into a ketogenic life and have dropped from 265 to 175. I’m past most cravings for carbohydrates and sweeteners so I don’t foresee any trouble eating this way for the indefinite future. However, I am intrigued to see if there are any adverse effects to long term ketosis that have been reported in studies.

    1. I just read a new study about obese patients going keto for 24 months. That’s the longest I’ve seen a study done. They found no adverse effects within those 24 weeks. There is anecdotal evidence of people being on a Ketogenic diet for well over 10 years with no negative effects, but there aren’t scientific studies that long term yet.

  15. Yay! You’ve done your homework! An excellent article. I’ve been on a ketogenic diet for 9 months and have lost 119 pounds so far. I have only 35 pounds to go to be at the weight I was in my 30s. I am turning 75 this summer. I am not hungry! Every other time I have been this close to goal, I started hungering and craving and just like a spring released, burst back into weight gain far faster than it was ever lost. Not this time. This is my way of eating for life! I will possibly add back occasional legumes and cold or raw potatoes, but most of my maintenance added calories will be from added healthy fats.

  16. Hi Mark,

    I have several of your books (the last I bought was Primal Endurance since I am a marathoner) and loved eating Paleo for years. I run into the ketogenic diet this past January and decided to try it. I used the recipes from another author’s book on ketogenic cleanse and I’ve never felt so fantastic after the 3rd week. The euphoria is real! I finally was able to wean myself off from ADHD medication that caused my HR to stay too high. As a full time college student, mom and wife I needed an alternative to stay focused with my school chores in a natural way. Keto diet was the answer. I am stil following the keto woe, although I’ve fallen off the wagon few times I always get back into it and pay the price with the annoying “keto flu” which on me manifests exactly as having the real flu without the fever. I am thrilled to read you put together a book about ketogenic diet, I just wish it was available sooner. As I mentioned before, I love the recipes in your books and I am excited to try the ones in your new book. Thank you!

  17. Mark – I’m happy to read about your book. Will it deal with the (relatively uncommon but horrible) “keto rash”? There is at least one website devoted to this phenomenon: Andreas Eenfeldt (the Diet Doctor) also addresses it briefly on his website.

    I’ve attempted ketogenic diets many times, in part for Type 1 diabetes blood sugar control. In the couple of weeks before the rash kicks in, I enjoy normal blood sugar levels, almost 24/7 (as measured by a continuous glucose monitor). The rash, which comes on quickly and covers most of my torso — a typical pattern — is unbearably itchy and painful. The only remedy I’ve discovered is re-introducing carbs and exiting ketosis — at which point I go back to dealing with the virtually impossible task of matching exogenous insulin doses to carb intake. My HbA1c when I’m not in ketosis is usually ~ 6.2% — considered “good” control, *for a Type 1 diabetic*. I’d love to have better blood sugar control, and I think it would be possible … if only I could remain in ketosis. But the rash cannot be lived with.

    Any theories as to causes or alternative remedies? Apparently some people have (temporary?) success with the anti-inflammatory properties of antibiotics, but I’m not willing to go there. Regular anti-inflammatory foods/supplements don’t seem to help.

    1. I would love to hear a reply to Heather B’s question.
      I have the same exact situation (Type 1 diabetic forever; adopted Primal diet for good blood sugar control; got it; went Keto or high fat/very low carb for even better control (nearly perfect blood glucose levels all day); but have have gotten worsening of minor psoriasis into very bad, highly inflamed and itchy rashes at times…)
      I’m not sure if it is bettered by eating more carbs because I’m hooked on eating this whole foods, nutrient dense, and very low carb diet (somewhere between a Keto and Primal Blueprint diet).

  18. I have tried a keto diet and I was always hungry. I followed the guidelines set forth by Marie Emmerich and Jimmy Moore (I admire both of them very much)–it just wasn’t for me. I have found what works for me now and I’m sticking with it.

  19. Mark, I been reading about keto on web, from diabetic consultants on line, books , for a while. It seems to point to extreme low carb ( 20-30 g. daily) and moderate protein, and high fat consumption for most energy. Those that study it, eating all the saturated fat, what are they saying that does to the lipids, the cholesterol and triglycerides in blood stream? If we take Lipitor to lower cholesterol and then we begin to eat more and more saturated fat , is that shown to be not increasing lipids too high in blood stream of those who used to be low fat eaters before this?

    1. Hi Jim,
      a ketogenic diet can actually improved blood lipids significantly. Check out the following study from Jeff Volek’s group:
      While the participants saw a small increase in LDL, the LDL particle size increased favorably, HDL increased more dramatically, and triglycerides decreased. Overall a very favorable change in blood lipids, and the participants were not even in full-on ketosis for most of the time (as evidenced by their b-HB levels of 0.28 mM at the end of the study), and it was a short study as well.
      Anecdotally, most people have beautiful blood lipid profiles on a strict ketogenic diet. Some people can easily get to a Triglyceride/HDL ratio of 0.5 or lower. That’s superb, and is likely a more more meaningful number than total cholesterol or LDL.
      Some people see a strong increase of their LDL on a ketogenic diet, and it is not well understood whether that is problematic or not. It may be only a transient increase because of the liberation of fat stores. It may be a marker of an inflammatory issue in the body. Or it may be a marker for a real artherosclerotic problem in a given patient. Because of the lack of studies so far, ever individual will have to judge that for themselves.

  20. Mark, an added question. After reading this for some time, on pro keto, I have an e-mail from to desire to provide medical oversight of a keto diet, but charge around $400 a month, I am guessing without going back to look again. There is a wellness doctor in my community that wants to charge $7000 , no insurance help in most cases, for help on keto diet for 6 months of oversight, and I got an e-mail yesterday from a diabetic consultant who has done on web diabetic web presentations, His cost was as I recall, lower than either one of these two examples. These 3 seem to want to charge folks as they move into a keto diet. Do you have an opinion most of us can do this on our own, or that we need an accepting and dedicated medical person to watch, or collect lab samples or other wise oversight what we do , in approaching use of a keto for type II?

    1. I’m not Mark, but I suggest you shop around if you want help with a keto diet. $7000 is pretty much highway robbery. So is $400/mo. There are always going to be unscrupulous people willing to take advantage of the latest diet trend. Avoid them!!

      Yes, you can do the diet yourself but you need some nutritional knowledge. Learn as much as you can about it, including what kinds of foods you can and can’t eat. If that seems insurmountable, find a doctor who treats T2D using dietary changes or a qualified dietitian. Buy a package of keto sticks to use as a guide. Mark doesn’t favor them, but they actually do give a pretty good indication as to whether one is in ketosis or not.

      1. Shary. the 3rd pay me for service offer is from a health education who has a functional medicine certification. he wants $250 a month for 10 months of keto oversight, and I am doubting his service does any lab work., might tell you to get some lab work done. Its all by internet with a few phone calls. So I have seen $7K, $400 a month, and $250/ month for 10 months. Looks like folks , making use of some level of keto diet, earn money telling you how to improve your type II diabetes. I guess that is not different from today, just is a new expanded kind of possible option. On down side, give up most carbs. Up side, might improve diabetes status.
        I have read keto strips not needed as much as more frequent blood sugar testing, for type II diabetics, and to cut back in meds, take in more water and electrolytes. Its a bit of good news and bad news story, I guess.

    2. You could check out Intensive Dietary Management. They don’t give medical advise, unless you are a Canadian living in Ontario, but they work with you to give dietary/keto/fasting advise. It’s 1000 Canadian dollars (about 700 USD) yearly.

  21. I’m so glad you finally made a post like this. I’ve done keto on and off for awhile now and had great success. You always bring a moderate, intelligent view to topics and you always back it with research.

  22. I consider myself to be borderline keto these days. Def higher fat/lower carbs. I am way too lazy to track anything, but having more fat keeps me extremely focused and energized. I’m a pretty positive person to begin with, but I think it even affects my mood (in a good way!)

  23. Keto is absolutely what got me in the best shape yet. I started with your Primal Blueprint and segued easily and effortlessly into Keto. I am leaner than ever, have tons of endless energy and have never looked better. This, at 59 years young.

    Thanks for all you do for us!

  24. Would anyone like to comment on Dr. Mercola’s most recent book Fat For Fuel. Would it contain similar ideas as are being discussed here?

    1. I liked the book. Lots of good information, although it is geared toward medical intervention.

  25. Thrilled about your coming book! Though keto definitely isn’t for everyone, I thrive on a very low-carb, sometimes-keto eating plan. So too do many of my clients (when that aligns with their individual needs and goals).

    After my “past life” as a sugar/carb junkie dependent on regular infusions of white stuff, eating this way is so freeing. My mind is clearer, my energy is sustained, and I don’t have any need or desire to snack between meals – to name but a few of the many benefits!

  26. You’ve touched on it before and here again but for most who do not *need* keto do you encourage cyclical ketosis as in not 24/7/365. In my opinion and experience and just thinking from an evolutionary and physiologic (maintain insulin sensitivity and reduce physiological insulin resistance of keto, gut microniome, nutrients) standpoint it makes sense that most would benefit from non constant ketosis. Any thoughts?

  27. Hi – Does anyone have resources on the effect of the keto diet has on kidneys? My dad got a heart transplant 5+ years ago and unfortunately the immunosuppressants they put him on destroyed his kidneys over time. He’s now close to needing dialysis. I’ve read keto can help prevent further degeneration, but would love to get your guys’ input. Thanks!

  28. After reading “Primal Endurance” I decided to give keto eating a try. Today, 6/72017 is day 3 of week 12. I’ve experienced essentially all the symptoms you describe in the book. My goal was/is fat loss and I’m getting leaner by the day. I use nutritional software to closely monitor my eating. I’m keeping my carb intake less than 10 grams/day. I’m also incorporating I.F. to help things along. I fast from 6 p.m. to 12 noon the next day every day.
    I’m surprised that I’m not more hungry than I am. Even after fasting for 18 hours I’m not famished.
    My experience has been good. Commitment is the key. The more committed one is to making changes, the easier those changes are to make.
    I’m looking forward to the new book.
    Thanks Mark.

    1. Mainly lower carb. Look up the Carbohydrate Curve in The Primal Blueprint. Keto is the area of lowest carbs: 50g or less

      1. In the book, Mark suggests that the daily carb max can exclude (net out) non-starchy vegetables and avocado. I just ate a salad of tomatoes, cucumber, avocado and olive oil and MFP reports that was 31g carbs. Can I net out this whole salad?

  29. Thanks for posting this. I’ve been loosely following the Primal Blueprint for sometime, but went keto (CKD I learned today) at the end of 2016. I’ve been hoping to hear your thoughts on this diet. I’m really enjoying the benefits so far. When I started keto, I was plateaued having lost about 115lbs and couldn’t get past it. Now after a few months on the keto diet, I’m down another 32 lbs making it 147 lbs total lost now. I’m also leaner, have very consistent energy and no longer need sugar on longer bike rides as I once did. I also feel mentally sharper, but that’s hard to quantify. Lots of other minor improvements along the way as well.

    As a cyclist, making the switch to ketosis was tough. I started in December 2016 so I wouldn’t have to miss too many rides while getting adapted. There were a few rides early on that were just demoralizing. Going 10-15 miles and being wiped out, this after doing centuries on copious amounts of sugar not that long ago. But I stuck with it and now feel like I am getting back to where I was in terms of cycling distance. I haven’t tried to regain my speed as I’m trying to stick to the “slow the F down” mantra, but I can still hang on the moderate group rides at least. Now trying to get into the lift heavy things thing next.

    Anyway, looking forward to the book. Thanks again for all this great info. It’s been a life changer for me. My friends and family get tired of hearing about this Sisson guy from me, hehe.

  30. I started eating very low carb when I started testing fasted blood sugar and found it regularly over 100. Two years later I’ve been I ketosis a few times and blood sugar averages about 97, but I’d like to see it in optimal 80-90 range. Anyone know if strict Keto for 6 weeks as Mark suggests will do the trick? I’ve also read in Fat For Fuel and The Blood Code that sometimes you need some more carbs to get a drop, but hasn’t worked for me, just makes it bounce around more.

    1. Steve
      Measure your HOMA-IR to see if you’re insulin resistant or sensitive. When you’re very low carb or keto, your fasting blood sugar may be high because your muscles are fueling from fat, refusing glucose to spare it for your brain.

  31. In typical Mark fashion, this is one of the best summaries of keto that I’ve ever read. I’ve noticed over the years how many of the success stories mention people dipping into keto as a tool yet keeping Primal Blueprint as their base “go-back-to” lifestyle diet. This book is both timely and was just a matter of time. Totally looking forward to it!

  32. Always a plethora of information.
    I’ll look forward to reading your book!!

  33. How long do I need to worry about pushing electrolytes? All the time or just as I start out and my body is equalizing by peeing a lot?

  34. A few questions:
    1) How do you know if you have depleted your glycogen? Is it that “can’t do much more” feeling in your muscles?
    2) If you are eating carbs to replace glycogen, will you stay in ketosis?
    3) Going along with the question, who shouldn’t be in ketosis, I have read on Paleomom that those with autoimmune should not do a ketogenic diet. What can you say to that? (though type 1 diabetes is autoimmune and you say it helped that)

  35. Do sugar alcohols in sugar free gum affect ketosis!? I sometimes chew a lot of gum while at work and worried it may be affecting my body going into Keto: thank you for any insights.

  36. I’m going to focus on eating primal, exercising and getting more sleep … but best wishes to everyone who is doing this.

  37. Thank you for this article. I’m in the UK and about to start chemotherapy for 6 months. My oncologist, quite enlightened for the NHS, mentioned a ‘high protein diet’ when I asked for advice which I took to mean low sugar. I am going to try to stay in keto while in treatment as I have read this supports your own cells while stressing the cancer cells. Looking forward to finding out as much as possible.

    1. Good luck with your chemo Jean and I hope all goes well for you. regards Sheila G in Edinburgh

        1. Jean, I’ve been reading up a lot on this recently. You’ve probably come across these but in case not:
          Tripping Over the Truth
          Optimal Terrain Consulting (Nasha Winters I think is the main person behind it. She was just interviewed recently on the Two Keto Dudes Podcast)
          Dom D’Agostino has 3 episodes on Tim Ferriss’ podcast, and cancer + keto are recurring themes.

          From everything I’ve read, yes, keto is a fantastic adjunct to traditional therapies, and outright fasting (not too hard if you’re already keto-adapted) before chemo greatly mitigates the side effects of the chemo, plus further weakens the cancer cells b/c they’re glucose dependent.

          Good luck to you!

        2. The formatting in my first reply makes it look like one long string of info! Sorry about that. Hopefully this is more clear: Tripping Over the Truth is a book about the metabolic theory of cancer. It’s interesting and well-written. Optimal Terrain is a consulting company and they probably have a ton of leads on their website. Dom D’Agostino is a researcher who has appeared on a number of podcasts in recent years.

          1. Jean – Actually my first reply has disappeared, so I’m trying again with this portion:

            From everything I’ve read, yes, keto is a fantastic adjunct to traditional therapies, and outright fasting (not too hard if you’re already keto-adapted) for several days before chemo greatly mitigates the side effects of the chemo, plus further weakens the cancer cells b/c they’re glucose dependent.

            Good luck to you!

          2. Thank you, Lina, for taking all that trouble. I have ‘Tripping Over The Truth’. It is a useful book.I will look for the interviews you mention. Fasting may suit me better than strong keto as I have been unlucky with ‘keto rash’ in the past but I will try both. If nothing else it turns me from a passive ‘patient’ into an active participant in my treatment.

          3. oh, I’m happy to see this! I was hoping you would see the responses to your post. Active participant sounds great 🙂
            There’s a new thread in the forums on cancer. I listed a bit more there and there will likely be some more interesting additions to the thread over the next few days.
            I’ve actually found it kind of frustrating to have found all these amazing resources and know that most cancer patients won’t ever come across them!

          4. I hadn’t thought of looking at the forum but I have now – thanks!

  38. While we’re waiting for Mark’s book, those in search of some answers or just more info might like to Google Maria Emmerich. She has a very informative site (though a little confusing to navigate, I find) and it has a search function, too. Plus recipes, life stories, etc. Like Mark, she has a scientific approach, not a woo-woo one!

  39. Just wanted to mention that it’s not quite true that there’s no research on the effects of ketosis on neural/cognitive functioning of healthy individuals. Our laboratory is currently conducting research on this topic at Massachusetts General Hospital. Preliminary results appear promising and we hope to publish in the near future.

  40. Zero carb is what I do. It’s not keto. The human species did not evolve tracking macros. The feral human species evolved as nomadic tribes tracking, and following herds, such as mastodons, and other herding animals, eating as much as they wanted, as often as they wanted. A domesticated member of the human species might track macros. I prefer to be feral, by eating meat, and drinking water instinctively.

  41. I really hate the word diet. I like to refer to this as a lifestyle choice just as Primal is a lifestyle, not a diet. When people hear the word “diet” they automatically think weightloss and forget the health/nutrition aspect of it. So Mark, can you drop the “diet” from the title and maybe add “life” ?

  42. Hi, Mark!
    Great meeting you at PFX!
    Is ketosis in women the same as in men? Should women cycle through more carbs or utilize a specific style of ketosis to prevent any thyroid issues? I’ve heard some women say that ketosis has helped thyroid issues and others claim that it has slowed theirs down. (I don’t know which style they were using, just “ketosis.”)
    Many thanks,
    Sheryl Janosky, PHC

  43. I ran keto (shooting for 50g carb max, some call that modified keto, sometimes a bit higher but quite often 30-40g and a lot of that was fiber) straight for 8 weeks. During that time frame: I lost ~21lbs, had absolutely ZERO cravings for carbs and especially sugars, had steady energy all day, appetite was virtually always low, and overall felt pretty great. First week were a bit hard, but very doable, I was also taking in exogenous ketones at that time and I do think it helped get me over that initial hump faster.
    The one thing though that never fully returned was my weight lifting strength. First two weeks I kept all my strength in workouts, 3rd and 4th week it went down. It did improve some through the rest of the keto run – but for example I had lost about 8% on my top bench set in the 3rd week, and I had only regained maybe half of that by the end of the 8th week even with consistent training efforts. In the 3rd and 4th weeks I had been reading on keto performance and seen that it takes 4 weeks to get performance back, so I had decided to run 8 weeks just to be sure in case I was a slow adapter.
    I am not totally blaming keto – I was chronically under eating and possibly overtraining, it was just too easy for me to not eat. I have been an intermittent faster for 6 years now, combining keto and IF was a killer on appetite. I did make some attempts to eat substantially more – but I did not really feel it was helping in terms of maximal strength, but it did slow down fat loss. I did however feel like I could do sub-maximal for longer/easier, but losing maximal strength was an annoyance to me.
    Side note: towards the end I removed exogenous ketones mainly to see if my fat loss would increase, and after that didn’t really feel any worse off. I still have some I sprinkle in from time to time, and still use MCT oil powder to assist with ketones and theorize they both will help with performance in general but are not required. In terms of helping with fat loss – I think it is like any other fuel source, if you have exogenous fuels you won’t tap endogenous fuels, it is possible my appetite was lowered by using them but you could probably find a similar balance with more food and no exogenous ketones. I also think they are overpriced, they need to be about 1/3rd the cost they are now for people to want to use them regularly.
    At the end of the 8 weeks I did a “reefed” of sorts eating around 400g of carbohydrate in one day, the next week my bench shot back up and my other lifts were easier.
    So I started to try to shoot for 100g carbs thinking this would be a good refueling point for glycogen based on my workouts etc…, but I find that adding more carbs back in (even when from non processed foods) – my cravings for carbs and sugars have returned. My performance is higher also, but I have also put back on 5lbs (I think some is muscle, some is water, some is fat though also) and it is now really easy to eat all my daily calories in one sitting – whereas before I was laboring some days to even eat 1000 calories. Especially if I break my fasting with carbs, it seems to make me ravenous in general.
    I think since my performance really did not tank until 2 weeks into keto, ideally for me I should probably run cyclogenic keto – eat mostly keto 5 days, eat higher carb 2 days, or some variation to find my optimal point. The goal is always for non processed carbs – but achieving that in today’s world is difficult when you tell yourself you need more carbs, and processed carbs are literally everywhere you go.
    In summary – I like keto; I think it is great overall. I wouldn’t say it is a lifetime thing for me, but it’s a really useful tool to have in the toolbox that I will keep around, much like intermittent fasting. Dom D’Agostino has done a lot of keto research and its worth looking into it, there are some great pod casts with him out there, and it really does seem like keto is the way to go (if it suits you) during cancer treatments and some medical conditions.
    For now, I still have 10 (vanity) lbs I want to lose, if I cannot get my caloric intake under control with carbs back in the picture – I think I may do another 4-8 weeks ketogenic to see if I can lose them. I may try cyclogenic or TKD though first – but keto in general will be a go too anytime I want to lose fat.

  44. I tried Keto for a number of months but was basically forced to give it up due to my gf and our two kids. It’s was just getting too much of a pain to not eat together as a family and with all the carbs in the house I was cheating too much. Would love to hear about some science-based info on keto and kids and how to do keto in a family with non-keto family members.

    1. Hi Alexander, there are lots of keto recipes on the internet such as keto pizza, keto crackers, keto cheesecake, etc. It would not be difficult to make things that are keto, that kids and adults would like. I make lasagna using eggplant or zucchini instead of pasta, for instance, and there are lots of variations on pizza crust using shredded mozzarella, almond flour, and cream cheese.

  45. Congrats on this new book! I can’t wait and am VERY interested in it – especially as a hardcore dancer (daily training) 53 year old perimenopausal woman. I’ve experimented with what I understood Ketogenic diet to be and found the effort not difficult during my ‘2-month rest periodization’ window but am confused about how to remain Keto and even Primal now that I’m back into intense training window. I seem to need more carbs…Will continue with Primal until book comes out and hope for clarity then!

  46. I was beginning to think your comment board was completely ambushed by menopausal hypothyroid women. (Not that there’s anything wrong with that)

  47. Hi! I have a question regarding what you say about fiber “not counting” as carbs. I live in Spain, so I will write things in grams, sorry for the trouble…

    Let’s say I check a nutrition label on a bag of almonds. It says (for example) that it contains 6g of carbohydrates per 100g of almonds, out of which 2g are fiber.

    Does that mean that if I eat 100g of those almonds only 4g of the carbohydrates which they include count towards my 40-50g daily carbohydrates?

    Thanks in advance

  48. After 3 years of partial ketosis (3-4 days/wk) 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. 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?

  49. Mark – I am curoius about how alcohol affects your ability to stay in ketosis? You mention the Spanish Ketogenic Diet which incorporates wine, but I am curious about how this loading on the liver affects its ability perform other functions, such as producing ketones.

    Additionally, you mention the CKD approach, which allows for weekend refeeds on carbs. A lot of my weekend activities still involve grabbing drinks with friends, going to concerts, etc. I am wondering if staying strict Keto during the week, while allowing for alcohol on the weekends (thinking wine or aged whiskeys/tequilas instead of sugary mixed drinks) could be an effective compromise that still allows for some or most of the benefits of going keto? Any thoughts you have would be great.

  50. Is mark still in favour of taking resistant starch like unmodified potato starch?

  51. So, Mark, I’m reading this keto stuff and I’m a little confused. Like what is the actual physiological difference between the “Fat Burning Beast” we all know and love and aspire to become and the Full-Blown Keto-Tard? I’ve always assumed that if I get up in the morning and do 12 miles and 1500 vert of single track on my 39 pound fat bike in the fasted state and feel totally fine I must be an FBB and all was good. I’m not seeing the cost to benefit ratio of Keto-Tardness. The menus lack appeal. If you can smarten me up, I’d appreciate it.

  52. It takes some people much longer to get into kerosis than 4 weeks. I have been trying to get there for several months. I am a post menopausal 62 year old woman.
    At first I was just eating macro ratios of 75% fat 20% protein and 5% net carbs every day and fasting 14-16 hours a day.After 6 weeks this wasn’t working. I had to start limiting my protein to 50 grams a day, start engaging in sub aerobic cardio several times per week and add endogenous ketones in the form of a drink. After 4 weeks of that I am finally showing the presence of ketones on the urine test strips. But I know this does not mean that I am in ketosis yet it just means that my tissues are being bathed in kittens. However at least I feel I’m on the path now and I will get there eventually

  53. What I am missing in all of this…what is a general starting point for macro distribution i.e. 60% Fat, 20% protein, 10% carbs, etc?Also I am a daily juicer (veggies/fruit not ‘roids!) and am wondering if I need to consider those carbs? My daily juice is about 20 oz, and includes lots of greens like kale, spinach, parsley, celery, but I do include one small granny smith apple and 3 medium carrots. Depending on the calculator I’ve used, this drink alone could be up to 50 grams of carbs (not net, just being conservative and using total carbs). Should I lay off the juicing (or at least eliminate the apple can carrot and just suck up the more bitter taste?

  54. in the second paragraph of final thought please correct typo that reads, “dies”, to diets. Those long term kids don’t die.. they just eat a keto diet

  55. Thanks for the guide. It was timely as I wa ted to make the shift from Paleo to Keto. VERY glad for the recommendations on sodium, potassium, and magnesium. I felt nauseous and supplemented and began to feel better. I’ve been all over the board with electrolytes for the last few years


  56. I’ve read the article above, and quite a bit of the comments below, but what I would like to know is just how detailed is this book going to be? I’m one of those people who need a plan laid out with measurements, not with eat this per so much per lean body mass, etc. I need amounts like tsp, tbsp, cups, oz, etc. Also, I pre-ordered Dr. Mercola’s book, Fat for Fuel, and was completely disappointed when I got it. i thought there would be a definitive plan to follow, but I shut the book, never to look at it again when I read about all the testing he suggested on a daily basis,as well as many blood tests that he suggested in addition to that, as well as ‘keeping your doctor apprised’ of what you’re doing. Huh? I avoid doctors as much as possible except in emergency situations, pretty much I need to be unconscious to go. (many bad experiences with MDs), so I was very disappointed with his book – drs. pretty much just throw RX drugs at you if you have a “medical” condition, so the best thing I can of is try to take care of myself thru diet, exercise, and relaxation.. I just don’t feel that eating should be so darned complicated. Making a short question long, does your book have a detailed eating plan so I can easily come up with menus I’d like to follow?? Thank you! ~~ Vee

    1. Vee, thanks for your question. You have my word that it’s a true beast of detail. My book might not be the first on the scene, but I was committed to making it thorough. It offers 1) all the science and benefits of keto and then 2) a step-by-step plan for dietary modification and also exercise, sleep and stress management, 3) guidance for going keto with macronutrient breakdowns, and 4) 21-Day menu plans for both Primal transformation and for going keto, and finally 5) keto recipes. Hope you enjoy!

      1. Wow. Thank you so much for taking the time to answer my questions Mark. I will definitely order your book, as it sounds like something I can follow – a *real plan* that can be properly (and w/o medical assitance!) implemented – thanks again!. ~~ Vee PS: I am NOT bashing Dr. Mercola’s book – I just can’t use the information it contains, but I know there are many out there that can.

  57. Hello Mark.
    I’m hoping that you can make this keto thing easier to understand, I’m talking about the biology of it. I couldn’t find a clear explanation of what the ketones are as opposed to fats, what happens to them when we get too many? Why do we even need them when we have fat available for energy? From what I understand, fat carbs and protein can be broken down for energy through conversion to ATP. Don’t ketones need to be converted to ATP? The words fatty acids, tryglicerides, fats etc are used interchangeably and they are not the same.
    Here’s a quote:
    “Ketogenic diets are especially effective for massive weight loss. If you have a ton of weight to lose, aiming for ketosis could help you lose body fat. Again, not because of any inherent fat-burning quality of the ketones, but because in order to make ketones you must liberate stored body fat.”

    Now you said that ketones are formed if there’s extra CoA available that will be sent to the liver to create ketones. So I can eat lots of fat, little to no carbs and bingo, extra CoA. And I haven’t touched my stored fat…

    This is just one of many questions..

    I bought Dr Mercola’s book Fat for Fuel, but same thing, you’re left confused with lots of question marks. I tried Dave Asprey’s book Headstrong, same thing, the science is confusing. I understand the benetits of ketosis and following the diet is pretty simple, but is there a way to understand the science properly without taking a course in
    Thank you

    1. Radu, thanks for your question. I might take up some of the more specific questions in future Dear Mark posts. Understanding the science behind ketosis doesn’t require another college degree, but it does require more than a short blog post can offer, however. I’ll cover various aspects of keto in articles to come, but my upcoming book is where I have the space to really delve into the functional science.

    2. The ketones are the broken down fat, a result of beta oxidation of the fat cell. The ketones are used by the mitochondria of the cells in the body to produce ATP instead of breaking down and using glucose by-products for that purpose. Here’s my biochemistry notes:
      The muscle cells import both B-hydroxybutyrate and Acetoacetate from the blood.
      ? Comes in from blood
      ? Gets a Succinyl CoA added to it by succinyl CoA acetoacetate CoA transferase.
      § Succinyl CoA becomes Succinate
      § Acetoacetate becomes Acetoacetyl CoA
      § Acetoacetyl CoA is broken into 2 Acetyl CoA
      § Everything happens in the mitochondrial matrix and Acetyl -CoA can go into the TCA cycle.
      An Acetyl-CoA is worth 10 ATP

  58. I was keto for 1 1/2 years and just recently switched to paleo. I began the journey to lose a couple inches of body fat before my wedding and honeymoon but it was never my intention to lose any weight. Ive felt great the whole time and just this year have noticed the biggest change in my body composition after switching from Insanity workouts to more lifting and HIIT. Then a few months ago my menses began getting screwed up and I stopped ovulating. That is why I switched to paleo.

  59. Hello,

    I would like to purchase this book as I am new to keto and want to try it. However, I find a lot of books from the US contain recipes that are not “adapted” to the European market (in terms of ingredients – some we don’t have in Europe – or units – metric vs imperial system). Are the recipes/meal plans in this book “European” friendly? 🙂
    Many thanks!

    1. Sylvie, the book includes metric measurements for all recipe ingredients. The Primal community is definitely a global one, so I make it a priority to have recipes accessible for everyone. Thanks for your question!

  60. The audio-book refers to pdf that are provided with the audio-book. I purchased mine on amazon. But did not come with PDF. Is this correct, or am I just hearing things.

  61. I did keto for about 5 weeks, lost about 17 pounds, then stalled. My energy level was pretty low the whole time. Then I switched recently to the 21 Day Bone Broth Diet, which is basically Paleo with bone broth. My energy is back to normal again and I’m losing weight again. I’m thinking maybe with the keto I wasn’t getting enough veggies? And I definitely didn’t have any fruit for that entire time, plus my calorie limit was barely above 1200 (I’m short). I wasn’t hungry, but I just felt blah. Thoughts? Paleo makes me kinda sad because the no dairy thing. Oh but I haaaaate tracking macros/calories.

  62. Mark,

    I bought your book. On page 76 second paragraph you wrote, “In Ch 6 I detail which items to eliminate in numerous food categories and provide suggested replacements.” Well, I read ALL of Ch 6 and nowhere in it do you detail WHAT TO ELIMINATE. I’m about to start the 21-day reset and clear out my cupboards as you suggest on page 76, but I have ZERO ideas what to keep and what to throw away! Is this a typo in your book? And more importantly, where do I find the list or details of what to throw out.

    1. Andrea, thanks for your question. I offer a detailed meal plan and snack ideas at the end of Chapter 6, but I’d also direct you to the end of Chapter 5 (beginning on page 82), where you’ll find a section called Food Categories: Purging and Replacing. That should give you direction in clearing your cupboards and stocking up on healthy alternatives. Best wishes for your keto transition!

  63. I purchased the Keto audio book on iTunes! It’s great. It references a pdf for meal plans. How do I get the pdf? It’s not showing in iTunes.

  64. Maybe I missed it but what is the number of carbs we are allowed in a day to strive towards ketosis?

  65. Hi team! Does anyone know if a black coffee kicks you out of Ketosis?

  66. I’ve regained, lost, regained the same 40lbs over and over and it’s frustrating when weight loss stagnates even with intense workouts. Until yesterday I never really believed protein gets converted to glucose. Switched to Keto after seeing an image comparing it to Atkins(high protein). I”m amazed that I’m seeing progress while also eating higher calories overall, from fat. I ate 6 oz of cheese last night! A wonderful way to diet! I’ve always loved the fat on a rib-eye steak or pork more than the meat and think there is something to that.

    1. There is logic to eating starchy carbs before intense workouts. The carb discussion on this site, someone mentioned that back in the days when we used to carry water, chop wood, walk to work, lift stuff at work etc and burn 5k calories a day, you could eat potatoes, rice and burn it off. Today’s urban lifestyle we do less intense physical activity daily/hourly yet there is more stores/restaurants that sell “cracky” highly processed carbs than ever.

  67. I read the book. Started the diet 5 days ago. I’ve decided I’m only going to weigh myself once a week. But it seems like I haven’t lost any weight. How long does it take to drop at least a few pounds?

    1. Heather, mitochondrial biogenesis, the making of new mitochondria, is one of the most dramatic benefits of keto. So, the short answer is yes. That said, I’d say you want to talk with your physician first in case there are secondary issues like fatty acid oxidation disorders or pyruvate carboxylase deficiency.

  68. I have Parkinson’s, and have been eating keto for about 9 months. My symptoms seem milder. Anyone else?

  69. I started reading your book the keto reset diet and became increasingly annoyed by the total absence of any references to vegetarianism, and to fit, lithe people who have absolutely no need to lose any weight at all. I am eighty years of age, very healthy, 11stone 2lbs in weight at about 5foot 10inches in height. I’m not fanatical about anything except Life itself, walk my dog three times daily, run my sizeable garden, consume organic foods (fruit, vegetables above and below ground, seeds, nuts, fats, kefir, unpasteurised cheese, small amounts of sourdough bread, ladled with goats butter, etc.) and remain in practice in herbalism for humans and animals, and in iridology and practice daily meditation. Vegetarianism is on the increase as more people question the practice of eating dead animals, paleoism or not. I can see that many sick people have benefitted from Ketoism but I certainly question the assertion that it is the one and only diet, and I question going back to a diet that might have served people hundreds of years ago. In consciousness we are not those people now. And consciousness is in the process of deepest transformation, so here is at least one person who will keep a very open mind as to the future of mankind – and it’s diet. One assertion I will make – it’s all about balance – and which is a very individual matter. Best wishes, Michael Brookman – Nature’s Sway.

  70. “Grok wasn’t starving all the time. He wasn’t living through famine after famine.” – But maybe it was Grok’s lifestyle for the most part because he was used to eating only at dinner time – a larger meal of fattier meat…? Sure, sometimes maybe they had a load of berries, but for the nomads (99% of our history) – they lived by walk, walk, walking, and hunting on the go. That means that we ARE surely adapted to eating this way, and we are not well-adapted to any other way. But hey, lets give it a few billion years more and then we will all be living in the sky WALL-E style. 😉

  71. Hello
    I just bout the Keto Reset book.
    Im just confused on the fat macros during reset. I have akrwady calculated tge protein. Help pleSe

  72. It’s funny, dude’s site’s name is “…daily apple”, which is exactly what he’s telling everyone to avoid now and be keto. ?

  73. I am diabetic. i been diabetic since 16. I am 31. I also have fibro. the primary doctor recommended keto to lower my blood sugars and to fight the inflamation from the chronic pain. i tried keto ealier this year but i got sick. stomach cramps and fatique. i was also in the middle of school semester. she told me to try again since I am off for the summer. i just bought the keto resist diet. next to primal fear it says straight whey protein instead can that be found at walmart or is it best to buy from gnc? also what a good whey protein to use?

  74. I would like more on trouble shooting. I am trying to lose weight, and it’s not happening. I already have the book, and have based my macros on the calculations. Testing my blood, I currently am at 2.0. I feel great, which is awesome, but I need to lose weight. Super confused as to why I’m not.

  75. So are you saying you should only do keto for a short time if you’re healthy? I’ve been doing keto for 7 months hit my goal weight 3 months on keto. What eating lifestyle do you recommend? I see you talk about keto and paleo. Still reading about paleo. I was eating lean clean and green but just couldn’t get the last 15 pounds off until keto. Need some healthy detection?

  76. Hi Mark,
    Thanks for this really useful guide. This is not so much a practical question as one of scientific curiosity. I have been wondering, if I eat low carb, but not quite low enough to get into ketosis, what is happening to all the fat I am eating? It seems to me it is not getting stored, as I don’t gain weight. And it would seem my body is burning something other than the 150g of carbs I eat a day. I am active and thin, exercising an hour a day. I can’t imagine that would be enough fuel. So is the body still utilizing the dietary fat in some way? Again just curious. Thanks.

  77. In your book your recipes call for full fat coconut milk. Are you talking about coconut milk in a can or unsweetened coconut milk in a carton?

  78. I just read The Keto Reset Diet and found it very informational. I have started the reset diet, but am also training for a half-marathon so I wanted to know if there are additional things that I should consider. I love the idea of working out below my max heart rate, but my training does not always allow that. Do you have any suggestions on how to exercise at the appropriate heart rate, while also trying to train for a half-marathon? Thank you!

  79. I am allergic to Avocados. What do you suggest as a replacement (i.e. on sandwiches or in sushi)? Is coconut oil the best replacement oil in recipes calling for avocado oil?

  80. Hi Mark,

    Great article on Keto to read and learn everything for a beginner. Truly impressed. One of my friends suggested your website know and understand everything about Keto Diet. Thanks for sharing. Keep sharing more like this in the future.

  81. Thank you so much for sharing this wonderful article This is so detailed about the keto and I would love to try this.

  82. Started Keto 21 day reset. After my heart attack, I’ve been taking 2g D-Ribose powder for years based on recommendation in Metabolic Cardiology by Dr Sinatra. Since D-Ribose is a sugar, is it a no-no for the Keto diet?