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What Is Ketosis, What Are the Benefits, and Is It Safe? Diet Doctor

Dec 21st, 2022

Does the brain need carbs?

Theres a long-standing yet misguided belief that carbs are necessary for proper brain function. In fact, if you ask some dietitians how many carbs you should eat, theyll likely respond that you need a minimum of 130 grams per day to ensure that your brain has a steady supply of glucose.

However, this isnt the case. In fact, your brain will remain healthy and functional even if you dont eat any carbs at all.

Although its true that your brain has high energy demands and requires some glucose, ketones can provide about 70% of the brains needed fuel. The liver provides the remainder of needed energy in the form of glucose, which is made by gluconeogenesis (literally making new glucose).

This system allowed our hunter-gatherer ancestors to go for long periods without eating because they had access to a fuel source at all times: stored body fat.

Being in ketosis doesnt have any adverse effects on brain function. On the contrary, many people have reported that that they feel sharper mentally when theyre in ketosis.

Food for thought: Does the brain need carbs?

In addition to providing a sustainable energy source, ketones and in particular BHB may help reduce inflammation and oxidative stress, which are believed to play a role in the development of many chronic diseases.

Indeed, there are several established benefits and potential benefits of being in nutritional ketosis.

Established benefits:

There is also exciting early research suggesting that ketosis may be beneficial for many other conditions, such as reducing the frequency and severity of migraine headaches, reversing PCOS, perhaps enhancing conventional brain cancer therapies, possibly slowing down the progression of Alzheimers disease, along with potentially helping people live longer, healthier lives. Although higher quality research is needed to confirm these effects, much of the early research is very encouraging.

Nutritional ketosis and diabetic ketoacidosis are entirely different conditions. While nutritional ketosis is safe and beneficial for health, ketoacidosis is a medical emergency.

Unfortunately, many healthcare professionals dont really understand the distinction between the two.

Ketoacidosis occurs mainly in people with type 1 diabetes if they arent getting enough insulin to meet their needs. In diabetic ketoacidosis (DKA), blood sugar and ketones rise to dangerous levels, which disrupts the bloods delicate acid-base balance.

In nutritional ketosis, BHB levels typically remain below 5 mmol/L. However, people in diabetic ketoacidosis often have BHB levels of 10 mmol/L or above, which is directly related to their inability to produce insulin.

This graph shows the vast difference in the amount of ketones in the blood between ketosis and ketoacidosis:

Other people who can potentially go into ketoacidosis are those with type 2 diabetes who take medications known as SGLT-2 inhibitors, such as empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin.

Also, in rare cases, women who dont have diabetes can develop ketoacidosis while breastfeeding.

However, for most people capable of producing insulin, its nearly impossible to go into ketoacidosis.

There are a number of ways you can get into nutritional ketosis safely and effectively.

Even more tips for how to get into ketosis on a keto diet

Note whats not on the list above: you do not need expensive supplements, like exogenous ketones or MCT oil (medium-chain triglycerides). These supplements will likely not help you lose weight or reverse disease. At least theres no evidence for that.

Ketone supplements do not lower insulin or blood sugar and dont increase fat burning. Its hard to believe that they would have any direct benefits for weight loss or type 2 diabetes reversal.

What these ketone supplements might do is improve mental and physical performance for a short time. To the best of our knowledge, this potential is also unproven. They do raise blood levels of ketones, an effect that can last anywhere from one to a few hours.

Were not saying dont buy these supplements. Perhaps you want to try them for yourself, and see how they make you feel. But you dont need them to be successful on a keto diet or to get into ketosis. Heres our big test of keto supplements:

Exogenous ketone supplements: Do they work?

Although getting sufficient protein on any diet is important for preventing muscle loss, many questions have been raised about proteins impact on ketone levels.

During digestion, protein is broken down into individual amino acids, which triggers the release of insulin. Although the amount of insulin needed to transport these amino acids into muscles is small, when large amounts of protein are consumed, the rise in insulin might reduce ketone production to some extent.

For this reason, ketogenic diets for epilepsy are restricted in protein as well as carbs, which ensures that ketone levels remain elevated at all times.

However, proteins effect on ketosis seems to be highly individualized.

For example, when Diet Doctors Bjarte Bakke conducted several n of 1 experiments to see how much protein he could eat and still remain in ketosis, he found that keeping net carb intake below 20 grams per day was what ultimately mattered regardless of his protein intake.

Clinical experience would suggest that others are likely to have the same results as Bjarte.

If you want to stay in ketosis and still eat plenty of protein and are concerned about potential negative effects, it might be a good idea to conduct your own n of 1 experiments in order to determine your personal protein threshold. It may be higher than you think.

Read more about protein on a ketogenic diet

Getting into ketosis on a ketogenic diet involves a broad range, and you can achieve different degrees of ketosis. The term optimal ketosis is frequently used, but it is poorly defined. For instance, those treating seizures or Alzheimers disease may benefit from targeting a ketone level above 1.5 mmol/L, whereas for losing weight or improving blood sugar the degree of elevation may not matter at all. The numbers below refer to values when testing blood ketone levels.

There are several signs that suggest youre in ketosis, although measuring your ketones is the only objective way to verify it. Here are the most common signs and symptoms:

For a shorter version, keep reading below. Note that we have no affiliations with any of the brands mentioned here.

Urine strips are the simplest and cheapest way to measure ketosis. It is the first option for most beginners on a keto diet.

Dip the strip in your urine, and 15 seconds later the color change will show you the presence of ketones. If you get a high reading (a dark purple color), youll know that youre in ketosis.

Con: Results can vary depending on how much fluid you drink. By drinking more water, you dilute the concentration of ketones in the urine and thus a lower level of ketones will be detected on the strips. Also, the strips dont show a precise ketone level just a range. Finally and most importantly as you become increasingly keto-adapted and your body reabsorbs ketones from the urine, urine strips may become unreliable, even if youre in ketosis.

This happens as the body becomes more adapted to using ketones, meaning that they increasingly stay in the blood to be used as energy instead of being lost through the urine. In one study, after 3 weeks the kidneys were found to excrete ketones at one-third the initial rate, despite having the same blood ketone levels.

Thus, the test may stop working always showing a negative result when youve been in ketosis for several weeks.

Order urine strips at Amazon

Breath-ketone analyzers are a simple way to measure ketones. At $79 and up they are more expensive than urine strips. But they are cheaper than blood-ketone meters in the long run, as they are reusable any number of times.

These analyzers vary in their specific results. Some older models do not give you a precise ketone level; rather, they provide a color code for the general level. Whereas other, newer models, report a specific number or level.

You can also hook the device up to a computer or mobile phone (newer models) to get a more exact ketone number via the app. According to the manufacturer, the device correlates decently with blood ketones in most but not all situations.

Pro: Reusable, simple test.

Con: Does not always correlate well with blood ketones. In some situations may show misleading values. For example, if you recently ate a lot of carbs or drank alcohol, this can result in misleading values. More expensive than urine strips, and higher cost upfront than a blood meter.

Video: Using breath-ketone analyzers

Blood-ketone meters show the exact and current level of ketones in your blood. They are the gold standard method for measuring your level of ketosis on a ketogenic diet. They used to be quite expensive, but prices have come down significantly over the years.

If youre on a keto diet but arent seeing any signs or symptoms of being in ketosis, here are a few strategies that may help:

GuideWith a blood ketone meter, you can test for blood levels of ketones. Heres our review of the top options.

Side effects typically happen within the first few days of starting a ketogenic diet and include headache, fatigue, lightheadedness, irritability, cramps, and constipation. These are known collectively as the keto flu, which can be remedied by managing fluids and electrolytes, among other things. Read more about the keto flu.

Being in ketosis is safe for most people, and it can provide many health benefits, including weight loss and reduction of blood glucose and insulin levels, to name a few.

However, certain individuals should only follow a ketogenic diet under medical supervision, and others are best off avoiding it altogether.

Conditions that require medical supervision and monitoring during ketosis:

Conditions for which ketosis should be avoided:

GuideDuring the first few days of a keto diet, you can experience the keto flu. You can feel tired, have a headache, and be easily annoyed. Learn all about the keto flu and how to avoid it here.

A year of self-tracking in nutritional ketosis

Read more:
What Is Ketosis, What Are the Benefits, and Is It Safe? Diet Doctor

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