When we start taking five grams of sodium from celtic sea salt, that makes me think the others need to be brought in the proper balance, and I have no idea what the right balance is. ACTH stimulates the adrenal cortex to release corticosteroid hormones. It would be incredibly useful to anyone who attempts one of these diets to have a target baseline, so they could compare their own results to someone who has been successful with the diet. Fat metabolism is still not optimized, and ketone production hasn't become significant. I don't think about eating all the time and I get a lot of time for some cool activities. It is very difficult to have a health problem and no answers. I'd like to get into a usable Keto state, but I hope it doesn't take weeks to be able to do physical things properly.
I have so much more to learn Thanks for the link. Hey—I recognize that guy! Steve Gibson has worked in software engineering and computer security for a long time, and I've seen his name and occasional posts by him. I too work in software engineering and computer security. And now that I think about it, I too have done so for a long time! It's fun to see that he's taking up a ketogenic diet kick. I like his bibliography page: Thank you for your informative and concise article.
I've been on a ketogenic diet for about 3 weeks and have ran into a few problems due to not educating myself properly before jumping into the diet. I ended up in the ER for a panic attack, but I wasn't aware of what it was when it happened that was first the time. I started having bouts of reactive hypoglycemia which I think triggers the panic attacks. I am not diabetic, I checked my A1C two weeks ago and it was at 5.
But it has come down from 5. After reading your article I suppose I am not cutting out enough carbs from my diet and I am in the limbo you mentioned.
But I fear I'm eating too many vegatables which might be keeping me in the state of limbo. Thanks again for your precise and informative article, it has given me the confidence that I can overcome these symptoms by sticking with it. I've been on a ketogenic diet for about 3 weeks too and still in the limbo. Hi ARM, Thank you for writing. We publish this blog as a way to communicate with the public about generic factual information that we've learned.
If you need specific advice about your health, then you need someone who is trained in medicine neither of us are and who is familiar with your condition and your history. Please talk to your personal doctor. Please continue reading our blog, and suggest to your doctor that he or she do so as well!
The adaption phase is interesting. First time I tried to get into Ketosis it nearly killed me. I woke up in bed on the fourth night after cutting carbs, with my head spinning and only just managed to summons the strength to get to the bathroom. It was the first of about trips over the next few days. I had extreme fatigue, nausea and kidney pain too. It's possible I got sick at a coincidental time, because my symptoms were so severe.
I have a short memory, so tried again recently, supplementing with sodium much earlier in the process. It was much, much easier that time. I felt fine generally and could even lift weights without problem. When I tried to play sport though it became very apparent I had not yet adapted. I tired very early and other people noticed that I was off. I'd like to get into a usable Keto state, but I hope it doesn't take weeks to be able to do physical things properly.
I can't say what was happening in your case. Nausea, fatigue, and kidney pain are all signs of dehydration. It is easy to get dehydrated during keto-adaptation, and it would make sense that sodium would help with that, by encouraging water retention, as would drinking more. Hi and thanks for the excellent article.
Just reading J Stanton's article on "low carb flu" at Gnoll and it seemed like you could be burning fat without being in a ketogenic state. This is a great question.
Ketone bodies are always being produced, but when carbohydrate intake is constantly high, ketone levels stay low. It's not called ketosis until they get above a threshold around 0. You can definitely still burn fat without being in ketosis. One difference, though, is that since you don't have a large supply of ketones to go around, you will need to use more glucose than you otherwise would.
Respiratory Quotient RQ gives an indication of how much fat a person is burning. Pure carbohydrate would be 1. In a normal person on a non-ketogenic diet, it's about. Petro Dobromylskyj estimates that a keto-adapted person would have an RQ of about. You might enjoy his post about that: I'm trying to find an email address to contact you on to ask if you would please consider adding a link to my website. I'd really appreciate if you could email me back. Thanks and have a great day!
If you posted a link to your site, either here or on your blogger profile, we could take a look. Currently, we do not have any links to other sites posted, except those in references, but we will probably add links at some point. I have been pretty much ketogenic for six months with fantastic energy etc. But every so often I am hit with mild bouts of carb flu — enervation and low mood.
Sometimes my cab intake might slide up a little bit — too much fruit for example — but largely I'm pretty good and very consistent. Any idea why this is happening? Does the carb flu work in reverse? Or could it be somehow I'm not properly adapted? I'm able to do a 24 hour intermittant fast with little effort so would have thought I am.
Curious for your thoughts on this. It seems like that could be any number of things or combinations of things. You could test whether it correlates with your blood levels of beta-hydroxybutyrate, though, or even with blood sugar. I'm the kind of idiot that lost weight low-carb and somehow went back to what I was doing prior to low-carb and gained all of my weight back and more.
I'm now low carb again and have lost 67 pounds in 6 months. I knew about ketosis, but until the last couple of days I didn't know anything about keto adaptation. Maybe I heard about it, but I wrongly assumed it was the same as ketosis.
One thing I would like to say is that I can get into ketosis really quickly with one hard full body weightlifting session and a long cardio session. However, I do mean hard I could get into ketosis the same day I started with an overload of exercise and would avoid some of the severe cravings that I would get if I just allowed myself to get into ketosis over several days of low carb.
I recently had been having cheat meals and getting back into keto right away, but now that I've been reading about keto adaptation, I don't know if I'm doing myself more harm by doing that. Long story short, can 1 "cheat" meal take you completely out of keto adaptation or do you have to have to string together several cheat meals over a series of days to be back at step 1?
Also, a lot of the reading said limiting carbs to 50 per day. I haven't found anything that says what's the most you can have at a meal. I don't think you can have 50 carbs at one meal and then none for the rest of the day and have that be okay. Congratulations on the 67 pounds! I don't have hard answers to your questions. As far as I know, it's an open question whether or to what degree a "cheat" sets back keto-adaptation.
One thing you could do, though, is measure your blood ketones rather than urinary, which I assume is how you currently know when you are back in ketosis? Volek and Phinney allude to performance improvements that continue for weeks, but I'm not sure exactly what they are, or whether they are reflected in blood ketones.
Still, it would be helpful to know if you are in the 0. Your second question is also interesting to me. Obviously eating g of carbs once every 4 days would have a different effect than 50g once a day, and surely 10g 5 times a day would be different still. It's likely to be quite individual, considering the range of carb intakes that people need to stay in ketosis.
Here again, I would advocate measuring. Find out what level of blood ketones you usually have while fasting, how it changes given different per-meal carb levels, and how long it takes to get back to fasting levels.
Tell us what you find out! I was wondering about potassium after adaptation. Are there any special things I should do or is eating adequate protein enough? Also, I once ate nothing but animal products for eight weeks on a bet. I found I quite enjoyed it but felt I would have enjoyed it more if I could have had a small side of vegetable or use them as a condiment. Would that sort of diet be sustainable do you think?
Toward the end of my eight weeks I must admit I didn't always feel my best. My husband thinks I was not eating enough. I liove what I've read so far and will be visiting regularly. Hi, and thank you for the wonderful article!
I have a question regarding fat intakes. After becoming keto adapted, if a person still has substantial weight to lose 30 to 50 lb , would it be wise to cut dietary fat so that the body uses stored fat rather than dietary fat? If so, should this be done gradually, and how low should the fat be reduced?
I realize that this would effectively create a high protein diet It would be high protein by percent, but not in absolute terms. There are mixed opinions on this. Personally, I lost 50 lbs without any fat restriction, and the times I have tried restricting fat, while I did lose a little faster, I felt bad during it, and the extra loss rebounded when I stopped.
Hi Barb, I know this comment is 2 years old, but I highly recommend getting your hands on a copy of Dr. Newbold prescribed an all-meat diet to his obese patients and continually emphasized the importance of including liberal amounts of fat. He recommended ribeye stakes for this reason and wanted his patients to choose the fatty cuts they could find.
I remember he had one case history of a man who did not feel that good on ribeye, so he switched him to fish the patient's ancestors haled from a sea coast town in Europe somewhere I believe.
This patient felt much better on the fish diet, but he had to use large quantities of butter on the fish to make it work. Newbold reported the same thing in his own and his patient's experiences that Amber has shared here about herself: Guys, this blog is fabulous. So well written and researched. I'm excited to read your forthcoming article on cortisol levels and health, my interest stemming from an understanding of the sympathetic nervous system "fight or flight" as the release mechanism for cortisol, and it's compliment, the parasympathetic nervous system "rest and digest" as a pathway to health and happiness.
Are you familiar with glycogen supercompensation ? The idea is that you can exhaust glycogen stores muscle, liver, and brain , e. My question for you is this: You might roll your eyes, I think, at the closing line of the NYTimes article wherein I found the cited papers: Do you have a link to a guide for n00bs? Pretty sure I don't have my head around what I can and can't eat to properly restrict carb intake.
I made a comment about super-compensation here: Volek and Phinney say that keto-adapted athletes also use glycogen more efficiently. I can't find the reference at the moment, though. Yes, I would certainly roll my eyes at that article. It's a sad state of affairs we're in. For a beginner, I would highly recommend getting the latest Atkins book: It will have everything you need to know from a practical point of view.
Will keep the other title in mind. Thank you again for the blog. I'm almost three weeks into the diet, and am loving it. Oh, that's a great choice, too, it's just more theoretical than practical. I'm glad you are having success! Lots of questions on my mind. Here is one for you along with some commentary.
Fat for fuel as an adaptation for survival is unquestionable. But is it the best for explosive type requirements ala "cross fit? However today a lot of us are interested in health and to increase our "weekend warrior'' performance times. Is fat and a keto diet the best choice? I also believe that honest fact based discussions by us "lay people" with a keen curiosity and a desire to improve our health and lives can lead to some pretty amazing "discoveries. This is a big contentious issue, and I'm going to mostly skirt it.
I don't think most people will have a problem with it, but if there is a problem, what will happen is that you will become hypoglycemic. See the section about Mat Lalonde in http: Essentially, you take g of fast carbohydrates preferably dextrose 30 minutes before your workout. You should be back in ketosis almost immediately after. Hi there, I went through exactly what the article described the diffrent phases of adaptation.
The result is wow! I can fast for a full day and be very active without suffering from hunger or weakness.
I don't think about eating all the time and I get a lot of time for some cool activities. The major source of energy is fat oils, butter, eggs, ghee - I just made my own today, meat fat, etc while I eat meats and nuts for proteins.
In the post, you write "When ketone levels are low, the muscles tend to use them directly for fuel, but as levels increase, the muscles use them less, turning to fat for fuel instead. Or is there a fat oxidation pathway that doesn't involve the production of ketones? Hi Neeraj, sorry for the long delay. I think what Volek and Phinney are saying is that when the amount of circulating ketones gets to a high enough level, the ketone bodies themselves will be used for fuel even by the muscles.
Below that point they will be reserved for the brain. I think you reversed it, probably accidentally. Beta-hydroxybutyrate and acetoacetate are made in the liver in about equal proportions, and both are initially promptly oxidized by muscle. But over a matter of weeks, the muscles stop using these ketones for fuel. Instead, muscle cells take up acetoacetate, reduce it to beta-hydroxybutyrate, and return it back into the circulation. Thus after a few weeks, the predominant form in the circulation is beta-hydroxybutyrate, which also happens to be the ketone preferred by brain cells as an aside, the strips that test for ketones in the urine detect the presence of acetoacetate, not beta-hydroxybutyrate.
The result of this process of keto-adaptation is an elegantly choreographed shuttle of fuel from fat cells to liver to muscle to brain. But, of course, the level of ketones, would also go up over time. Oliver, I do sometimes make mistakes, but I'm not sure what you think is mistaken here.
I don't see anything inconsistent. Could you be more specific about what I may have "reversed"? I was replying to the comment right above mine where you said: I don't mean to criticise. Just want to avoid confusion. Friendly criticism is good! I'm not sure about why I wrote what I wrote just above. Thank you for pointing it out! Oliver, I think I may have just phrased things badly above. When keto-adapted, muscles are using more fat, but they are still also using ketones. It's just that when blood ketones are higher, muscles use relatively less of what's available.
Presumably this is because high levels of ketones indicate low levels of glucose, which means the brain now needs to get priority for the ketones. But if there is so much in the blood that the brain's needs are met, there will be more available to the muscles as well. Thank you for pointing out the potential confusion. Nothing but meat for four years!?!?
I think massive acidosis is coming your way. Aren't you worried about that? I'm not sure what you mean. Are you confusing ketosis with ketoacidosis? Or are you talking about the common misconception that certain foods have a significant effect on blood pH? I'm not worried about either of those things. I'd like to address them in the myths section, but I'm quite busy with my thesis right now. There is a good description of ketosis vs.
Hi Amber - Thanks for this blog, it's a great resource. I'm about a week into keto-adaptation, consuming 10g carb, 85g protein, and g fat daily and supplementing with salt, magnesium, and potassium, among other micronutrients. I find that my mental alertness and physical energy level are generally solid until my first substantial meal, after which I fatigue significantly and become rather listless.
Have you ever experienced this or heard about it? Could this be something that levels out as I become more keto-adapted? You said you experience this dip in mental alertness and physical energy after a "substantial meal. Remember, digestion is an energy-intensive process.
This is why I think people tend to be semi-comatose after Thanksgiving dinner. It certainly has nil to do with the tryptophan in the turkey. It could be the huge bolus of carbs, but more likely it's just the sheer volume of food, regardless of macronutrients.
You might try just making the meal a little smaller and see what happens. I haven't heard of that kind of experience. Have you looked at your blood sugar before and after the slump? No I haven't, thanks for the suggestion.
I'll check it out! I have tried to adapt to low carb but starting from the point I reduced carbs under grams a day I have had a huge energy crash. I brought it down to under 50 grams at one point and that made the symptoms even worse. I suspect that what I am experiencing is some kind of electrolyte imbalance.
The main symptoms I am suffering from are a complete collapse of energy levels I went from working 14 hours a day to four hours a day, with bouts of unbearable fatigue throughout , absolutely no energy in my muscles and as a result I can no longer do high intensity exercises like sprinting.
Under 50 grams of carbs a day, I started to see the really serious electrolyte issues like change in breathing patterns, cardiac rhythm problems, and muscle cramping. I am prediabetic with A1C around 5. But I had some kind of osmotic reaction to that and it causes loose bowels. A big concern I have with supplementing high doses of electrolytes is that the four major electrolytes need to be in proper balance.
Excess sodium can deplete potassium. Excess potassium can interfere with magnesium. There are ions and corresponding anions to balance. When we get these things from food presumably they are in balance. When we start taking five grams of sodium from celtic sea salt, that makes me think the others need to be brought in the proper balance, and I have no idea what the right balance is. Even Volek and Phinney's book only gives this topic the most shallow treatment. Is there any place to read deeper on this?
The other thing I badly need to identify is a doctor who works with low carb diets and is familiar with these electrolyte issues. I cannot locate one. I have problems even finding nutritionists who specialize in ketogenic or low carb. The doctors who advertise on places like "Low Carb Docs" are either general practitioners with no specialization in diet or low-carb, or mostly chiropractors who again appear to have no specialization in diet.
I clicked on every single profile on the Low Carb Docs list, and not ONE of those had a web site that proclaimed any kind of diet specialization.
In terms of ketones, I measure with a blood serum meter. I don't get many ketones when rising, but usually after a mid-day salad I start piling on extra fat and ketones will get up to 0. No amount of fat eating seems to move me much over that 0.
After 30 minutes of walking, and then only eating fats during and after that exercise, an hour after exercise I can reliably get ketones to 1. I definitely feel better, but the high ketones really just feel like a mask that covers us the energy loss. If I had to make a wild guess, I think what is going on is that my body is shedding both sodium and potassium, and my body has significantly shrunk its fluid volumes.
It's the collapse of fluid volumes that leaves me with the unbearable fatigue. On blood tests during the subgram phases of low carb, my sodium tested at When I am closer to 80 to grams of carbs my sodium tests low normal range.
I'm not a doctor, and all appropriate disclaimers apply. Electrolytes can be very helpful for adaptation, and you should be able to count on your body to correct the ratios, provided you give it enough of each. That is, I wouldn't worry about trying to match your intake ratios to what your body is going to optimally adjust to.
However, I don't think that's your problem! I think you aren't keto-adapted, especially if going all out only gets you to only 0. Staying between 50 and g of carbohydrate is, in my opinion, the worst possible choice.
It's too high to adapt and too low to feel good on a sugar-based metabolism. Amber, I did limit to under 30 grams a day for a month, and that left me literally out of breath, pounding heartbeats, massive fatigue, absolutely disabled. I tried to supplement sodium up to five grams additional in drinking water, which I did not tolerate well because it created some kind of osmotic diarrhea in my gut.
I don't believe that most of the fatigue I experienced was due to ketones. I was losing up to four pounds of body weight just in sleep, never going to the bathroom. That has nothing to do with ketone levels. That has to be a diuretic effect from the diet, and nothing I did could control it. The thing is even increasing my carb levels I have had problems getting back to any kind of baseline.
I have been with these symptoms for five months. I have eaten less than 30 grams for more than a month. Every time I increase carb levels from 30 grams I start to feel a little bit better, but still have not recovered.
This diet has completely messed me up. Low carb or ketogenic is a miracle diet for people who are overweight. They have extra body fluid, so a diuretic is a very beneficial thing for them. But people who start out skinny and don't have any extra fluid to lose have to manage that issue very carefully. It was beyond my skill level, and my experience, to navigate this. For some of us, these diets are very technically challenging diets to implement, and there are simply no good professional resources available to us to help us through it.
Amber, is there any article on the site that shows what the ketone levels are over a 24 hour period, for a keto-adapted person? It would be interesting to see how those numbers ebb and flow over the 24 hour cycle. Well, I'm really sorry you are having such a hard time. It's hard to troubleshoot from afar.
I would have to know a lot more about you to even hazard a guess. I'm pretty confident that your problems are not because you don't have a weight problem. Lots of people who are already in great shape use ketosis to enhance endurance.
I also have at least one friend who keto-adapted quite easily and has never been overweight. I have another friend who had a very hard time on ketosis that turned out to be almost certainly due to adding large amounts of coconut oil to her diet, which she turned out to have an intolerance to, because of the salicylates. So you might look to see if you have greatly increased a food that wasn't part of your regular diet before, that might be triggering an intolerance.
At one point, I think Jimmy Moore was keeping a list of low-carb friendly doctors. You might try looking on his site. I don't have data on the circadian cycle of ketones, but I know they tend to be lowest in the morning and highest in the evening. Best of luck, Amber. The salicylate reaction was an IgE type allergic reaction? My symptoms are extreme, but there are many many people blogging online how they crash on low carb diets.
So that is extremely common. Advocates of these diets always say it is a keto adaptation problem. Yet my ability to lose four to five pounds a night and constantly be dehydrated, even when my ketones were high, tells me that it is just more complex.
At least for some of us I went through Jimmy Moore's list a while back, and none of those people have web sites that convince me they specialize in low carb or ketogenic diets.
You might think about a post in the future documenting ketone levels throughout the day. It would be incredibly useful to anyone who attempts one of these diets to have a target baseline, so they could compare their own results to someone who has been successful with the diet. I understand your frustration. It is very difficult to have a health problem and no answers. I've certainly been in that situation, and it's terrible.
I think the reason people like me who have been in this community a long time will point to keto-adaptation first, is because it is a very common problem. I have had many experiences with people having problems who turned out not to be keto-adapted. Also, your first letter was unclear to me. It sounded like your carb intake was much higher.
Beyond that, it does get complicated, and I'd have to learn a lot of detail about your life, and devote a lot of time. I'm sorry I can't help you further. ACTH stimulates the adrenal cortex to release corticosteroid hormones. LH is also referred to as a gonadotropin. Oxytocin is a strong stimulant of uterine contractions.
What role do the kidneys play in erythropoiesis? The kidneys detect low levels of oxygen in the blood. What triggers erythropoietin EPO production to make new red blood cells? What organ in the body regulates erythrocyte production? Ghrelin, produced by the stomach, is a powerful appetite stimulant.
Many factors influence BMR. What is the most critical factor? The preferred energy fuel for the brain is fat. Which hormone directs essentially all the events of the absorptive state? Which of the choices below happens during the absorptive state? Anabolic processes exceed catabolic ones. Where are oxytocin and antidiuretic hormone ADH made?
Which of the following is not a category of endocrine gland stimulus? Which of the following is not a steroid-based hormone? It does not require a second messenger to effect a response.
Oxytocin and ADH are produced in the posterior pituitary. FSH stimulates sperm production in the testes. Iodine is an essential element required for the synthesis of thyroxine. Thyroid hormone production requires the presence of iodine and calcium. The prime metabolic effect of cortisol is gluconeogenesis. Addison's disease is due to a insufficient output of glucocorticoids only. Hypersecretion of catecholamines can result in hypertension.
How do glucocorticoids enable the body to deal appropriately with stress? The pineal gland is used as a brain orientation landmark for brain X rays. The hormone that raises blood sugar levels is insulin. Which organ is responsible for synthesizing ANP? The beta cells in the pancreatic islets produce insulin. Which of the following is not a cardinal sign of diabetes mellitus? Which of the following hormones suppresses appetite and increases energy expenditure? Most type 2 diabetics do not produce insulin.
What part of the body does erythropoietin EPO target to increase erythropoiesis? Identify the thyroid gland. What is the primary function of hormones? What amino acid-based hormone uses the direct gene activation method illustrated in this image? What is required for the production of anterior pituitary gland hormones? What gland secretes growth hormone? Where is thyroid-releasing hormone TRH made? Which hormone is the body's major metabolic hormone?
What type of cell is shown at letter C? What hormone is released by the cells pictured in letter D? Which of the following would result from hypoparathyroidism? Which of the following is NOT a property of endocrine glands? Which of the following is NOT an endocrine gland? Which letter represents the adrenal glands? At what point does the receptor-hormone complex bind to DNA?
Which of the following is a hormone produced by the posterior pituitary? Which of the following hormones mainly serves to stimulate milk production by the breasts? Which of the following hormones helps the body avoid dehydration and water overload? Major hormones circulate to virtually all tissues.
Where are the hormones oxytocin and antidiuretic hormone ADH stored? What is the target organ of thyroid-stimulating hormone TSH? What is the target organ of thyroid-releasing hormone TRH? Name two hormones produced by the gland identified by letter B. Which of the following hormones regulates blood calcium ion levels? What type of stimulation controls parathyroid release? What cells release parathyroid hormone? Which of the following glands is found atop the kidneys?
What factor inhibits aldosterone release? Which pancreatic hormone functions to lower blood glucose levels? Which of the following best describes the main effects of insulin?
Which of the following is a hypoglycemic hormone? Which hormone is involved in diabetes mellitus DM? Which of the following triggers the release of glucagon? Which hormone can indirectly control insulin release? Which of the following best describes gluconeogenesis? Hormones are long-distance chemical signals that travel in blood or lymph throughout the body. Cyclic AMP and calcium may be second messengers.