Reprinted with the kind permission of Cort Johnson and Health Rising.
I thought that I MUST be in ketosis. I was eating lots of fat, lots of protein and cheating only intermittently. I’d been doing my version of a ketogenic diet for about nine months.
It wasn’t as if I’d prepared for it. I didn’t read any book or even check out any websites. I simply dropped all grains (which tended to put me to sleep), almost all starches (ditto) and all sweets (left me shaky) and ate lots of proteins and vegetables. I’d discovered a new appreciation for the pleasures of fats.
It was true that I hadn’t had the progress that I’d hoped for. I’d hoped for a health revolution and had settled for feeling a bit better. My sugar cravings had disappeared — that was good news even if I wasn’t getting great results. At least I was on a better diet and I was going to stay on it. I’d had enough of those depleted feelings I associated with starches and sugars.
I dipped my ketone test strip into my urine and waited for it to turn the reddish color indicating the moderate ketosis I was sure I was in. Instead I got tan — indicating nothing…no ketosis at all. I doubled down on the fats and proteins over the next couple of days, and I made it into low ketosis (dim reddish purple) and then poof I was back to tan — no ketosis.
I was out of my depth — so, after Lori presented her keto diet success on Health Rising and recommended Keto-Clarity, I picked it up. Boy, did I need clarity and boy, did I get some.
Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet — A Review
If you’re the kind of person who needs studies to validate a treatment, this book may not be for you. Written by a patient and a doctor, the book contains numerous “Moments of Clarity” blurbs from well-known doctors and ketogenic professionals that provide tips. A quick flick through the research section suggested that the pickings were pretty slim. If you’re going to act on the recommendations from this book, you’ll have the take the word of patients and doctors who apply the techniques.
That was fine for me. I found the book to be an easy, informative and entertaining read. It’s not a complete guide — you’re probably going to want to get a recipe book — but it appears to cover the major issues and most importantly, the most common mistakes people make on these diets.
If you’re not aware of what ketosis is, it is a metabolic state that occurs when we consume a very low carbohydrate, moderate protein, high fat diet that causes your body to switch from using glucose as its primary source of fuel to running on substances called ketones. Ketones are produced when our bodies burn fats; i.e. your body is using fats for fuel instead of sugar.
Why make the switch from being a sugar-burner to a fat-burner? Because, the authors assert, our muscles, heart, liver and brain actually do better when they’re running on energy derived from fats. Plus, since your body is now burning fats, even though you’re eating fats, the fat just melts off some people on ketogenic diets. (The author of the book lost 180 pounds in one year.)
Readers should know that many medical providers are not fans of a ketogenic diet. They associate ketosis with a condition called ketoacidosis — a potentially life-threatening condition that can occur in people with Type I diabetes. The authors argue that this condition simply doesn’t apply in people with other diseases.
In fact, proponents of ketogenic and paleo-type diets assert that the American dietary guidelines are backwards. Carbohydrates, including whole grains, beans and potatoes, are something of a historical aberration. Humans evolved eating lots of fatty substances, meat proteins and vegetables — not grains.
The low-fat kick the health profession has been on for decades is similarly backwards. Sugar, not fat, they assert is the big problem in the modern diet. Enormous sugar consumption (in combination with sedentariness) has caused the recent explosion of diabetes.
The authors assert that eating lots of fats is only problematic in the context of a high carbohydrate diet. In the context of a low carb diet, they assert that focusing on fats can make the pounds drop away and improve a legion of diseases from autoimmune disease to Crohn’s disease to chronic fatigue syndrome/fibromyalgia to diabetes. Metabolomics studies in chronic fatigue syndrome (ME/CFS) suggest that ketogenic diets might indeed be helpful.
A ketogenic diet that works for one person, though, might not work for you. A 60 gram carbohydrate and 110 gram protein diet might send one person into ketosis and leave another burning carbs instead of fats for fuel.
Protein is Not Necessarily Your Friend
The idea that a ketogenic diet is synonymous with a high protein diet is simply wrong. In fact, a high protein intake is a no-no on a ketogenic diet (!). Eat too much protein and your body will convert it to glucose (via “gluconeogenesis”) — exactly what the ketogenic diet is trying to avoid.
(Chris Armstrong has stated that gluconeogenesis might be enhanced in ME/CFS. We won’t know until more testing is done but it’s a possibility.) In fact, the possibility that gluconeogenesis is occurring increases when on low carb diets; i.e. people on ketogenic diets need to be careful not to eat too much protein. A common reason for not going into ketosis is eating too much protein.
One doctor suggested eating no more 140 grams of protein a day (and no more than 30 grams per meal) or to consume 1 gram of protein per kilogram per day of your ideal body weight, and then subtracting 10 percent.
Another suggested having 5-10% of your calories coming from carbs, 10-15% of your calories coming from protein, and 75-80% of them coming from fats.
Fat – Yummy, Saturated Fat – Is Your Friend
Contrary to accepted wisdom, the doctors associated with this book state that saturated fat is good. The author of the book eats butter with every meal. Some fats are better than others: monounsaturated fats (butter, coconut oil, avocados, olive oil, red meat, cultured ghee, MCT oil) easily convert to ketones — and, the author says, are anti-inflammatory as well.
Plus, fat is a hunger fighter. If you’re feeling hungry – eat fat! Eating fat is what propelled me through the “keto-flu” stage that some people go through as their bodies go into a ketogenic state. Plus, fat is extraordinarily good at turning off hunger pains.
It takes time — from four days to six weeks — to become “keto-adapted.” For most people, it takes 3-4 weeks for them to start making energy from fats instead of from carbohydrates.
For people with Type I diabetes or gall bladder problems, a ketogenic diet could be dangerous because of the possibility of ketoacidosis.
Although the author doesn’t say so, ketogenic diets just don’t work for some people. Always follow your body.
As your body transitions to ketosis, some people experience symptoms of the “keto-flu” (fatigue, headaches, cough, irritability, nausea, lightheadedness, etc.) which can last from several days to several weeks.
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See one website’s tips for avoiding the keto-flu here, here and here.
Check out some videos on starting out on a keto diet here.
Testing for Ketosis
If You Can — Test, Test, Test
The number one reason for failing on a ketogenic diet is not testing for ketones. People (like me) think they must be in ketosis if they’re on a low carb, high fat diet but it’s not necessarily so. Some people need to tweak their diet further and testing for ketones is the only way to do that.
Urine ketone strips
Pluses – cheap and easy.
Minuses – they only measure one kind of ketone — and not the most critical ketone produced; they could state you’re not in ketosis when you are…
The Gold Standard
Blood Ketone Testers
Pluses – incredibly accurate, plus the ketone testing tool is affordable for most.
Minuses – ketone strips are very expensive; $2-$6 dollars per strip — so not very affordable after all, plus you need to prick a finger.
Blood ketone monitors
Precision Xtra (Abbot) (called FreeStyle Optium in Europe and Australia) — preferred for its greater accuracy.
Nova Max Plus.
Best Overall (???)
Breath Ketone Testing
Ketonix – (Swedish manufacturer) measures acetone in breath — which correlates to levels of the key ketone, beta-hydroxyl-butyrate
Pluses – accurate and affordable for most; no ketone strips needed — but see this review for possible accuracy issues.
Minuses – have to blow into device from 10-30 seconds (not as accurate as blood ketone testers?)
Create Your Own Breath Ketone Analyzer (???)
In 2013, a Swedish engineer created a home-made ketone breath meter (the Ketosense) for about $30 and provided instructions here. The author tried it out and said the results were “remarkably close” to the readings he got on his blood ketone tester.
If You Can’t Afford a Blood or Breath Ketone Tester (or Even If You Can)
Use ketogenic ratio calculator on the Low Carb Flexi Diet (www.flexibleketogenic.com) website to determine how ketogenic your diet is.
Another Idea: Use a Glucometer to Keep You Blood Sugar Low, Low, Low
When your blood sugar goes down, your blood ketones should go up. Keeping your blood sugar low, of course, is a key aim of a ketogenic diet. Plus, it should result in reduced hunger pangs.
The Gist: use a glucometer to monitor which foods send your blood sugar levels up and which keep them low.
The Author’s Story
The author was severely overweight prior to going on the diet, and it sounded like he may have been verging on ME/CFS. Exercise for him was “disastrous” — he would experience dizziness, nausea, fatigue and even black out. It would take him from 7-10 days to recover from a weight-lifting session.
The author’s description of his own ketone testing was highly enlightening. He’d been on a ketogenic diet for 7 years and improved greatly but had never tested. When he found out that he wasn’t in ketosis at all, he was floored. In truth, he wasn’t far from being in ketosis, but testing him allowed him to find his optimum balance of fats, carbs and proteins.
After only a couple of months on the diet, his ability to exercise increased dramatically. Ultimately, he was able to work out without experiencing any dizziness, blackouts, fatigue, etc. He said it took him completely by surprise. He also lost almost 80 pounds the first year of being in ketosis. He also finally got good sleep.
Tests at the doctor’s office revealed that being on a ketogenic diet significantly dropped his blood sugar levels, reduced levels of bad fatty acids and increased levels of good ones, and reduced inflammation. Plus, despite being on a very high saturated fat diet, a CT scan revealed no build-up on his coronary arteries.
Metabolomics and anecdotal evidence suggests that ketogenic diets may be helpful in ME/CFS and FM. “Keto-Clarity” is a well-written and enjoyable book that will help keto beginners to transition to ketosis. It explains the basics of ketosis and ketogenic diets, and more importantly, explains why some people on “ketogenic diets” may not be entering ketosis. The book also provides a helpful 21 Day Kickstarter Menu and some recipes that can get a new ketogenic dieter started. An avid ketogenic dieter will probably want to purchase a separate recipe book.
About the Author: ProHealth is pleased to share information from Cort Johnson. Cort has had myalgic encephalomyelitis /chronic fatigue syndrome for over 30 years. The founder of Phoenix Rising and Health Rising, he has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort's and other bloggers' work at Health Rising.