I’ve spent a lot of time lately analysing three thousand ketone vs glucose data points trying to determine the optimal ketone and blood sugar levels for weight loss, diabetes management, athletic performance and longevity.
In this article, I share my insights and learnings on the benefits, side effects and risks of endogenous and exogenous ketosis.
- Exogenous vs. endogenous ketosis
- Ketones vs glucose
- What our ketone and glucose values tell us about our metabolic health
- hyperinsulinemia and metabolic disorders
- exogenous ketones and the low carb flu
- My experience with exogenous ketones
- Do exogenous ketones help with weight loss?
- Metabolically healthy
- total energy = ketones + glucose
- MORE investigation required?
- The lower the better?
- Fast well, feed well
- the real magic of ketones
- nutrient density
- the best exogenous ketone supplement
- More
- References
Exogenous vs. endogenous ketosis
But first, I think it’s important to understand the difference between exogenous and endogenous ketosis:
- Endogenous ketosis occurs when we go without food for a significant period. Our insulin levels drop, and we transition to burning body fat and ketones in our blood rise.
- Exogenous ketosis occurs when we drink exogenous ketones or consume a ketogenic diet.
Ketones vs glucose
Ketones are important. As blood glucose decreases, the ketones in your blood increase to keep your energy levels stable.
The chart below shows three thousand blood glucose vs ketone values measured at the same time from a range of people following a low carbohydrate or ketogenic diet.
While there is generally a linear relationship between glucose and ketones, each person has a unique relationship between their blood glucose and ketone values that provide a unique insight into a particular person’s metabolic health.
Some people produce more ketones than others. Some people have higher blood glucose levels.
What our ketone and glucose values tell us about our metabolic health
Hyperinsulinemia has been called as the “unifying theory of chronic disease“ [1] [2] [3] [4] [5]. It’s beneficial to understand where you stand on the spectrum of metabolic health and insulin sensitivity.
The chart below shows the typical relationship between blood glucose and blood ketone for a range of different degrees of insulin resistance/sensitivity.
If your blood glucose levels are consistently high, it’s likely you are not metabolising carbohydrates well. When you go without food, endogenous ketones are slow to kick in because your insulin levels are also high. You feel tired and hungry, and you are likely to eat again sooner and not stop until you feel good.
By contrast, if you are insulin sensitive, you may be able to go longer between meals naturally, and you will not feel as compelled to eat as much or as often. If someone is insulin resistant, a lower insulin load dietary approach will help with satiety and carb cravings while keeping blood glucose levels and insulin under control.
hyperinsulinemia and metabolic disorders
Exciting research is underway looking at the use of EXOGENOUS ketones as an adjunct treatment for cancer or to provide energy directly to the mitochondria for people with epilepsy, dementia, Alzheimer’s and the like.[6] [7]
EXOGENOUS ketones may help to relieve the debilitating symptoms and side effects of acute hyperinsulinemia, Alzheimer’s, dementia, epilepsy or other conditions where glucose is not used well.
exogenous ketones and the low carb flu
Patrick Arnold, who worked with Dr Dominic D’Agostino to develop the first ketone esters and ketone salts, has noted that exogenous ketones may help alleviate the symptoms of the ‘keto flu’ during the transition from a high carb to a low carb dietary approach.
However, once you have successfully transitioned to a lower-carb eating style it may be wise to reduce or eliminate the exogenous ketones to enable your body to fully up-regulate lipolysis (fat burning), maximise ENDOGENOUS ketone production and access your body fat stores.
As discussed in the article Are ketones insulinogenic and does it matter? it exogenous ketones require about half as much insulin as carbohydrate to metabolise (or about the same amount as protein). Hence the continual use of exogenous ketones will limit how much our insulin levels are able to decrease.
Someone with diabetes who follows a nutrient-dense low insulin load dietary approach may be able to successfully normalise their blood glucose and insulin levels. When this happens, your liver will be able to more easily produce ENDOGENOUS ketones which will help improve satiety between meals and decrease appetite which will, in turn, lead to weight loss.
Exercising to train your body to do more with less is also helpful.
My experience with exogenous ketones
The light blue “mild insulin resistance” line is based on my ketone and glucose tests when I started trying to wrap my head around low carb/keto.
I enthusiastically started adding generous amounts of fat from all the yummy stuff (cheese, butter, cream, peanut butter, BPC etc) in the hope of achieving higher ketone levels and therefore weight loss, but I just got fatter and more inflamed as you can see in the photo on the left.
My blood tests suggested I was developing fatty liver in my mid-30s! And I thought I was doing it right with lots of bacon and BPC?!?!?
The photo on the right is after I worked out how to decrease the insulin load of my diet and learned about intermittent fasting. I realised that ENDOGENOUS ketosis and weight loss are caused by a lower dietary insulin load, not more EXOGENOUS fat on your plate or in your coffee cup.
I recently had my HbA1c tested at 4.9%. It’s getting there. But knowing what I know now about the importance of glucose control, I would love to lose a bit more weight and see my HbA1c even lower.
I initially purchased a couple of bottles of KetoCaNa after hearing a number of podcast interviews with Dominic D’Agostino and Patrick Arnold.[8] [9]
Part of the reason for shelling out the money for the exogenous ketones was to see if it would provide a fuel source that didn’t need insulin for my wife Monica who has Type 1 Diabetes.
This metabolic jet fuel is definitely fascinating stuff! My experience is that it gave me a buzz like a BPC but also has an acute diuretic effect.
I had hoped it would have a weight loss effect like some people seemed to be saying it would.
I did find it had an amazing impact on my appetite. While it was in my system I didn’t care as much about food. However, once the ketones were used up my appetite came flooding back.
Unfortunately, my hunger and subsequent binge eating seemed to more than offset the short term appetite suppression that had occurred while the exogenous ketones were in my system. And it was not going to be financially viable for me to maintain a constant level of artificially elevated ketone levels which return to normal levels after a couple of hours.
Do exogenous ketones help with weight loss?
I asked around to see if anyone had come across studies demonstrating long term weight loss effects of exogenous ketones.[11] It was a VERY enlightening discussion if you want to check it out here.
The Pruvit FAQ says that one of the benefits of Keto//OS is weight loss. However, no reference to the research studies was provided to prove his claim.
Also, the studies that were referenced in the Pruvit FAQ all appeared to relate to the benefits of ENDOGENOUS or nutritional ketosis rather than EXOGENOUS ketone supplementation.
According to Dominic D’Agostino in a Pruvit teleseminar, the EXOGENOUS ketone salts were not designed to be a weight loss product and hence have not been studied for weight loss after all!
The only studies that we could find that mentioned EXOGENOUS ketone supplementation and weight loss were on rats and they found that there was no long-term effect on weight loss.[12]
So in spite of my hopeful $250 outlay, it seems that exogenous ketones ARE just a fuel source after all.
Even the experts don’t seem to think exogenous ketones help with fat loss.
Confused?
I don’t blame you.
Metabolically healthy
The “metabolically healthy” line in the chart above is based on RD Dikeman’s ketone and glucose data when he fasted for 21 days.
Due to his hard-earned metabolic health and improved insulin resistance RD has developed the ability to fairly easily release ketones when he doesn’t eat for a while. RD still doesn’t find going without food effortless, but it is easier than when his insulin levels were much higher which prevented his body from accessing his body fat stores.
Through a disciplined diet and exercise habits RD has achieved a spectacular HbA1c of 4.4%.
Perhaps a two or three-day water-only fast testing blood glucose and ketones with no exercise would be a useful test of your insulin status? You could use RD’s glucose: ketone gradient as the gold standard.
RD also told me that when he is not fasting and is eating his regular nutrient-dense higher protein meals his ketone levels are not particularly high. While RD fairly easily produces ketones when fasting, it seems they are also quickly metabolised so they do not build up in his bloodstream.
I know Ketogains’ Luis Villasenor finds the same thing.
total energy = ketones + glucose
Where this gets even more interesting is when we look at the glucose and ketone data in terms of TOTAL ENERGY. That is, the energy comes from both glucose and ketones.
The average TOTAL ENERGY of the three thousand data points from these healthy people working hard to achieve nutritional ketosis is around 6.0mmol/L. It seems the body works to maintain homoeostasis around this level.
When the TOTAL ENERGY in our bloodstream increases outside of the normal range the body raises insulin to store the excess energy. That is unless you have untreated type 1 diabetes, in which case you end up in diabetic ketoacidosis with high blood glucose and high ketones due to the lack of insulin available to keep your energy in storage.
Regardless of whether your energy takes the form of glucose, ketones or free fatty acids, they all contribute to acetyl-CoA which is oxidised to produce energy. Forcing excess unused energy to build up in the bloodstream is typically desirable and can lead to long-term issues (e.g. glycation, oxidised LDL etc).
I’m not sure if ketones can be converted to glucose or body fat, but it makes sense that excess glucose would be converted to body fat via de novo lipogenesis to decrease the TOTAL ENERGY in the bloodstream to normal levels.
A number of studies seem to support this view including Roger Unger’s 1964 paper the Hypoglycemic Action of Ketones. Evidence for a Stimulatory Feedback of Ketones on the Pancreatic Beta Cells.[14]
Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively. Ketones also have a direct inhibitory effect on lipolysis in adipose tissue.[15]
Looking at the glucose and ketones together in terms of TOTAL ENERGY was a bit of an ‘ah ha’ moment for me. It helped me to understand why people like Thomas Seyfried and Dominic D’Agostino always talk about the therapeutic benefits and the insulin-lowering effects of a calorie-restricted ketogenic diet. [19] [20] [21] [22]
Dealing with high ketones and high glucose is typically not a concern because it doesn’t happen in nature or when eating whole foods. But now we have refined grains, HFCS, processed fats and exogenous ketones to ‘bio hack’ our metabolism and send it into overdrive.
While fat doesn’t normally trigger an insulin response, it seems that excess unused energy, regardless of the source, will trigger an increase in insulin to reduce the TOTAL ENERGY in the bloodstream.
I am concerned that if people continue to enthusiastically zealously focus on pursuing higher blood ketones “through whatever means you can“[24] in an effort to amplify fat loss they will promote excess energy in the bloodstream which will lead to insulin resistance and hyperinsulinemia.
Using multi-level marketing tactics to distribute therapeutic supplements to the uneducated masses who are desperate to lose weight with a ‘more is better’ approach also troubles me deeply.
MORE investigation required?
There are anecdotal reports that exogenous ketones provide mental clarity, enhanced focus and athletic performance benefits. At the same time, there are also people who have been taking these products for a while that don’t appear to be doing so well.
A July 2016 study Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? didn’t find that EXOGENOUS ketones to be very exciting.
Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.
However, another study by Veech et al (who is trying to bring his own ketone ester to market) from August 2016 Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes found in favour of ketones.
Ketosis decreased muscle glycolysis and plasma lactate concentrations, while providing an alternative substrate for oxidative phosphorylation. Ketosis increased intramuscular triacylglycerol oxidation during exercise, even in the presence of normal muscle glycogen, co-ingested carbohydrate and elevated insulin. These findings may hold clues to greater human potential and a better understanding of fuel metabolism in health and disease.
I can understand how exogenous ketones could be beneficial for someone who is metabolically healthy and consuming a disciplined hypo-caloric nutrient-dense diet. They would likely be able to auto-regulate their appetite to easily offset the energy from the EXOGENOUS ketones with less food intake.
While it seems that EXOGENOUS ketones assist in relieving the symptoms of metabolic disorders I’m yet to be convinced that someone who is obese and/or has Type 2 Diabetes would do as well in the long term, especially if they were hammering both more fat and exogenous ketones (along with maybe some sneaky processed carbs on the side) in an effort to get their blood ketones as higher in the hope of losing body fat.
Some questions that I couldn’t find addressed in the Pruvit FAQ that I think would be interesting to answer through a controlled study in the future are:
- What is the safe dose limit of EXOGENOUS ketones for a young child? How would you adjust their maximum intake based on age and weight?
- IF EXOGENOUS ketones do have a long term weight loss effect what is the upper limit of intake of EXOGENOUS ketones to avoid stunting a child’s growth?
- Is there a difference in the way EXOGENOUS ketones are processed in someone is metabolically healthy versus someone who is very insulin resistant?
- Does the effect on appetite continue beyond the point that the ketones are out of your system?
- Do you need to take EXOGENOUS ketones continuously to maintain appetite suppression? Does the effect of ENDOGENOUS wear off as your own ENDOGENOUS ketone production down regulates? Do you need to keep taking more and more EXOGENOUS ketones to maintain healthy appetite control?
- How should someone with Type 2 Diabetes adjust their medication and insulin dose based on their dose of EXOGENOUS ketones? Should they be under medical supervision during this period?
- Is there a difference in health outcome if you are taking EXOGENOUS ketones in the context of a hypocaloric ketogenic diet versus a hypercaloric ketogenic diet? What about a diet high in processed carbs?
- Is there a minimum effective dose to achieve optimal long term benefits to your metabolic health or is MORE better?
- Are the long term health benefits of EXOGENOUS ketones equivalent to a calorie restricted ketogenic diet?
Unfortunately, I think we will find the answers to these questions sooner rather than later with the large scale experiment that now seems to be well underway.
Perhaps the burden of proof is actually on Pruvit to prove it rather than getting their Pruvers to demonstrate that within 59 minutes they are successfully peeing out the product they’ve just paid some serious money for!
The lower the better?
Alessandro Ferretti recently made the observation that metabolically healthy people tend to have lower TOTAL ENERGY levels at rest (and hence have a lower HbA1c), but are able to quickly mobilize glycogen and fat easily when required (e.g. when fasting or a sprint).
Metabolically healthy people are both metabolically flexible[25] and metabolically efficient.[26] These people would have been able to both conserve energy during a famine and run away from a tiger and live to become our ancestors, while the ones who couldn’t didn’t.
Similar to RD Dikeman, John Halloran is an interesting case. He has been putting a lot of effort into eating nutrient dense foods, intermittent fasting and high-intensity exercise.
He is also committed to improving his metabolic fitness to be more competitive in ice hockey. His resting heart rate is now a spectacular 45 bpm!
And he’s been able to lose 10kg (22lb) in one month!
At 5.2mmol/L (i.e. glucose of 4.0mmol/L plus ketones of 1.2mmol/L) John’s TOTAL ENERGY is well below the average of the 26 people shown in the glucose + ketone chart above. It seems excellent metabolic health is actually characterised by lower TOTAL ENERGY.
MORE is not necessarily BETTER when it comes to health.
Fast well, feed well
To clean up the data a little I removed the ketones vs glucose data points for a couple of people who I thought might be suffering from pancreatic beta-cell burnout and one person that was taking exogenous ketones during their fast that had a higher TOTAL ENERGY. I also removed the top 30% of points that I thought were likely high due to measuring after high-fat meals or coffee.
So now the chart below represents the glucose and ketone values for a group of reasonably metabolically healthy people following a strict ketogenic dietary approach, excluding the effect of high-fat meals, BPC, fat bombs and the like.
The average ketone value for this group of healthy people trying to live a ketogenic lifestyle is 0.7mmol/L. Their average glucose is 4.8mmol/L (or 87mg/dL). The average TOTAL ENERGY is 5.5mmol/L or 99mg/dL.
|
ketones (mmol/L) |
blood glucose (mmol/L) |
total energy (mmol/L) | |
| average |
0.7 |
4.8 |
5.5 |
| 30th percentile |
0.4 |
4.6 |
5.2 |
| 70th percentile |
0.9 |
5.1 |
5.8 |
The table below shows this in US units (mg/dL).
| ketones |
blood |
total | |
| average |
0.7 |
86 |
99 |
| 30th percentile |
0.4 |
83 |
94 |
| 70th percentile |
0.9 |
92 |
104 |
It seems we may not necessarily see really high ketone levels in our blood even if we follow a strict ketogenic diet, particularly if we are metabolically healthy and our body is using to ketones efficiently.
the real magic of ketones
When we deplete glucose we train our body to produce ketones.
This is where autophagy, increased NAD+ and SIRT1 kicks in to trigger mitochondrial biogenesis and ENDOGENOUS ketone production (i.e. the free ones).[27] The REAL magic of ketosis happens when all these things happen and ketones are released as a byproduct.
I do not believe that simply adding EXOGENOUS ketones will have nearly as much benefit to your mitochondria, metabolism and insulin resistance as training your body to produce ENDOGENOUS ketones in a low energy state.
Everything improves when we train our bodies to do more with less (e.g. fasting, high-intensity exercise, or even better fasted HIIT). Resistance to insulin will improve as your insulin receptors are no longer flooded with insulin caused by high TOTAL ENERGY building up in your bloodstream (i.e. from glucose, ketones and even free fatty acids).
Driving up ketones artificially through EXOGENOUS inputs (treating the symptom) does NOT lead to increased metabolic health or mitochondrial biogenesis (cure) particularly if you are driving them higher than normal levels and not using them up with activity.
You may be able to artificially mimic the buzz that you would get when the body produces ketones ENDOGENOUSLY, however, it seems you may just be driving insulin resistance and hyperinsulinemia if you follow a “MORE is better” approach.
Simply managing symptoms with patented products for profit without addressing the underlying cause often doesn’t end well.
Perhaps as more exogenous products come to market without the marketing hype that comes with a multi-level marketing (e.g. Julian Baker’s Insta Ketone which is a sixth of the price of the Pruvit products) people will get to see if they really do anything useful.
Just like having low blood glucose is not necessarily good if it is primarily caused by high levels of EXOGENOUS insulin coupled with a poor diet or having lower cholesterol due to statins, having high blood ketone values is not necessarily a good thing if it is achieved it by driving up the TOTAL ENERGY in your bloodstream with high levels of purified fat and/or EXOGENOUS ketones.
nutrient density
When we feed our body with quality nutrients we maximise ATP production which will make us feel energised and satisfied. Nutrient-dense foods will nourish our mitochondria and reduce our drive to keep on seeking out nutrients from more food.
Greater metabolic efficiency will lead to higher satiety, which leads to less food intake, which leads to a lower TOTAL ENERGY, increased mitochondrial biogenesis, improved insulin sensitivity and lower blood glucose levels.
Prioritising nutrient-dense real food is even more important in a ketogenic context.[28] While we can always take supplements, separating nutrients from our energy source is never a great idea, whether it be soda, processed grains, sugar, glucose gels, HFCS, protein powders, processed oils or exogenous ketones.
the best exogenous ketone supplement
If your goal is metabolic health, weight loss and improving your ability to produce ENDOGENOUS ketones, then developing a practice of FEASTING and FASTING is important.
To start out, experiment by extending your fasting periods until your TOTAL ENERGY is decreasing over time. This will cause your circulating insulin levels to decrease which will force your body to produce ENDOGENOUS ketones from your ENDOGENOUS fat stores.
Check out the how to use your glucose meter as a fuel gauge article or how to use your bathroom scale as a fuel gauge for some more ideas on how to get started with fasting.
If you want to measure something, see how low you can get your glucose levels before your next meal. Then when you do eat, make sure you choose the most nutrient-dense foods you possibly can to build your metabolic machinery and give your mitochondria the best chance of supporting a vibrant, active and happy life.
As my wise friend Raymund Edwards keeps reminding me, FAST WELL, FEED WELL.
More
References
[1] http://www.thefatemperor.com/blog/2015/5/6/the-incredible-dr-joseph-kraft-his-work-on-type-2-diabetes-insulin-reigns-disease
[2] http://www.thefatemperor.com/blog/2015/5/10/lchf-the-genius-of-dr-joseph-r-kraft-exposing-the-true-extent-of-diabetes
[3] https://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/
[4] https://www.amazon.com/Diabetes-Epidemic-You-Joseph-Kraft/dp/1425168094
[5] https://www.youtube.com/watch?v=193BP6aORwY
[6] http://fourhourworkweek.com/2016/07/06/dom-dagostino-part-2/
[7] http://www.thelivinlowcarbshow.com/shownotes/10568/848-dr-dominic-dagostino-keto-clarity-expert-interview/
[8] http://superhumanradio.com/579-shr-exclusive-patrick-arnold-back-in-the-supplement-business.html
[9] http://superhumanradio.com/shr-1330-best-practices-for-using-ketone-salts-for-dieting-performance-and-therapeutic-purposes.html
[10] http://docmuscles.shopketo.com/
[11] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/
[12] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0069-y
[13] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/
[14] https://www.dropbox.com/s/287bftreipfpf29/jcinvest00459-0078.pdf?dl=0
[15] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/
[16] https://www.facebook.com/BurnFatNotSugar/
[17] http://www.dietdoctor.com/obesity-caused-much-insulin
[18] http://www.lowcarbcruiseinfo.com/2016/2016-presentations/Hyperinsulinemia.pptx
[19] http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0115147
[20] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/
[21] http://healthimpactnews.com/2013/ketogenic-diet-in-combination-with-calorie-restriction-and-hyperbaric-treatment-offer-new-hope-in-quest-for-non-toxic-cancer-treatment/
[22] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjK8Jvku7DOAhUJspQKHS5-DkwQFggbMAA&url=http%3A%2F%2Fwww.rsg1foundation.com%2Fdocs%2Fpatient-resources%2FThe%2520Restricted%2520Ketogenic%2520Diet%2520An%2520Alternative.pdf&usg=AFQjCNFuTA7xmWX1pFr6wBTV_hsS7C5j_w&sig2=pcBN_f_kCLSgFKYUy–uug&bvm=bv.129391328,d.dGo
[23] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R9%22%7D&pnref=story&hc_location=ufi
[24] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R4%22%7D&hc_location=ufi
[25] http://guruperformance.com/episode-3-metabolic-flexibility-with-mike-t-nelson-phd/
[26] http://guruperformance.com/tag/metabolic-efficiency/
[27] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852209/
[28] http://ketotalk.com/2016/06/23-responding-to-the-paleo-mom-dr-sarah-ballantynes-claims-against-the-ketogenic-diet/
Reblogged this on Low Carb in Lowlands.
Great article Marty!! I’ve had people talk about the exogenous ketone crap… And for the life of me, never got how that would help your body learn to USE ketones… You can have plenty of ketones in your system, but if it’s not given to a body that prefers them … How is that even helping in energy needs? a color on urine stick means nothing…
Myself…. I average a 85 blood sugar … And a .7 blood ketone level… And my A1C was just 5.2.
My highest A1C was 6.9.. On drugs and 60 lbs heavier.
That’s what a ketogenic lifestyle and intermittant fasting (19/5) can do for a type 2!
Love your scientific mind !
Thorough, concise, BRILLIANT
For the last couple of years (as long as we’ve had the ability to measure ketones), Hubby has always been .01 no matter how I fed him, and no matter how low his blood sugar. Keto O/S only served to raise him to .02, and that was all. Pretty expensive stuff just to get another .01 from him.
We moved on to KetoCaNa-that stuff tastes like you’re drinking pure solvent!
At this point, we just quit measuring Hubby’s ketones. At least he wasn’t GAINING weight! Measuring him seemed to be a waste of test strips.
Last week, I switched brands of milk thistle (a liver cleaner supplement). When Hubby started taking the new stuff, we saw action–not real weight loss, but GIRTH loss, and rapid girth loss at that. So much so that he had to take his belts down to the leather shop to have them shortened and more holes punched on the inside. I’m also haunting thrift stores looking out for smaller waist size pants. FINALLY–SOME ACTION! After another week of this, I may return to testing his ketones just to see what’s what.
As for me, I found that the lower my blood sugar, the higher my ketones, and that acetone breath usually means a level around 1.5 or better. Needless to say, I also quit testing for ketones–I feel I have no need of it any more, because the diet does all the hard work. All I test for is blood sugar, and for me, that’s indicator enough.
” I switched brands of milk thistle (a liver cleaner supplement). When Hubby started taking the new stuff, we saw action-not real weight loss, but GIRTH loss, and rapid girth loss at that.” What is the new brand? I’ve taken milk thistle before but never noticed any results. Had Malathion poisoning back in 1989, so I’m always looking for nice things to do for my damaged liver.
Hi! I just started on Milk Thistle supplement and since you are so happy with the new brand you switched your husband to, I’d like to give it a go as well. Would you kindly provide the brand name? Thank you!
Hello.
I have taken various brands of milk thistle to support liver health. Do you mind sharing the brand you used to shrink your hubby’s waist?
Thank you.
Lisa
Thank you for offering a comprehensive and balanced view on ketosis and health. More (higher ketones) does not equal optimal and that is often forgotten.
Your work and writing are greatly appreciated. I wish more people would look to achieve optimal levels for their health and objectives and not a silver bullet to be everything to everyone.
thank you for the great article! really appreciate it.
I forgot to add in my comment – I do regularly consume Ketocana but not to chase a ketone level.
I can’t recommend for weight loss but I can give a huge recommendation for using it for an edge in physical performance*. I find significant improvement in physical performance and respiratory capability when I take KetoCaNa before working out or yoga.
*I cannot say it works for everyone since I have been in a nutritional ketosis state for over 2 years (defined as fasting blood ketones of over 0.5; I test every single morning). Another caveat is that I am underweight so I don’t have much body fat to convert.
Any thoughts on what to do when fasting raises blood glucose levels? My morning fasting levels are around 115-120 mg/dL and lower to around 90 mg/dL by the time I eat at 6pm. I had normal BG levels (70-80) before implementing fasting. I’ve been keto for 16 months and fasting regularly since February of this year.
Physiologic insulin resistance is not a big concern and can improve with further IF. https://optimisingnutrition.com/2015/06/08/physiological-insulin-resistance-and-coffee-addiction/
Thank you.
Any thoughts on C8 MCT oil? Would you consider that a supplement, food, or some of each?
By the way I agree that as a general principle it is better to let the finely tuned metabolic machine do its work rather than carpet bomb the mitochondria with various supplements.
Cool round-up of a lot of… stuff.
Dunno if I’d say “as BG decreases your ketones rise to compensate” – there’s no guaranteed mechanism whereby if your glucose tanks that ketones will magically increase to take up the slack. Worth noting that the levels aren’t really super comparable – otherwise we get into the fallacious simplified logic that was the disaster known as “calories”, eg carbs/protein have the “same” energy value therefore steak is the same as chocolate cake.
However, if ketones are present in high enough amounts (whatever that is), then there’s as yet unknown lower limits to asymptomatic BG. Great study around somewhere where some folks BG was lowered to what we’d consider comatose/dead levels, but they were ketotic up the wahoo and presented no symptoms.
I don’t chase numbers, but sometimes get close to “parity” just living my simple meaty existence:
https://twitter.com/AshSimmonds/status/663586047347965952
Your ketone values for nutritional ketosis tend to fall as you approach target weight. The key is that although overall levels are falling with weight, you are still in nutritional ketosis at all times. I don’t see how adding endogenous ketones changes anything, or am I missing something??
Comprehensive post 🙂
Absolutely fantastic post, Marty. thanks for all the work you do.
I like your long-form posts, your line of reasoning is clearer that way. Good one! 🙂
You say “maximise nutrient density as much as possible while working within the limits of your metabolic health and your pancreas’ ability to maintain normal blood glucose levels”. I agree.
==> There may be a few implicit assumption here – correct me if I’m wrong – that 1) to maximize the nutrient density of ones diet a significant portion of micronutrients will have to come from plant food and 2) thus most likely incurring a non-trivial amount of carbohydrate.
If 1 is valid then 2 follows (for the most part).
However, to determine if 1 is valid, we need to assess micronutrients in terms of their bioavailability to the relevant species (humans obviously). Although I already mentioned this consideration as essential to the evolutionary robustness of your nutrient density model, I reiterate it here because I’m guessing it’ll change the picture considerably. Or I’m wrong and it won’t, but either way, micronutrient bioavailability must be factored in.
Studies to get data on how to do this aren’t nearly as numerous as we’d want but there are a few to get you started. I really should dig some out for you but cannot do it right now – promise I will eventually!
Cheers Marty
As I’ve mentioned before, the nutrient density analysis is based on the values in the USDA food database which does not account for bioavailability. I have searched but have been unable to find anything to help account for this. Personally I don’t mind if you eat plant or animal based products. The system helps prioritize the optimal options from each group, and perhaps most importantly highlight clearly what we should be avoiding.
>perhaps most importantly highlight clearly what we should be avoiding
The “perhaps” is the only thing wrong with this statement. 🙂
95% of the battle is knowing what *not* to do. The other 5% is tweaking for personal lifestyle optimisation.
Yup.
I am sympathetic to your comments about Pruvit using the MLM business model to promote this supplement to the desperate, quote: “my heart sank when I saw the video”. This also made me nod sadly. I too see the MLM business model as a thinly veiled pyramid scheme which preys on the vulnerable and ultimately is a money making scam for those at the top of the pyramid. The fact that there may be concerns about its effectiveness, even worse, its safety, is irrelevant to those selling it.
Was really sad to see even Jimmy get sucked into this.
https://twitter.com/CarnivoresCreed/status/671440473404399616
Yes indeed! The more disturbing question is whether exogenous ketones will down regulate your own ability to produce endogenous ketones and potentially leave you more insulin resistant and less able to regulate your appetite unless you keep taking them. We might find out soon enough with the current large scale experiment.
Hi Marty. I have the exact same concerns – by supplementing with exogenous ketones do you downregulate your own ability to make your own. While this may or may not have an effect on insulin resistance, there is the risk of dependency upon them. I suspect that exogenous ketones do have a place, including getting people through the worst of the ketone flu, and possibly with some of the neurocognitive disorders and maybe as an athletic supplement. However, we have evolved without them so are they needed for healthy day-to-day living?
Thanks Catherine. I really do think these powerful therapeutic supplements have a place and are really exciting new technology.
It would be a shame if they became regulated and less accessible to the people who really need them or had damaging consequences through excessive use by people who don’t need them.
💡!
Makes such sense! Thank you for this data/article (found you through Ivors link). In a nutshell I’ve been wondering about my lower ketone levels….but I’m seeing such an increase in strength/body fat loss etc. this certainly shines a light on the pathophysiology of this process!! ðŸ‘ðŸ»ðŸ‘ðŸ»
So basically, as with insulin, antibiotics, wine, etc (and now ketones) more is just more and not better? Or have I misunderstood? I really appreciate your research and informative posts, thanks!
Just drinking ketone salts without a proper ketogenic diet is only beneficial if one needs ketone therapy or to avoid oxygen toxicity.
That said, ketone supplements like MCT and BHB salts (exogenous ketones) have their place inside the Keto diet. They will bolster ketone production and work at different levels.
Specifically, C-8 will elevate ketones more than C-8/C-10 blends and exogenous ketones more than C-8 and the combination of MCT and BHB the most. I recommend using a combination or pure C-8 whilst adapting in small amounts to help through the process. They can also be used as a preworkout or help push through a fast, lift brain fog or even as an energy boost. They also have therapeutic benefits.
That said, ketone supplements are no different than any other supplement, the minimal effective dose is all that’s needed. Moreover, be cognizant that in the presence of exogenous ketone supplements, endogenous energy needs will be diminished and can therefore actually hinder fat loss.
While I’m unsure they actually speed up adaptation, I am positive they help through the process by way of increased energy, mental cognition, appetite suppression and just help mitigate all the symptoms of early adaptation.
Furthermore I do recommend using 1-2 tbls of MCT to many folks in their daily routine, just being sure to fit it in their macros.
The bigger picture is this, while yes NPs turn on the pathways to lipolysis via exogenous ketones, there’s not data to my knowledge showing a volume effect, it’s only on or off. In addition, excess energy is still excess energy the body has to do something with it; again the Ketone fairies don’t just wisp it away.
Beyond that increased BHB can actually stall lipolysis in a couple of different ways, one by stopping ketogenisis because the abundance of energy signals the liver to slow or stop ketone production. And two, because when you artificially drive BHB too high without lowering BG simultaneously the body will release insulin to prevent ketoacidosis(while this is likely not possible the body has systems in place to prevent it), and therefore slow or stunt lipolysis.
Even Dom D’Agostino himself says that exogenous ketones do NOT promote fat loss.
This is why I always say that the minimal effective dose of any supplement is all that’s required.
Technically you could just restore the fat you just released from adipose tissue that would have resulted in fat loss because you had too much MCT or BHB.
So, if you drive ketones too high from exogenous sources like MCT or BHB, you can actually stall lipolysis. Ketones don’t cause fat to burn, rather they are the result of fat being burned in the form of fuel. As I mentioned they also turn on a pathway to lipolysis via natriuretic peptides, but here’s the rub, the ketones open the pathway, the fat molecules are released, but there’s enough exogenously created ketones(MCT) or exogenous ketones(BHB) to fuel the body, the released fats are not needed and repackaged up and restored. If there’s any other fat consumed, it gets stored too.
To sum it all up, elevated ketones are not a natural state unless the glucose levels are in balance and therefore artificially elevated ketones through supplementation for the goal of fat loss will often times have an opposite effect due to the likely insulin secretion and thus shunting lipolysis and/or excess energy and the body burning the exogenously created or ingested ketones preferential since they cannot be stored. In fact in my anecdotal experience and that of others around me they can and will cause weight gain, not just stalled fat loss and I’m not referring to increased lean mass.
Now, I do again believe they have a place and have seen them be effective in reducing BG, increasing insulin and leptin sensitivity and help many people more rapidly and easily get through adaptation, but beyond that period, their usefulness seems to greatly diminish. It may be beneficial for those that are more metabolically damaged to continue their limited use, but even then I recommend using a minimally effective dose. So the KEY here is to be mindful of the use of exogenous ketones and MCT along with dietary fat intake, especially when fat loss is the goal.
https://www.facebook.com/groups/ketosavedmegroup/
https://www.youtube.com/c/ketosavedme
Really nice article. Do you notice a difference in the amount of exercise you can do in a fed or energy depleted state? Is that improving?
Also do you every have a day where you just make sure that you remain insulin sensitive. Eat lots of carbs and let the insulin rip? Sort of a TIm Ferriss-esque cheat day?
I’m currently on day seven of a fast (my longest yet). I feel good but the workout power is definitely lower. Maybe this would improve with time? I don’t really eat bread or sugar but I definitely enjoy good food when it’s available. There’s no specific binge day. I just try to listen to my appetite.
Thank you, reducing total energy is so confusing, they say you can eat as much as you want “low carb” which is not the case for me. Then I’m afraid I’ll ruin my metabolism if I count calories and keep it nutritionally dense of coarse, low carb doctors say dont count calories, but then fasting is good for you, which has been proven, so why can’t I keep calories low and do low carb, but then again I think oh no, I’ll ruin my metabolism and get fat again!
If I’m reading your article right, you are reducing calories, eating nutritional dense food, low carb, HIIT, and fasting and finding success.
Yes! 🙂
Just to be not difficult; I have oodles of measurements (glucose, acetone (ketonix) and weight twice a day and blood ketones on most days (hate the expense, but hate the ketonix unpredictability even worse). I use weekly averages for arguments sake (so 14 measurements per week) and I was diabetic (H = 56) when I started).
It is now week 23 of a strict LCHF diet (5,20,75) and I have lost 18 kg (18% of me), brought my H down to 37 (goodbye diabetes) and feel generally OK (nothing special). My Blood ketones were 1.8 mmol ONCE and average 0,222 mmol over the entire period I have been in ketosis (from week 2). The last weeks average ? glucose 6 mmol, BK 0.4 and 0.6 kg less weight.
Ketone Supplements to lose weight are probably nonsense…..
Wow, what a great article and looks like will save me a whole lot of time and effort experimenting! Thanks for sharing!
Thanks Graham. Glad you found it useful.
Hi Marty,
This is a great article. Great to confirm my numbers show I’m in the OK range.
Would you like some numbers? I have Ketonix numbers with them, although I tend to cheat by measuring after my second fast day.
Michel Lundell seems to think acetone is a better measure of moment-to-moment ketosis. I’ve always thought it was beta HB. Have you looked at this?
I hope we can meet up in Queensland. Are you going on the lo carb cruise?
Ian
Definitely eager for more data! I have only plotted BHB and glucose but I would be interested to see how it correlated with acetone. It seems that BHB is a storage form of ketone and AcAc is more of a action form of the ketone. People who are more metabolically challenged struggle to convert BHB to AcAc. Yeah, I’m going on the cruise so there will be lots of time to hang and chat.
Hi Marty,
I don’t know how to send the files here. Can you send your email, or let me know how to upload on this site?
I like the way your graphs could be used to indicate metabolic syndrome. My numbers seem now to be on the healthy line, after 2 years of 5:2 and one year of LCHF. I wish I had data from earlier. It would be interesting to see if the slope changes.
Looking forward to chatting with you,
Ian
Marty my name is Eric Serrano and I am medical doctor that works with a few patients and I am very impressed, I will recommend your web site, well done.
My understanding is that your wife is a diabetic and that is very impressive what you have done with her.
Please don’t share my email
Thabks Eric.
Awesome Read! Been lowcarbing since the 90s. (Atkins/Dr. Pasquale/Lyle McDonald/etc) and been witnessing the evolution to date- Mitochondria/Gut Biome (Dr.Rhonda Patrick/Dr. Terry Wahls/Robb Wolf/Mark Sisson/Chris Kresser/Dave Asprey/Etc). Your articles/Website and personal analysis are amazing. Cutting edge, objective, and innovative. Keep up the good work. Really glad i stumbled onto your site. Cheers!
Wow. Thanks Justin.
Fantastic article thank you so much! Every time I see someone trying to push exogenous ketones to low carb folks it drives me crazy.
Thanks Paul.
I’m trying to figure out this Keto/HFLC diet as well! Do you know of a reliable calculator for fat intake to facilitate fat loss? Everything I read is so all over the place! I’m a very active woman- I Do HIIT and lift 6 days a week. My carbs are less than 30 net, and my protein is just under 1g x lean body mass. (Both of those intake recommendations are fairly easy to find!) it’s the fat intake I can’t figure out! Eat more fat to lose more fat? Eat less fat to burn more fat? HELP!!
Check out https://ketogains.com/ketogains-calculator/. You need enough protein to support your muscle growth and repair, enough carbs from non-starchy vegies to provide your vitamins and minerals and enough fat to give you enough energy so you don’t go insane with hunger. The Ketogains guys call it ‘using fat as a lever’. If you want to lose weight you need to drop the fat down low enough to force fat to come from your body rather than your plate.
Check out the food lists https://optimisingnutrition.com/2015/03/22/cheat-sheets/
I’ve been looking into exogenous ketones, just because of all the talk, but I haven’t tried them. They are a bit pricey, even if I wanted to experiment with them. Besides, I’ve been doing well on a ketogenic diet with MCT oil, combined with intermittent fasting. My ketone levels seem high enough going by the results I’m getting: cravings gone, hunger decreased, loss of body weight (now maintaining), improved mood, more energy, greater focus, etc. I don’t know what exogenous ketones would add to this.
Likely nothing. This article may also be of interest. https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/