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Entering Ketosis: A Protocol For Making The Switch Smoothly And Intelligently

(This is part two of a multi-part series on ketosis and ketogenic diets. You can find part one, explaining the extensive and compelling benefits of ketogenic diets here.)

Ready to make the leap to ketosis?

Not everyone thrives on a ketogenic diet, but if it does work well for you, it can easily be the single most significant thing you ever do for your mental + physical well-being. No exaggeration necessary here. Ketosis has profoundly changed tens of thousands of lives and will continue to change many more.

Seems worth giving it a proper shot to find out, right?

With that said, the reality is that the majority of people who try out a ketogenic diet and up abandoning it, most relatively quickly.

Is this because these people are fundamentally not well-suited for ketosis? In a minority of cases, the answer is probably yes.

But in far more instances, people that potentially could have thrived in ketosis abandon the diet because they went into it under-informed and unprepared, and never actually experienced the benefits of being fully in ketosis.


What is “keto adapted”?

You’ve likely never thought of it this way, but right now you are “carb adapted”. You’ve spent a lifetime adapting your body to a carbohydrate-dominated diet, and in response, your body has spent decades building robust digestive and metabolic pathways to efficiently use carbohydrates to power your body and brain.

There are a lot of pathways that are used in both carbohydrate and fat metabolism, but there are also a number of pathways that are unique to the digestion and utilization of fats.

For the body and brain to utilize fat for energy as efficiently, the body needs time to produce the metabolic components of these fat-specific pathways in levels that are sufficient for turning fats into energy fast enough to meet the energetic demands of the body and brain.

This, in essence, is “keto adaptation”.

 

What happens during keto adaptation?

  • Digestive System - The gallbladder steps up production of bile salts, and specialized cells in the stomach produce extra lipases. Both are required for the GI system to handle the additional fat in the diet.

  • Liver - The liver is the primary power plant where fats are oxidized (i.e. broken down) to produce ketones. To support the whole of the body and brain’s energetic needs, the liver needs to produce higher levels of the enzymes involved in this ketone-production process.

  • Muscle and Brain Cells - The brain and skeletal muscles are where the bulk of the body’s energy demand comes from, and cells in these tissues need to become more efficient at both using ketones and oxidizing shorter chain fats (like butyric acid from butter or caprylic acid from coconut oil), which can be used for energy in the cell directly, without needing pre-processing by the liver. [1]


  • Generally Good Ideas When Transitioning To Ketosis

  • Measure/Count Your Macronutrients - If you’re just “winging it” and guessing that the foods you’re eating are meeting your macronutrient (i.e. fats/carbs/fiber/proteins) targets, you’re unlikely to be right, and you’re setting yourself up for failure.

    The easiest way to track macronutrients that I’ve found is to use a food tracking app like MyFitnessPal.

  • Collect Data + Keep a Journal - Knowing how different foods affect your blood ketone levels, or even just the way you feel after eating is priceless information for putting together a diet that is perfect for YOU.

    I recommend getting a blood ketone meter (see section below) and measuring blood ketone levels several times a day, particularly before and after meals. Keep a journal in which you record this info, along with what you ate and how you felt afterwards. I guarantee you you’ll notice patterns around certain foods you might have been oblivious to if not journaling.


  • The Essential Transitioning-To-Ketosis Toolkit

  • A Ketone Measurement Device - Far and away the most effective way to measure your ketone levels is a blood ketone meter.

    Similar to how some diabetics test their blood glucose levels, you prick your finger (with a special device) to draw a drop of blood, touch the drop of blood to a disposable strip via which the meter can detect the level of ketones in your blood.

    The Precision Xtra has been the standard for at-home ketone meters for a while, and this is what I use personally. The CareTouch meter appears to be reliable also, and is a bit cheaper.

    Unless you have an extreme aversion to pricking your finger, I strongly suggest using a blood ketone meter, as it is leaps and bounds more accurate and precise than any other method.

    If the idea of pricking your finger makes you want to faint, you could also use urine ketone test strips or a breath ketone meter, but both are much, much less accurate.

  • A Scale - To accurately track the nutrient content of the food you’re eating, you need to know how much it weighs. I’ve been using this inexpensive portable scale for years.

  • A Food Tracking App - MyFitnessPal seems to be the best option.

  • A Journal - I use this Moleskine Daily Planner.

  • MCT Powder - We’ll cover this in more detail later, but essentially this is gives your body a specific type of fat that is exceptionally easy to convert to ketones, making the transition phase much smoother. We developed Ketobasis, a zero-net-carb MCT powder ideal for ketogenic diets (and transitioning to keto diets) 


  • Pre-Transition (1-2 Weeks)

    Jumping straight into a full ketogenic diet is usually the mistake that leads a lot of people to fail and abandon.

    The digestive system is simply not equipped to handle the big increase in fat intake, and the liver is certainly not equipped to convert that fat into energy fast enough to meet the body and brain’s needs.

    This pre-transition phase is designed to adapt the GI system and liver to higher levels of fat intake, and generally wean the body and brain off of carbs gently, avoiding energy “crashes”.

  • Target Macronutrient Ratio: 55-65% fat | 10-15% carb | 5-10% fiber | 15-25% protein - You’ll see a lot of people state macronutrients only as fat/carb/protein, but this means indigestible fiber is lumped into carbs, which ignores (a) fiber functions differently in the body than digestible carbs and (b) fiber is super valuable and should be tracked and optimized for.

    For a 2000 calorie diet, this translates to 121-143g fat, 50-75g digestible carbs, 25-50g fiber and 75-125g protein.

    How many calories should you eat in a day? Use this calculator

  • Cut Sugar Completely - One of our primary goals during this pre-transition stage is to get blood sugar and insulin levels stabilized, as the dramatic fluctuations in these creates broader hormone fluctuations that result in hunger, mood instability, low-energy, etc.

    Far and away the most important thing you can do to stabilize insulin and is to cut sugar from your diet completely. This means no soft drinks, candy and desserts (obviously), but it also means no fruit.  Most fruit is loaded with sugar and doesn’t fit into a keto diet anyways, so may as well cut it out now.

  • High-Quality Complex Carbs - Also in the interest of stabilizing insulin levels, it’s important that the digestible carbs you eat during this transition period come from sources with relatively low glycemic index.  This means focus on leafy greens, root vegetables and white rice. Skip processed grains like breads and pastas.

  • Prioritize Ketogenic Fats - The way the body processes fats varies quite a bit depending on the type of fat. Olive oil, for example, is comprised largely of long-chain monounsaturated fats (MUFAs). While these fats are ostensibly “healthy”, they are also relatively inefficient for the liver to turn into ketones for energy.

    Focus on fat sources with short- and medium-chain saturated fats that can be easily converted into ketones. Coconut oil (and coconut milk), butter/ghee and animal fat are quintessential ketogenic fats.  Eating these fats plentifully will help your liver to build ketone-generating pathways.

    Our on-the-go ketogenic chocolate wonderfood, KetoManna is ideally suited for this.

  • Eat Clean - A lot of the foods people consider staples of a keto or low-carb diet are frequently contaminated, pro-inflammatory, or both. We’ll cover this in more detail later, but in its simplest form, this means no conventional (i.e. non-pasture-raised) meats, no processed or cured meat and no dairy (a few exceptions will be noted below).

  • Exercise: Yes, but…. - Definitely continue your exercise routine in this transition period. The more calories you’re burning, the faster your body will start to build up metabolic pathways for making use of all that fat you’re eating.

    BUT, don’t be discouraged if you can’t workout at your normal intensity during the transition. Your body is switching energy sources, and will need a bit of time to get adapted in such a way that it can meet these moments of peak energy needs.

    No worries in the long run though: Studies show athletes are able to maintain strength/performance once adapted to ketosis, and in some cases, performance increases. [2]


  • 24 Hour Fast (Optional, Highly Recommended)

    By far the most efficient way to get the body switched over to ketosis is to do a fast.

    A 24 hour fast will essentially “skip you ahead” in your transition anywhere from a few days to a few weeks - meaning that after a 24 hour fast, most people achieve (and are able to maintain) blood ketone levels that would take 1-2 weeks to see consistently if simply switching over to ketogenic eating without fasting.

    If you’re intimidated by the idea of a 24-hour fast - don’t be! - I promise it’s way easier than you think, particularly since you’ve been stabilising your blood sugar/insulin levels for 1-2 weeks at this point. A 24-hour fast is just eating dinner normally on day one, and not eating again until dinner on day two. Easy.

    I recommend doing a modified fast, consuming 10-20g MCT powder 2-4 times throughout the day. (Exogenous ketone salts can also be used, but I recommend primarily using MCT powder for this application.)

    This will keep your energy levels more stable during the fast and the MCT powder will give your liver a signal to switch over to using fats for energy.

    You can see my full recommendations for a fasting protocol in The Profound Benefits of Fasting (and Autophagy)


    Ketosis: Week One

  • Target Macronutrient Ratio: 75-80% fat | <5% carb | 5-10% fiber | 10-15% protein
    The objective in week one is to send a strong signal to your body that it’s time to switch over to using fats as its primary energy source.

    To do this we increase fat intake significantly (prioritizing ketogenic fats, of course), cut carbs to a minimum and reduce protein intake.  

    Why reduce protein? If you consume higher levels of protein during this period, there’s a good chance the body will convert it into blood sugar (via a process called gluconeogenesis), slowing the transition to fats as the primary energy source.

    For a 2000 calorie diet, this ratio would translate to 166-178g fat, <25g digestible carbs, 25-50g fiber, 50-75g protein

  • Supplement With MCTs - Getting loads of MCT’s (a type of medium-chain ketogenic fat) in the diet will increase the amount of ketones the liver is producing, helping to keep your energy levels high and your brain online.

    More importantly, consuming a lot of MCT’s sends a “signal” to your liver, telling it that it’s time to start investing resources in building the metabolic machinery needed to efficiently turn fats into ketones.

    MCT oils and powders both work for this, but most people’s stomachs tend to tolerate MCT powders better. I use Ketobasis.

    During week one, aim for 20-30g of MCT per day via oil or powder supplements, spread evenly throughout your day.

    Our ketogenic chocolate, KetoManna is also an excellent tool for getting MCTs in your diet.

  • Use Exogenous Ketones Sparingly - Exogenous ketones (as the name would imply) are ketones made outside of the body.  In the past few years companies have started offering products containing synthetic ketones.

    For a short time (usually 1-2 hours) consuming exogenous ketone products allows a non-keto-adapted person to achieve a level of ketones in their blood equivalent to someone in low-to-moderate ketosis.

    These products can be tremendously useful as the body and brain adapt to life in ketosis. Nearly everyone transitioning to ketosis experiences low-energy periods at some point, often because their blood-ketone levels are simply too low to keep their body and brain in a high-energy state.

    Being able to raise blood-ketone levels essentially on-demand makes those low-energy moments significantly easier to deal with.

    BUT there is a catch (of course). While MCT’s tell your liver to ramp up ketone production, there is good evidence that consuming exogenous ketones sends your liver the opposite signal. In simple terms, when blood-ketone levels are raised artificially, the liver doesn’t have the a lot of incentive to work to raise levels on its own.

    In this transition phase (and ongoing, really), limit exogenous ketone supplementation to less than 20g/day (usually about 2 servings) and always consume it paired with MCT oil or powder.Pairing with MCT’s will keep your blood-ketone levels high longer, and mitigate the ketone-production-suppressing signal to the liver.  

  • Replace Electrolytes - To varying degrees for different people, carbs make the body retain water. For people for whom this water retention is significant, removing carbs from their diet will result in a shedding of water weight.

    With this water shedding, the body will also shed electrolytes, which is where problems can arise (generally headaches, fatigue and cramping).

    Out of precaution, make a point of consuming a fair amount of salt (5-7g/day) and use an electrolyte solution to replace other lost electrolytes. I like this product. (use 5-6tsp/day)

  • Prebiotics! Prebiotics! - No essential dietary component gets more overlooked by keto-advocates than prebiotics - the fibers and starches in our foods that we don’t digest, but instead get consumed by the the flora in our GI tract.

    You’ll see plenty of other “keto writers” advocating an ultra-low-carbohydrate diet with no special considerations for the indigestible fibers and starches our gut flora (and by association, our bodies) need to thrive. This is crazy.

    Given how much we now know about the essential role the microbiome plays in our health, to ignore prebiotics shows a serious lack of understanding about how the human body functions holistically.

    Within a keto diet, prebiotics have the added value of essentially being a source of butyrate, a highly-ketogenic short-chain fat. Butyrogenic bacteria in our gut consume prebiotics and convert them into butyrate, which is then absorbed by the body.

    Because keto diets are predominantly fats and proteins, getting adequate levels and diversity of prebiotics (often found in carbohydrate-rich foods) can be a bit of a challenge.

  • For this reason, I highly recommend supplementing with a prebiotic supplement that supplies a diversity of prebiotic fibers and starches. We formulated Pre • Bios Prebiotic Formula for this exact application.



    Ketosis: Week Two

  • Target Macronutrient Ratio: 70-80% fat | <5% carb | 5-10% fiber | 10-20% protein Priorities and ratios in week two are more or less the same as in week one. Protein intake can be increased slightly if desired, as the body will now be far enough into keto-adaptation that a consuming a bit more protein shouldn’t induce gluconeogenesis and throw the you out of ketosis.

  • Track Blood-Ketone Levels! - Really, you should be tracking ketone levels daily starting with your fasting day (or day one of week one, if you skipped the fast).

    Measuring your levels immediately before a meal and then again 90 minutes afterwards can tell you a ton about how your body responds to certain foods, and what that response means for your energy levels, how sharp your brain is, etc.

    Blood ketones are generally measured in “mmol”, and 0.6mmol is the number most people use to define the threshold for ketosis. Personally, I don’t feel as though I experience the full benefits of ketosis until I’m above 1.0mmol. If you’re able to keep your ketones above 1.0mmol for the bulk of the day, it’s a positive sign your body is adapting well to ketosis.


  • Ketosis: Ongoing

  • Target Macronutrient Ratio: 65-80% fat | <5% carb | 5-10% fiber | 10-25% protein Once the body is keto adapted, it’s possible to increase protein intake to ~25% and still maintain ketosis, but this is unnecessary unless you’re actively strength training and trying to add muscle. 15% protein is plenty for most people to maintain lean, strong muscles.

  • Keto Adaptation - In simple terms, one is “keto adapted” when the body can generate and utilize ketones efficiently and consistently. There is no consensus for when full keto-adaptation occurs, and the reality is it’s different for everyone. Some people get there in 2 months, for others it can take 6.

    The only real way to know where you stand in the adaptation process is to test yourself regularly. If you’re hitting your macronutrient targets consistently and meals are still bumping you out of ketosis (below 0.6mmol) occasionally, it means your body is still adapting (and potentially that something you’re eating is causing a blood sugar/insulin spike and should be removed).

  • Getting “Kicked Out” Of Ketosis, And Getting Back In - It gets progressively easier to return to ketosis (after a food causes a drop in blood-ketone levels, i.e. “kicks you out”) the further along your body is in the adaptation process.

    Once you’ve built the metabolic machinery for ketosis, that “machinery” will stay in place even if you leave ketosis for a few days - it usually takes somewhere around 4-6 weeks of non-keto eating to fully lose adaptation.

    If you eat something you suspect will raise your blood sugar (and thus, kick you out of ketosis), consuming a good dose of MCTs (~10-15g) immediately before or after will keep your ketone production online and help get you back into ketosis quicker.

    You could also consume exogenous ketones in this situation, which would keep your blood-ketone levels technically in ketosis while your body ramps back up it’s own production.

    If you go wild and eat a plate of pasta or something like that, you could easily be kicked out of ketosis for days. MCTs and exogenous ketones can only do so much - in this case, doing a 24-hour fast (supplemented with MCTs and exogenous ketones, as described above) is the best option if you want to get back into ketosis quickly.


  • Ketogenic Diet Staples

    These are the foods that I view to be the “staple foods” of a clean, healthy ketogenic diet. There are surely other foods that could be included here, but this list should give you a pretty good idea of the types of foods that should be treated as staples.

    Macronutrient content is per 100g and listed as (fat / digestible carbs / fiber / protein).

  • Eggs (12.2g / 2.2g / 0g / 11.1g)
  • Coconut Oil - (100g / 0g / 0g / 0g)
  • Coconut Milk/Yogurt - (19g / 3g / 0g / 3g)
  • Ghee (100g / 0g / 0g / 0g)
  • Leafy greens - using kale (1g / 9g / 4g / 4g)
  • Broccoli - (0g / 7g / 3g / 3g)
  • Cauliflower - (0g / 5g / 3g / 2g)
  • Grass-fed beef - using a filet, uncooked (5g / 0g / 0g / 18g)
  • Pumpkin Seeds - (45g / 15g / 9g / 30g)
  • Macadamia Nuts - (72g / 12g / 9g / 6g)
  • Wild Salmon - (11g / 0g / 0g / 27g)


  • Things Other People Consider Keto Staples I Don’t Believe Should Be

  • Cheese - Yes, the macros in cheese are ketogenic - but there are some fundamental issues with cheese that I believe make it poor choice to eat frequently.

    When cheese is made, some amount of protein is inevitably fermented, producing histamines, nitrates and nitrosamines - all of which are pro-inflammatory when consumed.  “Hard” cheeses (swiss, parmesan) tend to undergo more fermentation and generally have higher levels of these problematic amines, but all cheeses have this issue.

    And then there’s the issues with dairy in general…

  • 99% Of Dairy Products - There’s so many issues here.

    Modern large-scale milk production is a fundamentally sick industry. As a result, the vast majority of the milk it produces is contaminated to some degree with mold toxins and antibiotic and hormone residues.

    In addition, modern dairy cows almost always have “A1-dominant” genetics, meaning the milk they produce contains high levels of A1 casein, a protein that’s been shown to be pro-inflammatory for a majority of people.  Store-bought “organic” dairy generally will not have hormone residues, but the rest of the issues remain (yes, including antibiotic residues).

    So what’s the 1% of milk dairy products that might be safe to eat? Provided you’re 100% confident you don’t have a sensitivity/allergy to milk sugars or proteins (a lot of people do and are not aware) - dairy from a local organic farmer who raises entirely organic pasture-fed cows with A2 genetics would likely be free of the issues above. Finding milk like this generally takes some serious searching.

    If you’re interested to read deeper into the issues with modern milk, start with this article.

  • Conventional Meats - Unsurprisingly, conventional meat shares a lot of issues with dairy production. Thankfully, boutique high-quality meats are accessible in most places these days.

    In most cities in the US, you can find at least one boutique butcher that will source organic grass-fed, grass-finished beef.

    Organic-but-not-grass-fed beef doesn’t cut it, as this meat still comes from unhealthy cows fed an entirely grain diet.

  • Bacon + Cured Meats - Poke around the keto world, and it won’t take you long to encounter the almost fetish-level reverence for bacon.

    That short-lived uproar in the media last year about bacon causing cancer was perhaps a little overblown, but it also wasn’t bullshit. There is significant data showing chemicals found in cured meats to have mutagenic or carcinogenic effects. [3]

    But all is well for bacon fetishists: uncured bacon is usually available at specialty/organic grocers.

  • Overcooked Meat - This is more of a general principle for omnivores to be mindful of, more than something specific to keto-adherents.

    You know that charring on the outside of a grilled piece of meat?  Or the browning of the fat on a crispy piece of bacon? That’s oxidized fats and proteins, which are also pro-inflammatory and potentially carcinogenic. Cook your meat for less time and at lower temperatures to avoid this.


    Stay Synchro,

    Graham Ryan
     

  • [1] https://www.sciencedirect.com/science/article/pii/S0026049517302986

    [2] https://jissn.biomedcentral.com/articles/10.1186/1550-2783-9-34

    [3] https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/1741-7015-11-63

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