The ketogenic diet is a popular and effective way to lose weight and improve your health. If followed properly, this low-carbohydrate, high-fat diet will increase ketone levels in the blood. They provide a new source of fuel for your cells and are the source of most of this diet’s unique health benefits. As part of a ketogenic diet, your body undergoes many biological adaptations, including reduced insulin levels and increased fat breakdown. When this happens, your liver begins to make a large number of ketones to provide energy for your brain. However, it is often difficult to know if you are in ketosis or not.
11 Signs and symptoms of ketosis
1. Ketosis can cause bad breath
People in ketosis often experience bad breath. This is actually a side effect caused by high levels of ketones. The main culprit is acetone, a ketone that is released in urine and breath.
2. Increased ketones in breath or urine
Another way to measure blood ketone levels is with a breath analyzer. It monitors acetone, one of the three main ketones found in the blood during ketosis.
This gives you an idea of the ketone level in your body as more and more acetone leaves the body when you are in ketosis.
Acetone breath analyzers have been shown to be quite accurate, although less accurate than the blood monitoring method.
Another effective technique is to measure the presence of ketones in your urine, daily, using special indicator strips.
They also measure the excretion of ketone in the urine and can be a quick and inexpensive method to test your ketone levels every day. However, they are not very reliable.
3. Weight loss
Ketogenic diets are very effective for weight loss. As dozens of scientific studies have shown, you are likely to lose weight in the short and long term when following a ketogenic diet. Rapid weight loss can occur during the first week of the diet. Some people believe it is fat loss, but it is mainly the stored carbohydrates and water that are consumed and lost.
4. The increase of ketones in the blood
One of the hallmarks of a ketogenic diet is a reduction in blood sugar levels and an increase in ketones. As you move forward on a keto diet, you will start to burn fat and ketones as your primary source of energy. The most reliable and accurate method of measuring ketosis is to measure your blood ketone levels using a specific meter or blood tests.
According to some experts, nutritional ketosis is characterized by a ketone levels in the blood between 0.5 and 3.0 mmol / L
5. Lack of appetite
Many people report a decrease in appetite when following a ketogenic diet. The reasons why this happens are still being studied. However, it is perhaps due to an increase in protein and vegetable intake, as well as a change in hunger hormones in the body.
6. You are thirsty more often and your mouth is dry
When a person switches to the ketogenic diet, their thirst usually increases.
As insulin levels drop following a ketogenic diet, the body begins to release excess sodium and water. So drink more water, and add salt to your dishes.
Also make sure to eat foods rich in electrolytes (potassium, calcium, chloride, magnesium, sodium) to compensate for the losses.
7. Short-term fatigue
Switching to a ketogenic diet can have short-term weakness and fatigue as side effects. These often cause people to ditch their diets before going fully ketosis and to benefit in the long run.
These side effects are natural. After several years of operating with a carbohydrate-rich energy system, your body finds itself forced to adapt to a different system. It usually takes 7 to 30 days to be fully and permanently in ketosis. To reduce fatigue during this change, you can take electrolyte supplements.
8. Improved concentration and energy
People often report brain fog, fatigue and discomfort when starting a very low carbohydrate diet. We call the keto flu. However, in the long run, people who follow a ketogenic diet see a marked improvement in their focus and energy.
This is because ketones are an extremely powerful source of energy for the brain. They have even been tested in a medical setting to treat diseases of the brain and conditions such as concussions and memory loss. So it’s no surprise that people on a ketogenic diet see greater clarity and improved brain function.
9. Some digestive problems
A ketogenic diet usually involves a major change in the types of foods you eat. Digestive problems such as constipation and diarrhea may therefore appear at first.
Make sure you eat lots of healthy vegetables that are low in carbs and high in fiber. Most importantly, diversify your foods as much as possible.
When you are keto-adapted, the body no longer needs to break down amino acids to make sugar as soon as the glycogen stores are empty (and yes, since it can use fat instead !! ). In fact, once keto-adapted, it is much less neo glucogenesis : in short, it means that you are less catabolic and increasingly ANABOLIC.
So, if you workout, at the same training pace, you will notice that you gain muscle mass much more easily ! It is a good index of adaptation.
A big problem for many people who are on a Keto diet is sleep, especially when they are making changes to their diet for the first time. However, this usually improves within a few weeks.
I hope I’ve been clear that none of this taken apart is proof that you are in ketosis. It is the combination of all these elements , which are found in a stable and constant way in everyday life, that tells you whether or not you are in ketosis.
6 benefits of ketosis
There are different benefits to being in ketosis. Next, I will focus on the main ones.
Nº 1: Possible beneficial effects of ketosis against Alzheimer’s disease
Alzheimer’s disease is a terrible disease. It is the most common form of dementia. The idea has been around for some time, but recent research suggests that Alzheimer’s disease could be a form of diabetes. Some researchers even have called it “type 3 diabetes” (source, source).
They liken Alzheimer’s disease to insulin resistance affecting the brain. The idea is that Alzheimer’s disease is similar to type 2 diabetes, a condition in which the body becomes resistant to insulin. The only difference is that Alzheimer’s disease occurs in the brain (source).
With insulin resistance, the body no longer responds well to insulin. As a result, the brain is like “starving” for energy (glucose). The result is a build-up of glucose in the brain (hyperglycemia), which leads to oxidative stress and damage. Brain cells are starving because they don’t have enough energy.
Could ketones be an alternative fuel for damaged brain? The question is being studied. In a state of ketosis, the body produces ketones that the brain can use for its energy needs.
This doesn’t mean that an extremely low-carb or ketogenic diet can cure Alzheimer’s disease, but ketones may play a role in treating the condition.
Nº 2: Decreased blood sugar during ketosis
Blood sugar must be very low for ketogenesis to kick in. This results in particular in a decrease in the production of insulin (source). Also, a high fat diet reduces insulin release in diabetics.
Fasting hyperglycemia and hyperinsulinemia are associated with many chronic diseases.
Research has shown that hyperinsulinemia increases the risk of cancer, regardless of diabetes. In other words, hyperglycemia and hyperinsulinemia are harmful to everyone, whether they have diabetes or not (source).
The hyperinsulinemia is pro-inflammatory and there is a link between hyperinsulinemia and cardiovascular disease (source).
There are several ways to lower your blood sugar.
Studies show that ketosis helps lower fasting blood sugar and improve insulin sensitivity.
Besides nutrition, physical activity, sleep and stress reduction also play a role.
Nº 3: Regulation of mitochondrial metabolism
The mitochondria plays a vital role in every cell of the body because it produces 90% of the energy every cell needs (source).
Mitochondria convert carbohydrates and fatty acids into ATP (adenosine triphosphate), a form of energy that cells can use.
Mitochondria are essential for overall health and play a crucial protective role in cells.
They notably control apoptosis (programmed cell death). This process is essential for regulating the number of cells, especially for damaged cells.
Uncontrolled cell proliferation can lead to cancer, and recent research shows that mitochondrial dysfunction plays a central role in various chronic diseases (source).
Now, it appears that ketones can help protect against mitochondrial dysfunction. When ketogenesis begins and the body begins to produce ketones, some important changes take place.
First of all, mitochondria prefer to get their energy from fat because fat is easier to convert into ATP.
- Ketones stimulate and improve mitochondrial respiration and function.
- Ketones exert an antioxidant effect in the mitochondria and help inhibit oxidative stress (which can lead to mitochondrial dysfunction and other diseases).
It is a fact that a calorie restriction helps to extend the lifespan. In times of calorie restriction, the mitochondria start using fat instead of glucose. This phenomenon is also seen when limiting carbohydrates to enter ketosis.
Nº 4: Possible appetite suppressant effect of ketosis
Processed foods that contain fast sugars (or refined carbohydrates) cause big spikes in blood sugar. They provide momentary satiety; a few hours later, the hunger arises again.
For some people, resisting the temptations of junk food is a daily struggle.
However, people in ketosis claim to be less hungry, which is a plus that makes it easier to lose weight.
How to explain it? Can the presence of ketones in the body suppress appetite? Or should we see the satiating effect of proteins?
Either way, here’s what we know:
When we lose weight, the level of ghrelin (hunger hormone) increases, and with it, the desire to eat. In a recent study, this effect was found to be inhibited in people in ketosis, even in a calorie deficit.
In the same study, the levels of leptin and amylin (satiety hormones) were increased despite the participants’ weight loss. When subjects were allowed to resume carbohydrate consumption, there was a drop in satiety hormones and a rapid increase in hunger hormones.
A high level of ketones in the body can send a signal to inhibit the production of hunger hormones. A meta-analysis of the available studies suggests that ketones may help reduce appetite. This appetite suppressant effect requires some degree of ketosis, however.
For my part, I think the satiating effect of low-carb diets is also to be attributed to the increased protein intake. Indeed, proteins increase satiety, even more than lipids (source).
Nº 5: Lowering Triglycerides and Increasing HDL Cholesterol
Ketones reduce the level of triglycerides (lipids) in the blood and increase the level of HDL cholesterol.
The triglycerides / HDL cholesterol ratio is one of the most reliable indicators of cardiovascular risk.
You’ve probably heard of “good cholesterol” (HDL) and “bad cholesterol” (LDL). However, these markers are not good indicators of the risk of cardiovascular disease.
In recent years, the triglycerides / HDL cholesterol ratio has emerged as a much more reliable marker (source).
A 2015 study showed that the triglycerides / HDL cholesterol ratio is the main independent predictor of the risk of cardiovascular death (source).
How can ketosis affect this report? Low HDL levels and high triglyceride levels are often associated with high blood insulin levels (source).
In other words, regulating blood sugar helps lower insulin levels and improve the triglyceride / HDL cholesterol ratio.
Studies generally show that a ketogenic diet has a beneficial effect against cardiovascular risk:
In a study of obese participants, a ketogenic diet limited to 20g of carbohydrate per day reduced total cholesterol, LDL cholesterol, triglycerides, and blood sugar.
In contrast, there was a significant increase in HDL cholesterol. This study lasted 56 weeks and there was consistent improvement in all markers of health measured in the 7 tests performed every 8 weeks (source).
A 6-week study in healthy-weight men showed that a ketogenic diet (in which 8% of energy intake came from carbohydrates) significantly increased HDL cholesterol levels without affecting LDL cholesterol or total cholesterol (source).
Lowering triglyceride levels and increasing HDL levels appear to reduce the risk of heart problems. The triglyceride / HDL ratio usually improves when the body is in ketosis.
nº 6: Improved mental health
After the induction phase of ketosis, the brain can use ketones as a primary fuel. A considerable amount of studies suggest that it can lead to improvements in mental health and decrease in depressive disorders.
A randomized, controlled study concluded that a diet low in carbohydrates resulted in a statistically significant improvement in participants’ mood. Participants on a low-carbohydrate diet suffered less from mood swings and irritability than participants in the control group on a low-fat diet (source).
In a study on rats, rats on a ketogenic diet showed fewer signs of depression than rats on a control diet. In addition, this group of rats showed the same improvements as the rats treated with antidepressants (source).
Several randomized controlled trials, conducted with more than 280 participants, show that ketogenic diets may be beneficial for patients with epilepsy.
In summary, researchers believe that ketosis offers short to medium term benefits for seizure control (source).
Weight loss and ketosis
Is ketosis good for weight loss?
Indeed ! People who start a ketogenic diet experience significant weight loss within the first week.
What is this rapid weight loss due to?
Quite simply, the body also stores around 3g of water for every gram of glycogen. When you limit your carbohydrate intake, your glycogen stores decrease; suddenly, we lose a lot of water.
But besides short-term weight loss, ketosis is also beneficial in the long term.
Different studies have shown that a strict low-carbohydrate diet is more conducive to weight loss than a low-fat diet (source 1, source 2). A low-carbohydrate diet has the great advantage of reducing appetite, which helps reduce calorie intake.
How many pounds can I expect to lose with ketosis?
This is a difficult question to answer because everyone is different. In addition, there are several factors at play. Hormones, body weight, diet, body fat, lifestyle, quality of sleep and many other factors play a role.
People who are extremely overweight can lose tens of pounds, while others will lose less weight. If you are on a low carb or ketogenic diet, you should be losing weight for the foreseeable future.
Possible dangers of ketosis: 6 sins that beginners could make
The state of ketosis remains controversial. Some people believe that ketosis is the best way to lose weight, while others find such a diet dangerous.
Where is the truth ?
What is certain is that ketosis is not for everyone. A ketogenic diet can have beneficial health effects, but it can also have unpleasant (and sometimes dangerous) side effects if not done right.
Let’s take a look at the most common “sins” people make when it comes to going into ketosis:
Keto Sin #1: Not drinking enough water
It’s always important to have a good water balance, but it is even more important when you want to embark on a ketogenic diet.
When you drastically reduce your carbohydrate intake, a lot of things happen in the body. First, blood sugar and insulin levels drop (source).
Keep in mind that many people who eat a standard Western diet (high in refined sugars) have become unresponsive to insulin (we call this insulin resistance).
Why is this important? Because a high level of insulin pushes the kidneys to store more sodium, and therefore to retain more water (source).
Because a ketogenic diet severely limits carbohydrate intake, the first few days result in a drop in insulin levels. When insulin levels drop, the kidneys release large amounts of water. Failure to drink enough can lead to dehydration.
Many people in the first week of ketosis complain of headaches. Besides the electrolyte imbalance, dehydration can be involved. Not drinking enough water is a common mistake that can be easily avoided.
Keto Sin #2: Not Getting Enough Magnesium
As I just said, the kidneys help flush out excess water during the period of adjusting to ketosis.
Unfortunately, this water contains high concentrations of sodium and electrolytes. Magnesium is one of them.
An electrolyte imbalance can cause several symptoms that are often referred to as “ketogenic flu”.
All minerals are important, but magnesium plays an essential role in the body. It is involved in more than 300 biochemical processes (source).
No wonder, then, that a loss of this essential mineral can cause problems. A prolonged magnesium deficiency can cause various physical disorders : muscle cramps, irritability, decreased libido, hypersensitivity, etc.
To meet your magnesium needs, you’ll need to look for magnesium-rich foods that are allowed on a ketogenic diet.
Some examples :
- Leafy vegetables (spinach, chard)
- Brazil nuts.
It may also be worth investing in a quality magnesium supplement.
Keto Sin #3: Not getting enough sleep
I would first like to clarify that lack of sleep is not only dangerous for those in ketosis. Getting enough sleep is essential for everyone.
If you don’t get enough sleep, you are putting your health at risk. Good quality sleep is as important as good nutrition.
Going on a ketogenic diet to improve your levels but not getting enough sleep is like taking one step forward and then two back.
Good nutrition cannot make up for poor sleep habits. Sleeping well is extremely important whether you are on a ketogenic, paleo, or vegan diet .
Keto Sin #4: Not Getting Enough Fat
Not getting enough fat is a mistake many ketosis enthusiasts make. As you know, the body can get its energy from both carbohydrates and fats.
The whole idea of ketosis is to get the body to get its energy from fat. Therefore, if one consumes less carbohydrates, one must consume more fat.
However, some people reduce their carbohydrate intake, but do not compensate for the energy loss with lipids. This could be explained by the fact that we are always a little afraid of fat.
However, there is nothing to fear from fats of natural foods, such as avocados, fish, olives, oils, etc.
While protein can provide energy through gluconeogenesis, it is an inefficient source of energy compared to ketones (fat) and glucose (carbohydrate) (source).
Trying to live only on protein and vegetables would quickly lead to fatigue and lack of energy. In the end, the regime would be untenable.
Keto Sin #5: Eliminating Protein Completely
I have heard ketosis followers who avoided consuming too much protein for fear of getting out of ketosis. I think this is absurd. Proteins play an important role in the body, and their effect on blood sugar is exaggerated.
This belief is based on gluconeogenesis, a process that converts amino acids into glucose (source). In other words, it means that the body can turn protein into glucose. This biological process is a protective mechanism that can help us survive famine.
If it needs energy, the body can convert amino acids (or muscle tissue) into glucose. But increased protein consumption does not promote gluconeogenesis.
Protein, like fat, affects blood sugar less than carbohydrates (source).
In healthy subjects, the process of gluconeogenesis begins only when necessary, then it is regulated according to the availability of amino acids.
Also, you have to differentiate between healthy people and people with diabetes. Protein intake has a greater impact on the blood sugar of diabetics than on that of non-diabetics (source).
Keto Sin #6: Eating Too Many Carbohydrates
You can only go into ketosis at the cost of drastically reducing your carbohydrate intake.
A person who decreases their carbohydrate intake and increases their fat intake, but indulge in a cookie every now and then will have a hard time entering ketosis.
Also, the induction phase (the initial period) of ketosis can come with unpleasant side effects, so starting (and stopping) the diet over and over again is unwise, even dangerous.
A ketogenic diet requires the utmost dedication. Starting and stopping over and over is not good for the body.
Is ketosis dangerous?
No, in principle, ketosis is not dangerous for healthy people, provided they do it correctly.
However, staying in ketosis for too long is not good for your health, due to the increased level of oxalic acid in the body. Oxalic acid can reduce the absorption of iron and calcium. But people with normal kidney function have nothing to fear from a slight increase in oxalic acid levels.
Ketosis is a natural metabolic state that can be achieved by consuming very little carbohydrate for a period of time.
When you are in ketosis, urinary and blood levels of ketones are higher than normal. Ketones are chemical compounds that the body produces when it burns fat stores. Usually, the main problem is that short-term side effects are possible as the body adjusts to this new condition.
Personally, I find the ketosis diet too extreme, but I see no danger in consuming a lot of fish, avocado, oils, etc.
In practice, a ketogenic diet involves consuming more butter, olive oil, cream, coconut oil, avocados, fish, and meat. It comes as a shock to most people: for decades we’ve been told, wrongly, that fat is bad for you.
But the only really problematic fats are:
- Trans fats
- Vegetable oils (rapeseed, soybean, corn oils)
The ketogenic diet can be compared to the low-carb diet in that it is primarily about eliminating refined carbs. Suddenly, there is more room for proteins and lipids and we can better control our appetite.
A low carb balanced diet is less extreme than the ketogenic diet and in my opinion much easier to stick to. In this diet, processed carbohydrates are excluded, and the calorie intake is 30-40% carbohydrates from natural sources.
Ketosis is sometimes confused with ketoacidosis. Despite the similarity of their names, ketosis and ketoacidosis are two different things.
Ketosis is the presence of ketones in the body. It is not dangerous.
The word ” ketoacidosis, on the other hand, refers to diabetic ketoacidosis (DKA), a complication of type 1 diabetes. It is a condition that can be life-threatening, due to high levels of ketones and sugar in the blood, dangerously high.
How long does it take to enter ketosis?
To reap the benefits of a ketogenic or keto diet, your body must enter a state called ketosis. This is a metabolic state in which the body converts fat into molecules called ketones. These become then the main source of energy when the intake of carbohydrates (sugars) is very low.
The best way to achieve ketosis is to drastically cut down on carbohydrate intake. This is because in your digestive tract, carbs are broken down into sugar molecules – such as glucose – so that they can travel through the bloodstream and be used as a source of energy. If your body has excess glucose, it will build up stores in the liver and muscles in the form of glycogen.
By drastically reducing carbohydrate intake to less than 50 grams per day, the body finds itself forced to use its glycogen stores for energy before switching to ketone use.
The time it takes to enter ketosis varies from person to person. Usually, it takes 2-4 days if you eat only 20-50 grams of carbohydrate per day. However, some people will need a week or more to reach this state. This may be due to their usual daily intake of carbohydrates that exceeds prescribed doses, their daily intake of protein and fat, the type of workout they do, their age, and the type of metabolism itself.
For example, people who usually consume a lot of carbs before starting a keto diet may need more time to enter ketosis than those who usually consume little or moderate amounts. This is because the body must deplete its glycogen stores before entering ketosis.