by Dr. Josh Axe
The ketogenic diet — a very high-fat, very low-carb diet that entails getting 75 percent or more of your daily calories from fat — is unlike any other diet because it has the potential to actually change the way your metabolism works. When you correctly follow the keto diet, your body transitions into the metabolic state called nutritional ketosis, in which you produce ketone bodies that have various positive effects.
The traditional/classic ketogenic diet was originally designed by doctors in the 1920s for patients with epilepsy, including children, and later used to help treat adults with metabolic disorders and/or obesity.
Over the past century, researchers have uncovered much more about how ketones can have positive effects on health, including regulating body fat, blood sugar, cholesterol, hunger levels and inflammation.
What Exactly Is Ketosis — and Why Is It Beneficial to Our Health to “Enter” This Metabolic State?
Once blood levels of ketones rise to a certain point, you officially reach ketosis.
The production of ketone bodies (or simply “ketones”) indicates that you’re using fat for energy, both your own body fat and fat available from your diet, rather than carbohydrates (or glucose).
A major benefit of the keto diet is that there’s no need to count calories, feel hungry, or attempt to burn loads of calories through hours of intense exercise. You can eat as much as you need to feel satisfied, as long as you’re appropriately emphasizing fats and reducing your carb intake. In order to enter and stay in nutritional ketosis, it’s necessary to follow the ketogenic diet principles described below:
1. Increase your consumption of healthy fats
These should provide upwards of 80 percent of your daily calories. Aim to eat a mix of foods that provide saturated fats, monounsaturated fats and certain types of polyunsaturated fats (PUFAs), especially omega-3 fatty acids.
It’s best to include all types in your diet, with an emphasis on saturated fats, especially compared to PUFAs. Some of the best choices include MCT oil, cold-pressed coconut, palm fruit, olive oil, flaxseed, macadamia and avocado oil, butter and ghee, lard, chicken fat and duck fat.
2. Cut down on carbs and sugar
A traditional ketogenic diet consists of limiting carbohydrate intake to just 20–30 net grams per day, and just 5 percent or less of daily calories. “Net carbs” is the amount of carbs remaining once dietary fiber is taken into account.
Foods to be avoided include all added sugar, all grains (even whole grain products), all sugary drinks, cookies, bread, cereals, ice cream or other desserts, cereal, pasta, snack bars, etc. Fruit, most dairy products and starchy vegetables like potatoes, beets, etc. will also need to be avoided for the most part, or eaten in very small amounts (about 1/4 cup per day).
3. Be careful not to overeat protein
Note that the major differences between the keto diet and other popular low-carb diets, such as the Atkins diet, is that in order to be in ketosis you need to prioritize eating lots of healthy fats, not lots of protein. The keto diet is considered “moderate in protein,” with about 20% of daily calories coming from quality protein sources like meat, fish, eggs, aged cheeses, high-quality protein powders, etc.
4. Drink lots of water
Getting enough water and staying hydrated helps keep you from feeling fatigued, is important for digestion and aids in hunger suppression.
Benefits of Following the Keto Diet
Now that you know the basics of how the ketogenic diet and ketosis work, let’s talk about the benefits of following this type of very low-carb eating plan.
Most people on the keto diet lose weight and excess body fat rapidly, even when consuming lots of fat and adequate calories through their diet. However, weight loss is not the only reason to try the keto diet; in fact, many healthy adults, even some lean endurance athletes, choose to cycle in and out of ketosis in order to experience benefits like increased energy and mental clarity.
According to dozens of studies, plus years of anecdotal evidence, below are some of the most noteworthy benefits associated with the keto diet:
- Help with weight loss and loss of excess body fat.
- Decreased hunger levels and ability to control calories or fast more easily.
- Decreased circulating insulin levels, since carbohydrates (which trigger release of insulin) are restricted. With lower insulin levels, the body doesn’t store extra energy in the form of fat for later use, and instead is able to reach into existing fat stores for energy.
- Reduced risk for type 2 diabetes and normalized blood sugar levels.
- Reduced risk of heart disease markers, including high cholesterol and triglyceride levels. Some studies have found that the keto diet is unlikely to negatively impact cholesterol levels despite being so high in fat, and may in fact be capable of lowering cardiovascular disease risk factors, especially in those who are obese.
- Increased protection against cancer, since the ketogenic diet may “starve” cancer cells while a highly processed, pro-inflammatory, low-nutrient diet can feed cancer cells.
- Help preventing or treating neurological disorders and cognitive impairments, including epilepsy and Alzheimer’s symptoms.
- Emerging data also suggests there’s therapeutic use of ketogenic diets for patients dealing with stroke recovery, headaches, neurotrauma, Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis. The keto diet’s neuroprotective effects appear to be due to corrections in abnormalities of cellular energy usage, decreased inflammation, and normalization of pathophysiological processes that can cause symptoms like delusions, hallucinations, lack of restraint and unpredictable behavior.
Where Do Exogenous Ketones Fit In? Will Ketone Supplements Help with Entering Ketosis?
Exogenous ketones are ketones supplements that come from outside the body. Exogenous ketones, such as the types of ketone supplements called ketone esters or BHB (beta hydroxybutyrate) salts, are used to amplify the many positive effects of the ketogenic diet. They can make it easier to enter ketosis and also help mitigate side effects associated with the early stages of the keto diet, such as fatigue and brain fog, which have been nicknamed “keto flu” symptoms.
Ketones are defined as intermediate products of the breakdown of fats in the body. Ketone supplements mimic the effects of ketones that are naturally produced by our bodies under certain circumstances, including when we are in ketosis, purposefully fasting or starving.
Ketones are beneficial for our muscles, brains and other tissues during times of stress. In fact, researchers believe that humans, and many other animal species, too, developed the capacity to produce ketones (or ketone bodies) in order to prolong survival during periods of caloric deprivation.
Ketones are considered the most energy-efficient source of fuel for the body, releasing high amounts of ATP (adenosine triphosphate), which is often referred to as “the energy currency of life.” Benefits associated with use of ketone supplements (exogenous ketones) include:
- Helping you to get into ketosis more quickly and easily. If you take a break from the keto diet or practice carb-cycling, you can also use ketone supplements for support transitioning back the diet.
- Mitigating keto side effects, which are most likely to occur during the first week of the diet and differ from person to person. These can include diarrhea, cramping, nausea, constipation, bad breath, overall weakness, skin rash, irritability, headaches and fatigue. While ketones have loads of benefits, the transition into the keto diet can be rocky at first as your body makes some major changes. Be patient, as symptoms usually subside within 1–2 weeks.
- Supplying your brain with an energy supply that boosts cognitive performance and helps decrease brain fog. Ketones may benefit cognitive health by improving cognition in memory-impaired adults, focus, attention and learning.
- Controlling hunger and cravings.
- Helping you to shed excess weight and burn fat.
- Helping to protect your brain and cognitive health, including decreasing the risk for neurodegenerative diseases and mood swings.
- Improving metabolic pathways, including preventing or treating diabetes and insulin resistance.
- Potentially helping you to perform physically and recover more easily from exercise.
An Overview of How to Use Exogenous Ketones
Because there are many types of ketone products available that are used differently, always read directions and dosage recommendations. There are three main types of exogenous ketone supplements:
- Ketone salts (sometimes called BHB salts), which are ketones that are bound to minerals, including sodium, calcium, magnesium or potassium. Ketone salts are typically the type used in powdered ketone products, which usually contain some combination of BHB, sodium and other ingredients.
- Ketone esters, which are basically “raw ketones” that metabolize quickly into BHB.
- Ketone oils, which can include MCT oil (medium chain triglyceride) that are used to boost ketones and help with fat burning.
Beta hydroxybutyrate (or BHB) is the most abundant type of ketone that humans produce and the ketone found in most exogenous ketone supplements. Some products will provide minerals/electrolytes that help to decrease keto side effects, such as muscle weakness and digestive issues, as well as medium-chain triglycerides (MCTs) that help with your natural production of ketones.
Products may also contain other ingredients that support ketosis and decrease keto flu symptoms, such as bone broth, caffeine, coffee or coffee extract, apple cider vinegar, spices, collagen, probiotics, and/or adaptogen herbs like ashwagandha. These ingredients have various benefits, including helping to support a healthy response to everyday stress and overwork, improving digestion, boosting muscle mass and performance, etc.
Fat-digesting enzymes, such as lipase for example, may also be added to support digestion of fatty acids/lipids and to break down fats into smaller components that are easily absorbed.
Here are tips on using ketone supplements depending on your goals and schedule:
- Ketone supplements can be used in between meals or before a workout to provide you with a quick source of ketones. For help with exercise performance and recovery, use one serving/scoop about one hour before a workout.
- Exogenous ketones can be taken with food or on an empty stomach, but may be more impactful if you take them on an empty stomach (such as first thing in the morning) or when fasting.
- If you’re using a powdered ketone supplement, try mixing one scoop/serving with about 12 ounces of water, plain almond milk, coffee or tea. Ketone drinks/smoothies can be enjoyed warm or cold and can tailored to your taste preference with ingredients like stevia extract, cocoa, vanilla extract, etc.
- You might use exogenous ketones for about 3–5 days while you’re transitioning into ketosis. Use about 1/2 to 1 serving (such as one scoop or 3–6 capsules) per day.
- Another approach is to try having smaller amounts/doses spread throughout the day so your body has a steady supply of energy coming in. Depending on the type of product you use, it might be recommended that you take 1/3–1/2 of a scoop/serving at a time, several times per day.
- To help keep keto side effects to a minimum, you might decide to have one scoop of a ketone product in the morning, or to use half a servings 1–3 times per day.
- If you’re taking keto capsules, a typical dose will be about 6 capsules daily with 8 ounces of water. Capsules can be taken with or without food but may be most helpful if you take them early in the morning.
To really maximize ketone production and enhance effects like fat-burning, you can combine a ketogenic diet, intermittent fasting, exercise, and exogenous ketones like ketone capsules, a powdered product, or BHB salts. Depending on your reason for following the keto diet, you may want want to track your progress. The optimal range of blood ketone levels is between 0.6–6.0 mmol/L, depending on your goals and the condition you’re treating. When you’re not purposefully limiting carb take, levels will stay below 0.5 mmol/L.
Remember that using exogenous ketones is a way to boost the effectiveness of the keto diet, but it can’t take the place of following the keto diet correctly. If you’re having trouble getting into ketosis or staying there, try tracking your macronutrient intake to be sure you’re following the diet correctly.
As described above, on a “strict” (standard) keto diet, fats should typically provide about 70 percent to 80 percent of total daily calories, protein about 15 percent to 20 percent, and carbohydrates just around 5 percent.
Dr. Josh Axe, DNM, DC, CNS, is a doctor of natural medicine, clinical nutritionist and author with a passion to help people get well using food as medicine. Author of the books “Eat Dirt,” “Essential Oils: Ancient Medicine” and the upcoming “Keto Diet: Your 30-Day Plan to Lose Weight, Balance Hormones and Reserve Disease” (February 2019), he also operates the No. 1 natural health website in the world at DrAxe.com, with over 15 million unique visitors every month. He’s a co-founder of Ancient Nutrition, a health company where the mission is to restore health, strength and vitality by providing history’s healthiest whole food nutrients to the modern world.
†These statements have not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure or prevent any disease.