Keto Alkaline Diet: The Missing Link of the Ketogenic Diet - Dr. Axe

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Keto Alkaline Diet: The Missing Link of the Ketogenic Diet


Keto alkaline diet - Dr. Axe

My 49-year-old patient Jini arrived in my office with 40 pounds of excess weight, a family history of breast cancer, and complaints of fatigue and low libido. But she had an idea.

She’d recently read an article about how ketogenic diets could boost weight loss, provide cancer prevention plus other health benefits, and even help her menopausal conditions. Yet when Jini discussed the keto diet with her primary care doctor, he told her that such a diet would put her in a “dangerous, potentially deadly state.”

He was wrong. Originally used for epilepsy, studies show that keto diets are far from dangerous. In fact, they benefit numerous conditions, including cancer, dementia, and overweight/obesity, and modern history only supports these claims. During the early 19th century, physicians had dramatic success implementing keto diets, yet they eventually found that prescribing drugs was much easier that than scrupulously monitoring what people ate. (1

But Jini’s doctor — intelligent though I’m sure he was — fell victim to the common confusion between nutritional ketosis and diabetic ketoacidosis, the latter of which being a life-threatening complication of Type 1 diabetes, where ketones are produced rapidly, overwhelming the body’s acid-base buffering system. This is a common misconception or myth about keto diets that I seek to dispel. 

Nutritional ketosis, on the other hand, involves the regulated, controlled production of ketones, during which blood pH remains buffered within normal limits. (2)


The Modern Glucose Shift

Put simply, ketosis refers to the fuel source that your body uses on a day-to-day basis, and shifting into fat burning (instead of glucose, or sugar, burning) is the central focus of the keto diet. Most organs use glucose, but your brain uses more than any other — 20 percent, in fact — which puts a steady demand on glucose supply for energy. (3)

While your body can make some glucose in a process called gluconeogenesis, most of it comes from your diet as protein or carbohydrates. When you eat carbs, your body’s blood glucose increases and spikes your blood sugar, releasing the hormone insulin and pushing glucose into cells, where it is converted to energy.

Continually eating carbs keeps insulin elevated, eventually creating insulin resistance when your cells have received too much and begin to resist this master hormone. When this happens, your blood sugar continues to rise and sets the stage for Type 2 diabetes and all its detrimental (and sometimes deadly) consequences.

To be clear, you can’t cut off your body’s fuel supply completely, and not getting that steady glucose source means you would quickly perish. Fortunately, though, your body can utilize an alternate, efficient and (I would argue) superior energy source called ketones.

Your liver oxidizes fatty acids to produce three ketone bodies — β-hydroxybutyrate, acetoacetate and acetone — that provide an alternative to glucose to fuel your brain and other tissues. And most organs, including your brain, thrive on ketones. Increased ketone levels replace glucose as your primary energy source, reducing need for gluconeogenesis and sparing protein breakdown. (4)

You increase your production of these ketones through a process called ketosis. To get and stay in ketosis, you increase your dietary fat intake while modifying protein and dramatically limiting carbohydrate consumption, and you incorporate intermittent fasting. Human adults have little need for dietary carbohydrates, and reducing intake to shift into mild ketosis can provide dramatic benefits. (5)

That doesn’t mean you shouldn’t eat carbohydrates for other reasons (nutrient density, fiber and variety among them), but you want to choose the best sources and limit your intake in order to effectively shift into ketosis, at least periodically.

For most of our evolutionary existence, we didn’t eat many carbs, especially not in the quantity or frequency we do today. Among other problems, eating copious flour, sugar and processed foods — staples of the Standard American Diet — create inflammation, the root cause of nearly every disease, including as obesity. (6)

What is more common throughout the history of the human race is fasting. Islamic Ramadan is a 28- to 30-day fast where food and drink are prohibited during the daylight hours. Christianity also has a strong fasting foundation, and in the Bible, Jesus fasted to have higher and clearer communication with God. Greek Orthodox Christians fast for a total of 150–200 days each year!

Meanwhile, the 21-day Biblical-based Daniel Fast prohibits consuming things like animal products, refined carbohydrates, sweeteners, caffeine and alcohol. Lately, intermittent fasting (IMF), which involves alternating fasting with eating, has become popular for its ability to improve fat loss, along with other health benefits.

Unfortunately, fasting isn’t widely practiced today. From our breakfast cereals, to afternoon snacks and late-night munchies, near-constant grazing has become a staple of modern diets. We’ve even been advised to eat three meals and three snacks daily — such a dietary routine is gravely incorrect, except in extreme circumstances.

And it isn’t just that we’re eating throughout the day; we are also eating the wrong foods. A high-carbohydrate diet keeps blood glucose (sugar) and insulin elevated, putting fat burning on the backburner as it stalls your metabolism and increases belly fat. Think about opting for keto friendly snacks instead.

Researchers note favorable fasting benefits, including improved blood pressure, blood lipids, insulin sensitivity and oxidative stress, but you don’t have to abstain from food for days at a time to see these results. (7) Ketosis resembles fasting because both states utilize ketones as their main energy source. (8)

Turning on the (Good) Fat Switch

With the agricultural revolution over the last 10,000 years — especially the last 200 years — we’ve seen a dramatic shift in nutrient density and overall food quality. And among the health-destroying repercussions of our modern diet is the condition known as metabolic acidosis.

An increased acid load (caused by too many processed carbs — as well as too many high-fat proteins) actually shifts urinary chemistry. Urinary magnesium levels, urinary citrate and pH decrease, while urinary calcium, undissociated uric acid and phosphate increase, putting you at risk for problems like kidney stones. (9)


Consuming too many acidic foods creates a “chronic low-grade acidosis” that depletes precious minerals like magnesium, calcium and potassium from the body, while adversely impacting bone health, increasing inflammation and paving the way for chronic disease. (10)

Then keto diet is a step in the right direction as it minimizes the consumption of carbs. But this is only one step …

The Keto-Alkaline® Diet

Unfortunately, traditional keto diets — great as they are in other ways — can also be acidic. In other words, your urine and saliva — not blood — pH become acidic when you focus on keto-friendly foods like meat and dairy.

Typically, traditional keto diets neglect alkaline foods, which become critical for optimizing pH and therefore maintaining an optimal keto diet. The missing link for a successful keto diet is to first get alkaline — in other words, eating enough of the right nutrient-dense foods to stay in ketosis but also stay in an alkaline state.

My Keto-Alkaline® diet is rooted in ketogenic methodologies, but it also incorporates the “reality of everyday life,” as well as the alkaline component that is missing in standard keto diets.

I developed pH and ketone urine test strips to help patients easily measure alkalinity and ketone levels. While there are limitations, this is the only way to really know if you are alkaline and in ketosis.

Once a patient is alkaline, I then help them get into ketosis by eating about 56–70 percent healthy keto friendly fats, 20 percent protein, and about 5-to-10 percent healthy carbohydrates.

The principles of my Keto-Alkaline® Diet include:

  1. Restricting carbohydrates.  Studies show that after three or four days without carbohydrate consumption, your body starts tapping its fat storage also known as ketosis. You’ll want to stay between 25–35 grams of carbs to get into ketosis, and that requires bucking mainstream, carb-heavy, and supposedly nutrient-rich foods like fruit and grains. There are good carbs you can eat that will help you stay in ketosis. Be sure to look over these more keto diet friendly fruit options.
  2. Practicing intermittent fasting. This works wonders to help patients get into ketosis. Ideally, you’ll go 13.5–15 hours between dinner and breakfast to help your body find energy reserves beyond stored glucose. (Your body can only store reserves for about 24 hours, so if you are eating much less, intermittent fasting will allow you to drop your storage levels way down, requiring your body to burn fat instead.)
  3. Getting more alkaline foods. Foods like green leafy veggies and lots of good clean water help you become more alkaline.
  4. Identifying not-so-obvious acidic foods. There are a few acidic veggies (like Brussels sprouts), as well as alcohol (sorry!), coffee, and most dairy that are acidic and must be avoided. That doesn’t mean you’ll never eat them again. I can’t imagine life without wine and chocolate and brussel sprouts! Just be aware that as your body shifts into alkaline mode, they will be off limits temporarily.
  5. Shifting lifestyle factors. Besides eating the correct foods, reducing stress, getting great sleep, increasing movement, having healthy daily bowel movements, reducing environmental toxin exposure and cultivating positivity all contribute to a Keto-Alkaline Diet®.
  6. Doing it gradually. Getting familiar with alkaline foods and testing your urine pH are my week-one goal. Eventually, we further restrict carbs, but we take all this on a step-by-step basis.
  7. Taking your temperature. A keto-alkaline diet should increase your metabolism. That’s why I want you take your temperature about 10 minutes before getting out of bed. Ideally, it will be about 97.6 F. A lower temperature could indicate a thyroid issue and the fact your metabolism isn’t functioning optimally.

Weight Loss: Just the Beginning of a Keto Diet’s Many Benefits

As with most of my patients, it took Jini about four days to shift from glucose to ketones as her primary fuel source, but once she did, she immediately started losing weight and feeling better. And her experience was far from unique.

Ketosis stabilizes appetite-regulating hormones like ghrelin and leptin. And because you’re not getting that constant sugar surge, insulin levels stabilize so you don’t have the blood sugar spikes and crashes that lead to hunger and cravings. Being in ketosis also lowers inflammation that, when elevated, hordes fat.

One study looked at the effects of a 24-week keto diet based on 30 grams of daily carbohydrate intake by obese patients. Researchers found that the keto diet significantly reduces body weight and body mass index (BMI), while also improving lipid profile and blood glucose levels without any significant side effects. (11)

Research has proven that ketosis can boost overall health, and I discuss weight loss and the many other benefits of keto diets in my new ebook, “The Secret Science of Staying Slim, Sane & Sexy after 40”!

After all, having your skinny jeans fit again provides motivation to take action and become more proactive about your health.

Dr. Anna Cabeca is an Emory University trained gynecologist and obstetrician, a menopause and sexual health expert and international speaker and educator. She created the top selling products Julva® — an anti-aging feminine cream for women, MightyMaca™ Plus — a superfood hormone balancing health drink, and online programs Magic Menopause, Women’s Restorative Health and SexualCPR.  Read her blog at, and follow her on Facebook, Twitter and Instagram.

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