August 26, 2013


Ketones and Carbohydrates: Can they co-exist?

Can you "carb-load" and stay in ketosis?

Read Time 8 minutes

For reasons I’m still struggling to understand, the idea of “nutritional ketosis” (NK, to be distinguished from starvation ketosis, SK or diabetic ketoacidosis, DKA) is often discussed and debated in much the same way as religion or politics. Perhaps this can be said of all nutrition, which is a shame.  Nevertheless, in my continued defiance of such sensitive topics, I’d like to add another layer of complexity and nuance to this discussion.

The “rule of thumb” for NK is that caloric intake is determined as follows (this excludes a subset of ketogenic diets known as calorie-restricted KD which, as the name suggests, is specifically restricted in calories):

  1. Carbohydrate (total, not “net”): less than 50 gm/day, but ideally closer to 30 gm/day
  2. Protein: up to 1 to 1.5 gm/kg, but ideally below about 120 gm/day
  3. Fat: to satiety

Let me illustrate what this looks like for Joe (left), Jane (middle), and Jeff (right — an example of a calorie restricted KD), three hypothetical people in NK — but each with different caloric requirements.


As a general rule, as caloric requirement increases the proportion of calories derived from carbohydrate and protein decreases (and the contribution of dietary fat increases), even while absolute intake of carbohydrate and protein increases.

Anyone who has bought a blood ketone meter knows how tough it can be to get “into” ketosis by carbohydrate restriction (since everyone asks, I use the Abbott Precision Xtra meter which uses two different strips: one for glucose and one for beta-hydroxybutyrate, or BHB).  Most practitioners consider the minimum threshold of NK to be a fasting serum level of BHB above 0.5 mM.  I’m a bit more stringent in my practice and like to see fasting BHB levels above 1 mM.   To give you a sense of one person’s numbers (mine), over a 6-month stretch in 2013, when I was in NK, my mean (i.e., arithmetic average) morning fasting level was 1.7 mM with a median value of 1.4 mM.  The highest morning level during that period was 5.2 mM.  (The highest morning level I have ever measured in myself is 5.7 mM.)

But, it took me a long time to get it right, especially since at the outset of my foray into NK I was consuming between 4,000 and 4,400 kcal per day.  (My average daily caloric intake for weight stability was about 3,800 kcal per day, which was validated by doubly-labeled water.)  I could still easily “fall out” of NK.  For example, on my daughter’s 5th birthday she insisted I have some of her tikka masala (contains lots of sugar), naan bread, and mango ice cream.  How could I say no to a birthday girl who insisted on going to the nicest Indian restaurant in San Diego?  As to be expected, the next day my BHB was 0.2 mM, and it took me 2 days to get back above 1 mM.

Here’s a little secret I’m about to let everyone in on… I like carbohydrates. I love sushi (though I now mostly eat sashimi).  I love Indian and Thai food, though I prefer to make curry myself to keep sugar out.  I make (and eat) the best hummus this side of the Nile River. I’ve figured out how and when I can eat them to meet the following conditions:

  1. Stay in NK (except on a few occasions like my daughter’s birthday);
  2. Increase my anaerobic performance;
  3. Preserve most (but not all*) of the benefits I enjoyed when I was much more strict about my ketogenic diet.

How, you ask? By learning to calculate my glycogen deficit.

(*) For me, the leanest body composition I achieved as an adult was in strict NK with no attempts to do what I’m about to describe below.  Since I’m not a model and nobody cares if my body fat is 7% or 10%, I’m happy to be a little less lean if it gives me the flexibility to increase performance and live a slightly more sane life.  At least for now.

PLEASE NOTE: I have never suggested, and can’t imagine I ever will suggest, that a KD is “best” or “right” for everyone.  What I describe below may seem extreme, both in the amount of work required and the actual application.  I fully acknowledge that (1) this is a highly analytical approach to eating, and (2) that I’m a “freak” (my wife’s words, not mine). I certainly don’t do this often, unless a lot is on the line (e.g., a big ride), but I like having this technique in my armamentarium.

If you’ve watched my presentation from 2013 at the IHMC, then you’re familiar with RQ.  Through years of metabolic testing I have a pretty good sense of my RQ at any moment in time – when I’m sleeping, when I’m sitting around (most of the time), when I’m riding my bike at 200 watts, when I’m riding my bike at 400 watts, when I’m lifting weights, etc.  This allows me to calculate what proportion of my energy I derive from glycogen and what proportion I derive from fatty acid.  Consider the following example:

If I ride my bike at an average of 185 watts (you’ll need a power meter to infer this) for, say, 2 hours, I know my average RQ is between 0.76 and 0.80.

The approximate formula is %CHO = 3.333*RQ – 2.333, which can easily be derived from the observation that %CHO utilized increases linearly from 0% at RQ 0.7 to 100% at RQ 1.0.

Furthermore, I know my VO2 at 185 watts is 2.9 liters per min, which means (using the Weir formula which I presented previously) my energy requirement was about 14 kcal per minute, or 1,680 kcal over 2 hours.  Hence, of these 1,680 kcal needed to pedal 185 watts for 120 minutes, 336 to 554 kcal came from glycogen.  In other words, I utilized between 84 and 138 gm of glycogen.

(By comparison, several years prior to being in NK, this effort in me would have taken place at a slightly higher VO2 – closer to 3.2 liters per min – and at a much higher RQ – between 0.90 and 0.95 – meaning the exact same work output would have required somewhere between 300 and 400 gm of glycogen!  That’s a real state of metabolic inflexibility.  Basically, I was entirely dependent on carbohydrates for energy.)

Since the first metabolic priority for ingested carbohydrate is glycogen replenishment, I can, in this setting, consume probably somewhere between 60 and 120 gm of carbohydrate following this ride and stay in ketosis.  Why? Because those carbohydrates are prioritized to replenish my glycogen stores AND I am highly insulin sensitive.  Note the *AND* in this last sentence. (The especially astute reader will realize some of this glycogen debt will be replenished by protein and glycerol, the latter of which is liberated by lipolysis – see post on fat flux for a primer).

Clearly I didn’t consume this amount of carbohydrate on my daughter’s birthday, so why was I out of ketosis the next day? Because my glycogen debt was not high.  Of course, I knew this and didn’t really care.  But, if I know my wife wants to go out for sushi one night, and I know she’s going to make me eat a California roll, I can “rig it” such that I show up to dinner with a glycogen debt appropriate enough to enjoy them without significantly interfering with my liver’s BHB production.

Extreme example

At one point, I did two tough bike rides on consecutive days.  Each day we rode 110 miles under challenging conditions.  Over 6,000 feet of climbing each day and very strong winds, which were either headwinds or cross-winds.  On top of this, we rode pretty fast. For the purpose of illustration I recorded everything I did and ate on the second day, which I rode a bit easier than the first day.

The second ride took 6 hours and 5 minutes.  My average normalized power output was 225 watts, and arithmetic average power output was 184 watts.  Based on mechanical work output, this required about 5,000 kcal.  Factoring in the other 18 hours of that day, my total energy expenditure was about 6,800 kcal for the day, obviously not an average day. (A detailed explanation of where the extra 1,800 kcal were expended is beyond what I want to get into now, but it’s basically the energy required to keep me alive – transport ions, contract voluntary and involuntary muscles, etc. — plus move me around, and digest food).

So what did I eat that day?

  1. Breakfast (pre-ride): 5 scrambled eggs, 2 sausage links, 3 pieces of bacon, coffee with cream.
  2. In ride nutrition (I spread this out over 6 hours): 14 oz (not a typo) of salted cashews, 2 Quest bars, 1 peach, 1 apple, 6 bottles of Biosteel High Performance Sports Drink, water. (Since I know someone will ask, I did not consume super starch this day since I was craving cashews as my carbohydrate source and was craving more sodium, given the 90+ degree temperature.)
  3. Late lunch/early dinner (post-ride): 2 oz ham, 3 oz pulled pork, large salad with oil and vinegar dressing, 2 slices of cheddar cheese, 6 mini hamburger patties, 2 tomatoes.

What did this amount to?

  • Fat – 351 gm, or 3,160 kcal of fat
  • Protein – 245 gm, or 980 kcal of protein
  • Carbohydrate – 321 gm, or 1,284 kcal of carbohydrate

(I used package information and Nutritionist Pro software to calculate this.)

Hence, on this day I consumed about 5,400 kcal in total at the following ratio:

  • Fat – 58%
  • Protein – 18%
  • Carbohydrate – 24%

By all conventional wisdom I should not have been in ketosis the next morning, right?

The following morning, my BHB level was 2.2 mM and blood glucose was 5.1 mM.

Teaching point I can’t resist: Following 2 days of significant caloric deficit, about 3,000 kcal in total, I should have in theory lost about a pound (mostly fat, possibly some muscle) which would have been noticed on a scale.  Instead, I gained 8 pounds over those 2 days! Sure it was mostly water retention, both from the glycogen (small) and the fluid accumulating in the interstitial space (“thirds space” fluid losses, large) due to a systemic inflammatory response.  This happens under extreme conditions of exercise.  In fact, the harder I exercise, the more weight I gain, transiently.  I am at my absolute lightest following 2 days of travel (i.e., rest).  So before freaking out at the sight of the scale, keep in mind that most day-to-day weight movement in our bodies is indeed water movement into and out of the plasma and interstitial space, respectively.

What’s my point?

Context matters!  If I ate even one-quarter of that amount of carbohydrate and two-thirds of that protein on a normal day – say, 2.5 hours of riding or 1.5 hour of riding followed by 1 hour of swimming, or a day of travel with no exercise – I would have been out of ketosis for two days or more. (Of course, my appetite on those days would not have allowed me to eat 5,400 kcal without feeling sick, but I won’t get into that until a later post.) But on this day, with these glycogen demands, I was able to maintain the perks of ketosis AND glycolysis simultaneously.

There are days, though, when I overshot my glycogen need and end up with a low BHB and high fasting glucose the following morning. Conversely, there are days I underestimate my glycogen depletion and wake up with very high BHB levels and very low glucose levels (i.e., BHB levels higher than glucose levels, when both measured in mM).

Final thoughts

I felt a bit like I was in unchartered territory because the literature on nutritional ketosis hadn’t really (to my reading) explored this level of extreme activity.  In future posts, I may write about other experiences and self-experiments, including my experience with exogenous (i.e., synthetic) ketones (which I did not use on this ride, but have experimented with on other rides – no, this is not “raspberry ketones” or other such gimmicks).

2017: You can read about one of my earliest experiences with exogenous ketones in this post.

Are carbohydrates necessary to produce 225 watts or more for hours on end? Yes. But, the key is knowing how much you need and when to take them.  A lower RQ at a given level of intensity means less demand on glycogen. In my experience, working with athletes and non-athletes, most tend to make two errors (for lack of a better word):

  1. They over-estimate their carbohydrate requirement, and/or
  2. They forget that no factor influences RQ – and therefore substrate requirement – more than dietary composition during lead up to event (or “life”, which is sort of the ultimate event).

Know your engine, first.  Then fuel it appropriately.

Photo by CloudVisual on Unsplash

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.


  1. Dr.Attia, I was curious your thoughts on why you have been able to escape the negative effects on your labs from marathon style exercise that others like Ben Greenfeild had. Do you attribute it to ketosis only, or is there something else I am missing. If so that could drastically change the workout protocol for most of us.

    The Best

    • I think Ben is doing a remarkable job, certainly based on the long conversation I had with him on Sunday after his race. There will be a few things we tweak going into Hawaii, but overall, and certainly for the first 8 hours of that race, he was on fire. I’ve had many missteps, myself, remember. This is new territory, and progress is highly empirical.

  2. Peter, question for you:

    I currently stay in ketosis for about 2 months, and then cycle back out for a month.

    While I find ketosis to be my preferred state, both mentally and physically as far as my running and biking, the reason that I cycle out is because I have seen a fair amount of other N=1 experiments (mostly paleo VLC forums) where thyroid issues have arisen from longer term VLC diets.

    I am aware you have been pretty consistently in ketosis for the past two years, do you think these issues are a cause for concern? Is there any way to mitigate thyroid issues from occurring on a long term ketogenic diet?

    • Perhaps, just be sure to distinguish between CLINICAL hypothryroidism and LAB hypothyroidism. The former requires intervention. The latter does not.

    • Thanks for the response.

      Additionally, I have been reading a lot of Ray Peat’s & Danny Roddy’s articles regarding PUFA’s and treating hyperglycemia as part of an adaptive reaction in diabetes rather than the cause of diabetes. Also there are the implications of ketosis acting as a stressor on the body due to more readily freeing fatty acids as well as increased cortisol and estrogen production for lack of glucose. Ray argues for a diet higher in sucrose/fructose in order increases metabolism and overall health sans weight gain.

      While personally, since beginning my N=1 experiment, my BP has dropped to normal levels, my BMI is now normal rather than overweight, my fasting glucose and waist have both shrunk, and all other bio markers of health I have tested thus far have improved, I am curious if this was solely due to the restriction of sucrose, or an overall improvement in my diet.

      I am curious to your thoughts regarding such research showing an opposing, but healthful view of the other side of the coin. If we are viewing insulin resistance as the main cause to metabolic syndrome, and a solution to insulin resistance is ketosis, do we also view ketosis in general as a healthy state?

      I ask this not for a personal recommendation on my N=1 but for your opinion on the overall view for people utilizing ketosis as a longer term diet targeting overall well being.

      Ray Peat articles on sucrose

      Danny Roddy’s comments on Ketosis (summary of Ray Peat’s analysis)

  3. My crazy question (we all get one, right?):
    My very beautiful wife complains that years of very vigorous training (6 days a week/intense cardio/some weights/some boxing) combined with years on a very low fat diet have decreased the size of her breasts. I couldn’t care less, but she cares. So, having read a fair amount here and Gary Taubes’ book, I am convinced that hormones (growth, sex, and insulin) play a huge but not exclusive role in how much fat the human body stores and where it stores it. Is it crazy to hypothesize that a low fat/high carb/low calorie diet might result in more fat where the insulin will direct it (mid-section) leaving less fat for the estrogen to direct (breasts); and a high fat/low carb/no sugar diet might result in less fat where the insulin would direct it (mid-section) leaving more fat for the estrogen to magically direct (breasts) in post-pubescent but pre-menopausal women?

  4. Peter, I am a 62 year old runner. I compete in a series of races in the Arkansas Grand Prix. They are from 1 mile up to a 1/2 marathon. I know I can probably compete at full potential from 5K up in a 1/2 in a NK state. But what do you think about 1 and 2 miles. Do I have to worry about carb loading in distances that short?

    • You need glycogen, but use the formula I’ve outlined to estimate it. We’re talking about up to 10 min of all out running This can’t use more than, say, 200 kcal. The issue is more about training, where you’ll run multiple intervals. There is no need to load for such a short event. Fuel partitioning is more important for most.

  5. Peter,
    I wonder if you wanted my experiences to add into the mix? I have been doing similar stuff to be, ketogenic triathlon, not ironman this year but half ironman, then ironman next year.
    We have briefly discussed on another thread that I have had similar experiences to you with regards to carbs and ketosis, in that I can sometimes consume upwards to 200-300g of carbs and not only still be in ketosis but record very high levels 4-5mmol, just hours after this consumption around long hard training.
    I have also never noticed a drop in my top end, like many seem to have experienced.

    Anyway, I have been ketogenic now for a while, not far off a year. It has given me much greater metabolic flexibility.

    I decided to test this ability to run on my own fat stores with a half ironman earlier this year.

    It was a fairly hilly race, both bike and run. I ate at 6pm the night before, then no breakfast and consumed only water. In the race i felt great, about 50th out of the water, 8th coming in off the bike, ran up to 3rd on the run, got to mile 9 out of 13 and bonked spectacularly, I could barely walk! Had a gel and finished 7th, and this was a national level race with the first 2 pro athletes so not too displeased.
    But I found out that I could go for just over 4 hours on water.
    I had averaged nearly 300w on the bike, so I was pushing it a bit and there were many many hills, normalized power was about 320w.

    So I learned a lot.

    I raced again this weekend, this time, I had a keto shake for breakfast, with a bit of coconut milk, oil, spinach and cinnamon, yum! On the bike I had some vitargo, about 2 scoops max as I didn’t drink much of it, so around 50g of carbs, or 200kcal. Then nothing on the run. I made up for my lousy swim, running through the field to come 2nd with the fastest half marathon by over 5 mins, finishing only 1 minute behind the winner who took 7 minutes out of me on the swim!
    I honestly think if the races were reversed (this one was flat) I would have been fine on nothing in this one.

    I don’t have RQ testing to indicate my level of glycogen utlisation etc. but I am guessing it must be at a pretty high intensity as I was pushing hard for the whole race of 4 hours, which living very low carb (and no carb loading at all prior to race) I don’t think I can have much of it!

    Next year I plan to take my experiment to full ironman where I am aiming (and don’t laugh) for around 8 and half hours. based on the fact that I felt like I could have biked all day at that intensity and run a full marathon no problem (I’m very efficient when running).

    Thanks again for all your info Peter.

  6. Peter – some very interesting new products out on the market that are keto related. the one i am most excited about is called “KETOFORCE”, by a well regarded nutritional chemist Patrick Arnold. it’s BHB in a bottle, supplying your body with exogenous ketones on demand. it’s quite interesting. he’s done some work with a leading researcher in the field. Instant Ketosis. elevates blood ketones significantly for 3-4 hours after ingesting. it also seems to lower blood sugar. i’ve taken it a few times pre workout, and have had some of the best workouts of my life, with ridiculous stamina. Users are either using the product as a) a pre-workout in order to boost endurance b) a transition product to help your body ease into ketosis while eliminating a lot of the transitory side effects such as fatique, brain fog, etc as your body becomes keto adapted. i really enjoy the product, and feel it gives me energy, mental accuity, and great work outs. it’s a bit too expensive to use on a daily basis, but i think this sort of product has a place in the market. as of now, they can;t market it for “medical” benefits, but it certainly has a lot.

    what are your thoughts on a product like this?
    more info on

  7. To your knowledge, is the HOMA-IR model being used (adopted) more in clinical practice than I am simply aware of? I’m not a clinician but from what I’ve read it SEEMS like it would be a good idea as a screening tool. Fasting glucose and C-peptide are easy enough to obtain, but most of what I’m getting back from PubMed concerns POS and Gest. D. I wish my doctor had known about it when hints of my metabolic syndrome began to show up. I had never heard of it until I began reading your blog. The RIAD study published out of Germany back in 2002 (Henkel, E. et al.) is interesting. Especially the correlation of IR and higher levels of Plasminogen-Activator-Inhibitor. I was reading that part as I was taking my b.i.d. 81mg enteric coated ASA and 100mg Nattokinase. Gotta cancel out that one bad copy of Factor V Leiden I inherited, coupled with IR, somehow.

    • HOMA-IR is pretty widely used, but it’s not very accurate at predicting IR relative to the gold standard — insulin suppression test (IST) or euglycemic clamp, which is not quite as good as IST, but is used in research settings a bit more frequently. Best “simple” test is probably 60 min and 120 min insulin response to OGTT.

    • Hi, Peter, quick question for you: I’ve read that if one eats a low-carb or ketotic diet one should eat at least 150g of carbohydrates daily for three or so days before an OGTT, to avoid getting a false positive on impaired glucose clearance due to transient insulin resistance. Should the same protocol be followed before the test to get a proper reading on the 60 min and 120 min insulin response?

      Many thanks

      • Yes, this appears to be correct, just as you’ve described. Probably true for the more complex tests also. BTW – a properly done OGTT gives you 60 and 120 min insulin and glucose response.

  8. Peter,

    Thanks for providing such a wonderful forum and being so engaged with your audience.

    I wanted to hear your thoughts on this recent study reported on by Gina Kolata.
    People are beginning to accept that there is more to obesity than “calories in/calories out.”

    If the causes of the obesity epidemic involve not just human physiology, but also the ecology of the bacteria in our digestive systems can we ever hope to “prove” exactly what all those mechanisms are? The human fetus is sterile, but it must be colonized by bacteria to survive, a hugely complex and variable process. Can science ever find the mechanisms by which processed foods, for instance, upset our bodies natural balance, both with regard to physiology and to the microbiome? Or should we look to the ideas of the natural foods and/or “paleo movements, and cut the Gordian knot?

    • This effect has been noted for several years, in fact, it may partially explain some aspects of gastric bypass (e.g., resolution of IR before reduction of weight, suggesting gut flora change in response to biliary changes, which alters IR before reduction in adiposity). Very exciting topic. Of course, the obvious question — how does the foods we eat impact the gut flora?

    • > … how does the foods we eat impact the gut flora?

      This topic may be one of the next big things in nutrition (for those cut loose of consensus dogma, anyway). Over on the Wheat Belly blog, I see a steady stream of people who have quit wheat reporting acute re-exposure reactions. What’s that about? Dr. Davis also commonly suggests a course of probiotics to recovering ex-wheat eaters. Are these related?

      My conjecture is that goat grass (what modern semi-dwarf hybrid wheat largely is), and gluten-bearing grains generally, are violently incompatible with ideal human gut flora. And “ideal” means, among other things, preventing leaky gut, which is the starting point for any number of ailments.

      >> The human fetus is sterile, but it must be colonized by bacteria
      >> to survive, a hugely complex and variable process.

      Saw that and immediately thought: T1D?

      T1D is rising (and it’s obviously not because the modern fetus is eating too much junk food and not getting enough exercise). What does cause it? Might parental gut flora, and by implication parental diet, play a role?

      Based on reactions to one of Dr.D’s provocative posts, parents of T1D kids are generally denialist about what role parental diet might play, and are also not keen on using NK to manage the condition, but if progress is to be made, we have to be open to all the implications of dietary choices.

  9. Dr. Attia,

    Ketones vs Carbs, can they co-exist? How about Ketones vs. Alcohol? Can they co-exist in some fashion as carbs and ketones do in your article?

    I’ve read that alcohol will kick you out of ketosis until your body burns the alcohol for energy first (because it takes priority being a toxin). Then once it’s used up your body goes back into ketosis? or does it go back to burning glucose?


    • Two separate issues — the ethanol itself and the sugar and carbs that often accompany it. The latter is obvious — beer and drinks make with juice will kick you out — but dry wine and hard etoh, less clear. Seems to be does dependent. Yes, etoh is typically a prioritized “nutrient.”

    • from my testing it reduces ketones – as it obviously contributes energy and hence the body needs to produce less ketones – but not keto-adaptation, i got easily back even after bottles of wine (dry) or other non-sugary drinks (caipirinha with lemons w/o sugar + sucralose), though i gained weight when drinking too much, despite work out.

  10. Peter, can PEF, Peak Expiratory Flow change due to a ketogenic diet? I am on a strict ketogenic diet and train on a regular basis. When I visited a clinic at the hospital this week, I had 570 in PEF. If I’m not wrong this is quite good for a woman of 48 years and 161 cm tall. And also another test (not sure if it was Spirometri) turned out to be “very good and high on the scale compared to my age and size” the nurse said. Or are those testings and numbers just due to genetics?

    • I can give a little bit of “correlation” on this topic. I have allergy mediated asthma which is not overly severe but it would always be a constant thorn in my side. Always there just bad enough to drive me crazy and the only way I could force it to go away as I have gotten older was to combine q.d. Singulair + Zyrtec, and I’m allergic to damn near everything in North America that’s not a food. After being on an ultra low carb diet for about 2 weeks I noticed a remarkable reduction in my “latent” asthma. All I have to take is the occasional O.T.C. Zyrtec if something is in bloom or if I dust a ceiling fan or something like that, or cut the grass. That will get me every time. I have always had very good spirometry results as well, mainly because of my size as most spirometers just aren’t really scaled for me just like the sphigmo cuffs. That and I grew up doing a lot of free diving in Florida so I have really good chest expansion. The docs could always hear the wheezing but the restriction just wouldn’t register on the spirometer results at all. My thought though is the low carb diet just reduced inflammation enough to make the issue go away for the most part. That alone is enough to keep me eating this way irrespective of how it helps with my IR issues. Maybe you had some low level inflammation in your airways that was bad enough for you to take notice now that the dietary changes have eliminated, or greatly reduced, it. Either way it’s a nice feeling. Breathing problems are just one of the worst to have.

  11. Hi Dr Peter,

    Are there any existing or potential supplements that can enhance the ability of skeletal muscles to use ketones or hasten their adaptation to NK?

    Thanks for all your work,


  12. I shouldn’t have said “enhance the ability of skeletal muscles to use ketones” since beta-Hydroxybutyric acid is technically not a ketone.

  13. Beyond The Pale

    Really?! – Various fruit-loops have commented how Magnesium helps relieve cramps – you could have fooled me – the stuff is totally worthless in that regard –

    I take some every day to keep me as empty as possible so as to prevent a Hernia attack at the lower intestine/colon valve juncture – it works in this regard –

    What does help cramps?

    Oddly enough – one Green Stuffed Olive per day is totally effective – So – it’s either the Pimento or the Green Olive

    I could expand on this further by asking this salient question : -Does mean Black Olives or Olive Oil serve the same purpose ?

    Who knows – I don’t – and I’m not inclined to pursue the matter for the time being –

  14. Hello,

    thank you for your post(s).
    I have a few questions:
    1. were cashews raw, roasted or soaked (in water)?
    2. what other source of carbohydrates would you (yourself) also eat during that ride, ifnot those you wrote you did?
    3. Do I understand you correct, that if the next week you know you will have a hard ride/triahlon (or whatever), you would eat every day the same as you did the past months and than ONLY DURING (not a day or a meal before or after that) you would consume carbohydrates? -> acording to your past or latest observations?

    Thank you.

    • 1. Roasted and salted
      2. Super starch, other nuts
      3. Correct – no use eating that much CHO when glycogen stores are already near capacity; only when demand is greatest.

  15. A couple of questions;

    Do you know if taking a mineral citrate supplement, such as potassium or magnesium citrate, will stall ketoadaptation possibly because of the “extra” ingested citrate finding it’s way into the mitochondria and upregulating, or at least supporting, the Kreb’s Cycle through increasing Acetyl CoA carboxylase activity and thereby increasing Malonyl CoA, thereby INHIBITING Carnitine acyl transferase I? Does the body produce so much citric acid anyway that any extra you ingest is simply trivial? I was also wondering if you know of anyone else besides Prototype Nutrition producing BHB salts for sale to the general public? I can’t seem to find anyone else.

  16. Hello
    I tried looking for the answer for this on your site but couldn’t. I’m an Ironman triathlete and ultrarunner, I have been low carb for about 9 months now and started NK for over four weeks now with the aim of putting my pre-diabetic state in remission (family history of type II). How can I manage a ‘miss’ on NK? ie. taking my wife to a Thai/Japanese meal or having a glass of two of wine every now and then.
    I’m loving NK but it’s very antisocial at times so wondering how I could manage this.
    Many thanks.

    • might seem so, but its not anti-social, though you have to get used to always be modifying orders/dishes/plates in restaurants, which in 99% works out without problems. in canteens you will be more selective, but thats not a problem, as you can just hold out until you get some proper food.

      japanese is easy: sashimi, hand-maki w/o rice, edamame, fried fish & sea food w/o sweet sauces. yes, no rice.
      thai: replace rice & potatoes with lightly steamed broccolis or other greens, i do it all the time, it tastes even better now. I say broccolis because its usually available.

      wine/sake will – according to my exp – pure alcohol (ie, not beer) will not throw you out of keto adaptation, but may reduce them for a while, i did some testing, even with some bottles of wine, i always had ketones. as far as my understanding goes, alcohol will be burnt with preference, probably thats why you get extra drunk and dont need that much and probably doesnt cause an huge insulin response (or else i wouldnt have ketones).
      however, naturally, the calories in alcohol will be found in you belly, like every calorie, unless you spend it. i noticed weight gains frequently when missing too much on alcohol.

      when in ketosis, eating a keto meal and drinking alcohol AND THEN on top having a sweet desert (1-2 a year that slip happens) I will become usually kind of hyperactive and my body will make me burn as much as possible.

  17. Have you noticed your resting pulse rate going up as a result of ketosis? Mine has gone from 42 to 68 over the last four months of being keto adapted.

  18. Interesting stuff but I can’t help but read your work and think.. “man.. he is way over-thinking things”.

    The level of carbs/fats just doesn’t matter if your overall calories and protein are right. Those 2 variables equal, you’ll get just as lean upping the carbs or lowering the carbs.. but you won’t look as good unless you up the carbs.

    It really is that easy.

    • So you are saying that with the constant amount of protein, let’s say 1-1.5g per kg of lean body mass, in my case 70-105g/day, I could limit the fats and add carbs as the main energy source and I would be fine?

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