Ketosis Questions & Answers
Ketosis and ketogenic diets can be difficult to manage, especially for those new to the concept. Although we have a FAQ for enhancing ketosis, we wanted to include a questions and answers section for those with keto specific questions.
If you would like to ask a question, please send an email to Q&A@herbaladjunct.com. We will try to address as many questions as we can.
Below are the short answers to the most common questions we receive.
Most are followed by links to a full article with much greater detail on the subject. I’ve added an approximate word count of the larger article as well.
- What is dietary ketosis?
- What is a ketogenic diet?
- What are the rules for ketogenic diets?
- What are the types of ketogenic diets?
- What happens to your body during ketosis?
- How do you get into ketosis?
- How do you stay in ketosis?
- What can you eat on a ketogenic diet?
- What are Net Carbs and why do they matter?
- How do sugar alcohols affect ketosis?
- What is a keto cheat day?
- How does cheating affect ketosis?
- How can I get back into ketosis after a cheat day?
- Can I eat low carb and low fat?
- Are packaged keto diet foods really ketosis friendly?
- When should I check my ketones?
- Can you be on a keto diet and not check ketones?
- Why should I use a ketone meter instead of urine test strips?
- Why am I not in ketosis in the morning?
- What is a no carb diet and is it safe?
- What are keto pills?
- Do keto pills work?
- Should I take exogenous ketones?
- I’m in ketosis. Why am I not losing weight?
- What is Keto Flu?
What is dietary ketosis?
At a basic level, ketosis is just a switch in the fuel source your body uses. Without enough carbohydrates coming from your diet, and once you’ve burned through your body’s storage, your body starts making ketones from the fats you eat. Ketones become the new fuel source for the body.
Without enough fat in your diet to meet all your caloric needs, your body starts burning through its fat stores. That is why ketogenic diets are famous for fat / weight loss.
For more information, see the full article “What is dietary ketosis?“.
What is a ketogenic diet?
Simply put, a ketogenic diet is any diet that is very low in carbohydrates and high in fat. Ideally, you would get the vast majority of your calories from fat, have enough protein to maintain your lean body mass, and ingest as few digestible carbohydrates as possible. We will discuss some of the relevant types of diets below, but we do not endorse any particular “brand” of ketogenic diet.
Although complicated at the biochemistry level, at a basic level, ketosis is just a switch in the fuel source your body uses. Without enough carbohydrates coming from your diet, and once you’ve burned through your body’s storage, your body starts making ketones from the fats you eat.
Ketones become the new fuel source for the body. Without enough fat in your diet to meet all your caloric needs, your body starts burning through its fat stores. That is why ketogenic diets are famous for fat / weight loss.
For more information, see the full article “What is a ketogenic diet?“.
What are the rules for being on a ketogenic diet?
There are a lot of different ketogenic diets out there, but at the core they are all about limiting carbohydrates.
You can eat 20 grams of carbohydrates a day during induction and upwards of 50 without breaking ketosis if spread out over the day (non-dieting maintenance phase).
Protein is the most straight-forward macro when it comes to ketogenic diets. It is absolutely needed for bodily repairs and many amino acids (what makes up proteins) are only available through diet. Your body cannot produce them on their own. These are called Essential Amino Acids, so you need to make sure your protein sources contain them.
The recommended range of protein intake is between 0.8 g/kg and 1.8 g/kg of body weight, dependent on many factors (see the article for a link to a calculator).
One of the hardest parts of using ketogenic diets for weight loss is getting enough fat into the diet. Even with a loose interpretation of keto rules, fat should account for a minimum of 65% of your calories.
As we discussed in “What are the types of ketogenic diets” in the high-protein diet, 65% of calories coming from fat is barely ketogenic, if at all.
The higher the fat intake, the better. Shoot for 70-90% of your calories from fat, depending on how strict you want to be.
For much more information, including formulas, see the full article “What are the rules for ketogenic diets?“
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For much more information, including formulas, see the full article (~1250 words) “What are the types of ketogenic diets?”
What gets you out of ketosis?
The simple answer is: carbohydrates. The long answer is that different carbohydrates affect you differently (see “How do you stay in ketosis“). Some you can think of as “sugar” and you avoid them. Some are starches that are broken down into sugar and you should avoid them as well. Some, like dietary fiber, are not digested and therefore aren’t counted. Sugar alcohols can go either way, so you should check their GI (glycemic index) before eating them to see if they are safe. For more about carbohydrates and “net carbs”, see “What are Net Carbs and why do they matter?“.
What does insulin have to do with ketosis?
The biochemistry of ketosis is complicated, but it mainly revolves around glucose and insulin. Once starches and sugars are broken down and absorbed, your body’s response is to release insulin. Insulin is an anabolic hormone. Its purpose is to help cells get the glucose they need for fuel and then store the rest. That is the most import part to remember. Any glucose that is not immediately used is converted by the liver to glycogen, which is what the body uses to store carbohydrates. The next time the body needs more glucose, it will break the glycogen back down into glucose and use it for fuel. The entire time your body has higher than baseline levels of insulin in your blood, it is not producing ketones and not burning fat for energy. In terms of ketosis, insulin is the enemy.
Isn’t insulin just for diabetics?
When we think of insulin, we think of diabetes. In diabetic patients, they are either lacking enough insulin or their bodies are resistant to it. Either way, the body needs more insulin to accomplish the same thing as non-diabetics. However, because ketosis is linked to insulin, we can learn a lot about managing it by the way we treat diabetics. Outside of pharmaceutical management, there has been a lot of research into the treatment of diabetics with botanical extracts. We can use that research to enhance the ketogenic process.
What does diabetes research tell us about Ketosis?
The treatment of diabetes with botanical extracts focuses on five different targets.
- Enhancing the ability of glucose to enter muscle cells (for fuel) or to enter fat cells (for storage). Insulin does both of these, but to augment ketosis, we need to enhance the transport into the muscles and body cells, but avoid fat cell storage.
- Enhancing the body’s ability to produce insulin. Because insulin is the enemy of ketosis, we will not explore this target.
- Suppressing the production of glucose by the liver. In diabetes, this increases the blood glucose regardless of sugar intake. In regards to ketosis, this increased glucose triggers insulin release, so by suppressing glucose formation, we can minimize the time insulin suppresses ketosis.
- Suppressing carbohydrate absorption in the intestines. In diabetes, decreasing the amount of starch breaking down into absorbable sugars and keeping those sugars from getting into the bloodstream keep the blood glucose low. In regards to ketosis, this same process keeps insulin from being triggered and the body can stay in ketosis.
- Suppressing glucose reabsorption by the kidneys. Normally, most of the glucose that passes through the kidney is reabsorbed back into the bloodstream. By using medications or botanical extracts, diabetics can decrease their blood glucose levels without increasing insulin.
How can we use these areas of focus to enhance ketosis?
By focusing on four out of the five targets for diabetic research, we can learn how to optimize ketosis to be even more effective. The main focus has to be on limiting the impact of insulin by eliminating as much glucose in the blood as safely possible.
What about keto supplements on the market?
The answer is yes and no. There are currently two types of supplements on the market. Although both have some impact on ketosis, neither is sufficient to adequately enhance ketosis. Please see HERE for information on supplements designed for enhancing ketosis.
The first type of supplement is based on adding exogenous ketones to the diet. Basically, the ketones that your body produces during ketosis are taken in pill form (or other route) to raise your blood ketone levels. These can be helpful during induction phases by giving your body adequate fuel during the period that your body has stopped relying on carbohydrates, but isn’t yet producing enough ketones on its own. However, if you are using keto for weight loss, these supplements are counter-productive. The whole point of dietary ketosis for weight loss is to burn your own fat to produce the ketones you need for energy. If you take them as a supplement, your body will burn less of your own fat for energy. Another problem with these supplements is that they artificially increase your ketone blood levels, which will show up in urine, blood and exhalation ketone testing. So, even if you are not in active ketosis, your tests may tell you that you are. False positives like this can make you think you are burning fat, but you may not be.
The second type of supplement is based on one of the targets previously discussed. The term Carb Blocker is used for these supplements (although technically, they are Starch Blockers). Although these can be helpful, most people on ketogenic diets don’t have much use for them. Blocking the breakdown of starch into smaller digestible sugars would be beneficial to reducing blood glucose and insulin secretion, but starchy vegetables are considered “bad” carbohydrate sources, so aren’t consumed in large quantities. That being said, there is a place for these supplements during “cheat days” when a dieter intentionally breaks ketosis. Remember, any additional carb will be stored as glycogen, so blocking starch on a cheat day will shorten the time needed to get back into ketosis. However, these only help with starch and have no effect on simple sugars or starch breakdown products, or any other target for enhanced ketosis.
How does someone enhance ketosis based on the targets?
Each target, or area of impact, has different ways to be changed to enhance ketosis. These are most often biochemical in nature and are usually involved in the transport of nutrients or communication pathways in the body.
How can we affect glucose utilization?
The first target is the utilization of glucose, or how easily it enters muscle or fat cells. Non-diabetics, or anyone without Metabolic Syndrome, don’t have the same issue as diabetics when it comes to utilization. Part of the diabetic disease process is insulin resistance. This is where you have enough insulin in your blood, but it doesn’t move glucose into your cells correctly. Although non-diabetics don’t have this problem, there is a way to use the same process to enhance ketosis.
By using botanical extracts that help glucose enter the muscle cells without the aid of insulin, we can get the same effect without raising insulin levels, which would result in blocking ketosis. The non-diabetic will continue to move glucose into the cells using insulin, but the botanical extracts will do some of the work and lessen the amount of insulin needed to do so. As you are aware by now, the less we use insulin, the more enhanced the ketosis.
There is a secondary aspect this this as well. Insulin also helps move glucose into adipocytes (fat cells) for longer term storage by converting to fat. Although useful for diabetics by removing glucose from the blood, it hurts the ketogenic dieter. The goal of weight loss is to burn fat, not add to it. Although muscle uptake of glucose is important, blocking uptake of glucose into fat cells is even more important to enhance ketosis.
There are two main ways to influence this process using botanical extracts. Both of these work by targeting Glucose Transporter type 4 (GLUT4) expression, which is the transporter that moves glucose into muscle and fat cells.
The first of these is adenosine monophosphate-activated protein kinase (AMPK), which is one of the metabolic regulators in your body that controls energy usage at the cellular level. AMPK activation adapts rRNA synthesis away from a growth and storage state toward energy production and release state, common to fasting states. In short, activating AMPK stimulates the body to burn more fat and decrease energy storage as new fat or glycogen.
The second is something called peroxisome proliferator-activated receptor (PPAR), which regulates gene expression. There are multiple subtypes, but subtype α and γ are the two most important ones for ketosis. The two main functions of PPAR-γ are to up-regulate genes that code for lipid uptake and adipogenesis (maturation of fat cells) and increased transport of glucose into the muscles for use as energy, thus removing glucose from the blood stream and decreasing the amount of insulin the body needs to produce. The interesting thing about Honokiol, the PPAR-γ partial agonist in our formulas, is that it makes lipids and glucose available for use as energy, but does NOT lead to excess energy storage as new fat. This adipogenesis is the primary drawback for using PPAR-γ agonists for the treatment of diabetes, as many patients end up gaining body fat while taking them. The lack of this trait is very important as you still reap the benefits of PPAR-γ agonists, but without the drawback of fat storage.
How can we minimize glucose production in the liver?
One source of glucose that doesn’t come from the diet is the liver. Through a process called gluconeogenesis, the liver is able to make glucose from other chemicals in the body. This, among a few other things, is how your body can continue to function even if you eat no carbohydrates. However, once the glucose enters the blood, it has the same insulin stimulating effect as carbohydrates that you have eaten.
The goal of decreasing gluconeogenesis in diabetes management is to control circulating blood glucose. In ketosis, the goal is only to reduce glucose not coming from the diet. Reduction is an important term, because your body needs glucose to function and if gluconeogenesis is the main source of glucose (with limited dietary sugar), we don’t want to suppress it too much. Instead of limiting enzymes responsible for gluconeogenesis, it is better to use communication pathways, such as AMPK, which tell the liver not to produce glucose.
Admittedly, this target is not high on the list of interventions for ketosis. That being said, even a nominal decrease in gluconeogenesis during ketosis will help lower fasting blood glucose, and thus, circulating insulin. However, an increase in AMPK inhibits gluconeogenesis by inhibiting several transcription factors that promote the expression of gluconeogenic enzymes. Basically, AMPK turns off the genes responsible for increasing gluconeogenesis by blocking the enzymes needed to create new glucose. This helps reduce the internal production of glucose so that you only need to worry about the amount of glucose entering the system through the diet.
How do we suppress carbohydrate absorption in the intestines?
This is the biggest intervention we can make while enhancing ketosis, primarily because it is also the largest source of carbohydrates our bodies have access to. Although the body first starts to digest starches in the mouth, there is not enough dwell time to make a significant impact on carbohydrate absorption.
Once carbohydrates get to the intestine, they start to be broken down into smaller sugar molecules. Starches are broken down by something called α-amylase, which is produced by the pancreas. The keto “carb blocking” supplements that are currently on the market are almost entirely α-amylase inhibitors, which means that the starches are not broken into absorbable pieces and pass undigested into the colon. However, these only work on starches, not simpler sugars. Of course, if you are still eating potatoes, corn or other starchy vegetables, you are going to have a hard time with the ketogenic diet. It is best to avoid these on keto, but a small amount of starch can still be blocked without many digestive problems.
Smaller sugars are not affected by α-amylase, so continue to be moved across the intestinal lining and into the blood. This includes the vast majority of sugars that people on ketogenic diets continue to eat. After eating a meal with digestible carbohydrates, your blood sugar dramatically increases causing a large spike in insulin. In order to decrease this spike, we need to block the sugars from being absorbed.
Whereas α-amylase brake down starches, α-glucosidases break down smaller sugars (sucrase for sucrose, maltase for maltose, etc.) so they can be absorbed. Α-glucosidase inhibitors stop the breakdown from happening, and therefore are passed into the colon undigested.
Sugars that are broken down by α-glucosidases are then transported from the intestine into the blood using sodium-glucose linked transporter 1 (SGLT1). This gives us another target. SGLT1 inhibitors stop this transport from occurring, leaving the sugar in the intestine. Some of these still get through, despite SGLT1 inhibition, but the delay they cause also helps because the glucose levels rise slowly which keeps insulin levels low.
As you can see, stopping glucose absorption goes far beyond just stopping starch from being broken down. In fact, there are three areas we can impact with botanical extracts. After eating is when your glucose level is the highest, called post-prandial glucose level. Using any or all three of these targets decreases how high the blood glucose levels get post-prandial, therefore decreasing how much insulin is secreted.
How do we keep the kidneys from reabsorbing glucose?
During normal physiological conditions, almost 100% of glucose passing through the kidneys is reabsorbed and remains in the blood. SGLT1 does about 10% of the work, but the rest is done by SGLT2 in the kidney. When blood glucose is high, SGLT2 will stop transporting glucose back into the blood and let it escape into the urine. By using an SGLT2 inhibitor, diabetics can lower their blood sugar. From a ketogenic standpoint, SGLT2 inhibitors do the same thing as they do in diabetic patients. By targeting SGLT2 around the same time as glucose enters the system (meals), you can decrease the total amount of glucose in the system during the post-prandial time, so it is highly effective at reducing overall blood glucose levels. Although a good target, there is a risk when allowing glucose to escape in the urine. Urinary tract infection bacteria love glucose, so there is a risk that feeding them may lead to infection.
What keto supplements actually work?
Until now, there was nothing on the market that could target the four areas discussed above. However, there is plenty of research in the scientific literature that describes botanical extracts and how they impact these areas. In fact, there are many botanical choices that will impact these. However, there are also a lot of botanicals that both help and hurt ketosis at the same time. This is especially important when looking at diabetic botanical extracts. For example, berberine is a supplement that many diabetics take. It does a good job lowering post-prandial glucose and fasting blood glucose. However, some of the ways it does that is by increasing the number of β-cells in the pancreas (more cells to make insulin) and directly increases the insulin released due to glucose in the blood. Additionally, it can stimulate free fatty acids (fat broken down) to induce the secretion of insulin. This is the exact opposite of what we are trying to achieve with enhancing ketosis.
What is KetoGuardian™?
KetoGuardian™ and KetoSavior™ are the first supplements in the USA to focus on enhancing ketosis and making the ketogenic diet more effective by protecting the ketogenic process. KetoGuardian™ is our daily use supplement that, taken before meals, can help decrease post-prandial blood sugar and insulin, thus helping maintain ketosis. All of Its ingredients impact one or more of the four targets discussed. Most of the research on these ingredients is from the study of diabetes; however, some of the studies were focused on weight loss. Please see the Science Page to learn more about the different ingredients and how each one impacts ketosis. There are links to multiple studies for each ingredient there as well as the science behind our other products.
What is KetoSavior™?
KetoSavior™ and KetoGuardian™ are the first supplements in the USA to focus on enhancing ketosis and making the ketogenic diet more effective by protecting the ketogenic process. KetoSavior™ is our maximum strength ketogenic diet protector when used prior to a heavy carbohydrate meal. All of Its ingredients impact one or more of the four targets discussed. Most of the research on these ingredients is from the study of diabetes; however, some of the studies were focused on weight loss. Please see the Science Page to learn more about the different ingredients and how each one impacts ketosis. There are links to multiple studies for each ingredient there as well as the science behind our other products.
*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.