Ketosis: Explanation, Symptoms, Side Effects and Risks

You have probably heard that glucose is essential for your body because it is used as a primary energy source.

However, this is not entirely true, and the idea that carbohydrates are essential for energy is incorrect.

Ketosis is a popular weight-loss method for weight loss.

When ketosis occurs, the body starts burning fat, and the body produces ketones as an alternative fuel for glucose.

Understanding ketosis is very important for a ketogenic diet to succeed.

A ketogenic diet is only wise if you are willing to limit your daily carbohydrate intake severely. Of course, there are exceptions that I will tell later.

In this article, you will learn everything you need to know about ketosis.

You learn, among other things:

  • What you can and cannot eat during ketosis
  • The fastest way to get into ketosis
  • The most annoying side effects of the keto diet
  • How long your body needs time to adjust to ketosis
  • 6 possible dangers if you perform the diet in the wrong way
  • The redeeming answer to the question of whether ketosis can help with weight loss
  • And much and much more…

What is ketosis?

Ketosis (or ketogenesis) is a metabolic process in which the body breaks down fatty acids into ketones or ketone bodies.

In other words, when the body produces ketones, we are in ketosis.

Synthesis of ketones by ketosis occurs with severe carbohydrate restriction or fasting periods.

The moment our body no longer has sufficient carbohydrates at its disposal, an alternative energy source is used: body fat.

This physiological reaction is known as ‘ nutritional ketosis ‘, the primary goal of a ketogenic diet.

To bring your body into the state of ketosis, you should drastically limit carbohydrate consumption to a maximum of about 50 grams ( source , source ).

Most people will come in ketose with up to 50 grams of carbohydrates per day, while some have to limit their carbohydrate intake to less than 30 grams per day.

The best way to take advantage of the benefits of ketosis is to follow a strict keto diet for at least a few months. This is the only way for your body cells to adapt to this way of life.

How does ketosis work?

When we eat large amounts of carbohydrates, our body stores them as glycogen.

Glycogen is a form of stored glucose that is found in our liver and muscles. In the presence of sufficient glucose, the body burns this carbohydrate as a primary energy source.

However, if we limit carbohydrates considerably, our glycogen stores will become exhausted after a few days. As a result, our body has a need new energy source: fat.

To burn fat for energy, our body must first convert the fatty acids in our body into compounds known as ketones .

The liver produces these molecules in times of drastic carbohydrate restriction, and they are also known as ketone bodies .

The term “ketosis” refers to the condition or the process by which the body burns fat for fuel.

The body produces three types of ketones during ketosis:

  • Beta-hydroxybutyric acid
  • Acetoacetate
  • Acetone

What happens to your body in ketosis?

Several things happen when your body switches from burning sugar to burning fat.

As our body adjusts and starts to get into ketosis, enzymes begin to break down the fat molecules. This process takes place in the liver.

Our liver starts to convert fatty acids into ketones as fuel. Limiting carbohydrates affects blood sugar levels (and insulin).

However, remember that it may take a while for the body to get used to these changes …

After years of following a diet with industrially processed food, our body knows no better than to burn glucose for energy. The primary energy source has been glucose for a long time, we cannot just turn a biological switch and immediately start burning fat.

Moreover, most of the population will never get into ketose because they are constantly exposed to processed carbohydrates. When the intake of (processed) carbohydrates is drastically restricted, either due to a lack of food or following a low-carbohydrate diet, our body can be put in ketosis.

While this sounds like a radical change for the body, it is a natural metabolic state. It is highly likely that humankind has been in a ketogenic state during the famine (ice age) or for more extended periods of fasting.

Because we used to do something, it naturally does not necessarily make it right or healthy of course. But getting into ketosis actually provides certain health benefits that I will discuss later in this article.

How long it takes before you are in ketosis

Your body needs some time to adjust to the ketogenic state. We call this the induction phase .

During this adjustment period, carbohydrate intake is considerably reduced and the glycogen stores are depleted. Most people get into ketosis after 5 days.

It is important to realize that being in ketosis does not mean that your body has fully adapted to ketosis.

First of all, we are all different and this transition is not the same for everyone. Getting into ketosis means major metabolic changes, and the body needs time to get used to it. For some people, the adjustment period can be quick and painless, while for others it can take a little longer. The most difficult part of starting a ketogenic diet will always be the first week, due to the first flu-like symptoms.

During this adjustment period, many people do not feel so well or even sick until they can burn fat efficiently. The common side effects are also described as the ‘ keto flu ‘.

Until the body becomes efficient in using fat for energy, these symptoms of fatigue persist. For the majority of people, these side effects last 2 to 3 days to a week. 

How long it takes before you get into ketosis depends primarily on how closely you follow the diet.

Some people want to try a ketogenic diet, but eat carbohydrates immediately when they start to lack energy.

If you suffer from cravings in sugar, then it is vital to resist.

If you can’t resist the temptation and still grab something sweet, this will only delay the ketosis process.

To fully exploit the benefits of ketosis, it is crucial that your body adjusts well to ketosis. However, this can take longer than a month.

Therefore do not try a ketogenic diet if you are not prepared to drastically limit the daily amount of carbohydrates. After all, it makes no sense at all.

How you know if you are in ketosis

A common way is to test for ketosis. Some people want to see if they are in ketosis or not.

If you want to keep up with this, you can have a urine analysis done to find out. This is done with the help of ketose sticks and ketose strips.

After taking a urine sample, hold the ketosis strip in the urine until it changes color. The colour in which it changes represents the number of ketones in the urine.

Ketose strips are not a 100% watertight method to measure the concentration of ketones but generally work reasonably well.

Ketosis symptoms and side effects

It can sometimes be challenging to know if you are capable of ketosis or not.

However, there are some signs and symptoms of ketosis that often occur during the adjustment period. These symptoms usually appear in the first five days. These symptoms are unfortunately, not all pleasant.

Bad breath is a common side effect in people who get into ketosis. This creates a fruity odour that is caused by an increased concentration of ketones. The specific culprit is acetone, a type of ketone that leaves the body through urine and breath ( source ).

Although this breath odour is less ideal for the people around you, it is a positive sign that your body is adapting to ketosis.

You can brush your teeth several times a day or use sugar-free chewing gum to solve this problem. If you use chewing gum, check the carbohydrate packaging. These can increase your blood sugar level and lower the number of ketones.

Other common ketosis symptoms are:

  • Sudden weight loss (mainly due to loss of moisture)
  • Digestive problems and stomach upset
  • Headache (headache is a common side effect of low carbohydrate intake in the first few days)
  • Irritability (changes in diet influence hormones and can make people irritable)
  • Complaints of tiredness and sleepiness as the body adjusts to fat burning
  • Lack of focus
  • Decreased sports performance (less power, explosiveness)
  • Nausea (nausea is experienced particularly during the first few days)
  • Sleepiness (this feeling is due to a lack of energy because your body is less able to burn glucose)
  • A desire for sugar and carbohydrates (refined carbohydrates and added sugars can be very addictive, giving up can cause withdrawal symptoms)
  • Better satiety (reduced appetite and less appetite for food)

Known side effects that occur with the ketogenic diet are:

  • Constipation (blockage)
  • Stomachache and cramps
  • Fatigue
  • Headache
  • Brain fog
  • Bad breath

As you can see there are overlapping side effects with the symptoms of ketosis. They can be explained by the fact that the body has to adapt when using fats as a new energy source.

All of the above symptoms and side effects related to ketosis are generally only short-lived and disappear within the first two weeks (except for improved satiety).

What can I eat during ketosis?

To achieve ketosis you will need to follow a diet based on low carbohydrate foods.

The ratio is usually 65% ​​fats, 35% proteins and 5% (complex) carbohydrates.

A keto diet contains the following groups of foods:

  • Dairy: limit the milk and give preference to high-fat dairy products such as butter, cheese and sour cream.
  • Meat: all types of meat are allowed.
  • Fish: all fish is good in principle, but it is best to eat fatty fish to get a lot of omega-3 fatty acids . Think of salmon, trout, anchovies, sardines and herring, etc.
  • Eggs: eggs contain fats and proteins for the most part, and are packed with essential vitamins and minerals.
  • Nuts and seeds: most nuts and seeds are suitable for ketose, but eat cashews and pistachios in moderation because they contain a reasonable amount of carbohydrates.
  • Vegetables: you can eat green vegetables as much as you want.
  • Herbs and spices: feel free to use herbs and spices during cooking.
  • Fruit: only select fruits that are low in carbohydrates, such as berries, avocados and olives.

Which diet should I avoid or limit during ketosis?

In particular, foods with a high carbohydrate content and industrially processed fats (trans fats) must be avoided.

  • Vegetable oils
  • Breakfast cereals
  • Starchy vegetables
  • Rice
  • Pasta
  • Bread
  • Pastries and cookies

What can you drink during ketosis?

You might not think so, but many drinks are allowed on the keto diet.

You can drink all the drinks on the condition that they are low in carbohydrates.

Then think of:

  • Black coffee
  • Water
  • Green tea
  • Black tea
  • Herbal tea
  • Red wine (in moderation)
  • Zero and light drinks

As you can see, red wine is also allowed in moderation.

Beers and sweetened alcoholic drinks (cocktails) should not be drunk. However, red wine and spirits are low in carbohydrates and are suitable for a ketogenic diet.

That said, you still have to be careful with alcohol. Although a small to moderate amount of alcohol can be healthy, excessive alcohol consumption is very harmful to health.

Persons with alcohol addiction or dependency problems must altogether avoid all alcohol.

Benefits of ketosis

Being in ketosis has several health benefits. In this article, I will focus on the most important benefits.

# 1: May have a beneficial effect on Alzheimer’s disease

Alzheimer’s disease is one of the most terrible conditions and the most common cause of dementia.

The idea has been around for some time, but recent research suggests that Alzheimer’s disease can be a form of diabetes. Some researchers have already given it the provisional name of ‘ type 3 diabetes ‘ ( source , source ).

They refer to Alzheimer’s disease as insulin resistance of the brain. The idea is that the condition is similar to type 2 diabetes, where our body becomes resistant to insulin. The only difference is that with Alzheimer’s it happens in the brain ( source ).

Insulin resistance means that our body no longer responds well to insulin, and so our brains become ‘starved’ by energy (glucose).

As a result, glucose builds up in the brain (hyperglycemia) and causes oxidative stress and damage. Brain cells starve and die because they cannot use enough energy.

Can ketones be an alternative fuel for the damaged brain? That is now being investigated. Ketosis allows the body to produce ketones that are a source of energy that the brain can use.

This is not to be understood that an extremely low carbohydrate or ketogenic diet can cure Alzheimer’s, but ketones may play a role in the treatment of the disease.

# 2: It lowers blood sugar

The blood sugar level must be very low for the induction phase of ketogenesis. The moment the body makes ketone bodies, the blood sugar level will be very low.

A lowered blood sugar level also means that the amount of insulin (which the body releases) decreases.

source )

As the diagram above shows, a high-fat diet reduces insulin delivery in diabetics.

What are the benefits of regulating blood sugar levels and insulin sensitivity?

Firstly, there is a difference between insulin delivery in the short term (of course) and too high fasting insulin levels.

Higher fasting blood glucose and hyperinsulinemia (constantly elevated insulin levels) are associated with many chronic diseases:

Research shows that hyperinsulinemia increases the risk of cancer, independently of diabetes. In other words, higher fasting blood glucose and insulin levels are harmful to everyone – whether you have diabetes or not ( source ).

Higher insulin levels have a pro-inflammatory effect and there is a connection between hyperinsulinemia and cardiovascular disease ( source ).

There are different ways to lower your blood sugar.

Research shows that ketosis helps to lower fasting blood sugar and improve insulin sensitivity.

In addition to food, exercise, adequate sleep and stress reduction also play a role.

# 3: Ketones regulate mitochondrial metabolism

Mitochondrion plays a vital role in every cell of our body because it produces 90% of the energy that every cell needs ( source ).

The mitochondria break down carbohydrates and fatty acids and convert them into a usable form of energy (adenosine triphosphate, or ATP).

The mitochondria are essential for our overall health and play a crucial protective role in our cells.

For example, they control apoptosis (programmed cell death). This process is essential to keep the number of cells in our body in balance, especially for damaged cells.

Uncontrolled cell growth can lead to cancer, and recent research shows that mitochondrial disruption plays a central role in various chronic diseases ( source ).

It now appears that ketones may help protect against mitochondrial dysfunction.

As soon as ketogenesis starts and the body starts producing ketones, some important changes take place.

First, mitochondria prefer fat for energy because it is easier to convert into ATP.

Ketone bodies also play a protective role in protecting the mitochondria against dysfunction ( sourcesourcesource ):

  • Ketones stimulate and improve mitochondrial respiration and function
  • Ketones exert an antioxidant effect in the mitochondria and help to inhibit oxidative stress (which can lead to mitochondrial dysfunction and other diseases)

Calorie restriction is known to extend the life span. In times of calorie restriction, our mitochondria begin to burn fat instead of glucose. Therefore, these benefits may also apply to the restriction of carbohydrates to get into ketose.

# 4: Probably helps to suppress appetite

Processed foods with fast carbohydrates (also referred to as refined carbohydrates) cause high spikes in the blood sugar level. We only become saturated for a moment and feel hungry again within a few hours.

For some people, it is a daily fight to resist the temptations of unhealthy food.

People who have experience with ketosis, however, claim that they are hardly hungry, which makes losing weight easier.

How come?

Can the presence of ketones in the body suppress appetite? Or is it mainly due to the satiating effect of proteins?

Several researchers have tried to answer this question, but have not yet been able to draw a clear conclusion ( sourcesourcesource ).

What we at least know is that:

The hunger hormone ghrelin increases during weight loss and this fuels the desire for food. In a recent study, this increased concentration was suppressed in people in a state of ketosis despite a lack of calories.

In the same study, the saturation hormones leptin and amylene increased, although the participants in the study lost weight. When the subjects were allowed to eat carbohydrates again, the satiety hormones dropped and the hunger hormones increased rapidly.

A high presence of ketones in the body can send a signal to suppress the production of hunger hormones. A meta-analysis of available studies suggests that ketones can help directly suppress appetite. To achieve this effect, a minimal level of ketosis is required.

Personally, I think that the satiety benefits of low carbohydrate diets also stem from higher protein intake. The fact is that eating proteins increases the feeling of fullness and satiety, even more than fats ( source ).

# 5: Decreased triglycerides and increased HDL cholesterol

Ketones reduce triglycerides (a type of fat in the bloodstream) and increase HDL cholesterol.

The ratio of triglycerides to HDL cholesterol is one of the most reliable predictors of cardiovascular risk.

You have probably heard of ‘good cholesterol’ (HDL) and ‘bad cholesterol’ (LDL). But these markers are not yet clear predictors of cardiovascular diseases.

In recent years, the triglycerides / HDL-cholesterol ratio has become a much more reliable marker ( source ).

A 2015 study found that the triglyceride to HDL ratio is the most critical independent marker for cardiovascular death ( source ).

How can ketosis exactly influence this ratio?

A low HDL level and a high concentration of triglycerides often go together with a large amount of insulin in the blood ( source ).

In other words, when we keep our blood sugar levels under control, insulin usually falls and the triglycerides / HDL-cholesterol ratio improves.

Research generally shows that a ketogenic diet has a beneficial effect on cardiovascular risk:

In a study with obese participants, a ketogenic diet of fewer than 20 grams of carbohydrates 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 all measured health markers were found to be consistent during the seven different tests that were done every 8 weeks ( source ).

A 6-week study of men with a healthy weight showed that a ketogenic diet, where about 8% of the energy requirement was obtained from carbohydrates, significantly increased HDL cholesterol levels without affecting LDL or total cholesterol ( source ).

A lower concentration of triglycerides in the blood and a higher HDL value seems to reduce the risk of heart disease. When the body is in ketosis, the triglycerides / HDL ratio usually improves.

# 6: Ketosis improves mental health

After the induction phase of ketosis, the brain can switch to using ketones as the primary fuel.

A considerable amount of research suggests that this can lead to improvements in mental health and the reduction of depression complaints.

A randomized, controlled study concluded that a low-carbohydrate diet brought about a statistically significant improvement in mood in the participants. In comparison with a low-fat intervention group, participants on a low-carbohydrate diet also experienced fewer mood changes and irritability ( source ).

A rat study found that the rats following a ketogenic diet exhibited fewer symptoms of depression than those on a control diet. This group of rats also showed the same improvements in positive emotions as those treated with antidepressants ( source ).

Several randomized controlled trials with more than 280 participants show that ketogenic diets can be beneficial for epilepsy patients.

In short, the researchers think that ketosis offers benefits in the short to medium term in the management of epileptic seizures ( source ).

Losing weight and ketosis

Is ketosis good for weight loss? Hell yes!

People starting with keto will experience significant weight loss in the first week.

Why this rapid weight loss?

This is simply because the body also stores around 3 grams of water with every gram of glycogen. By limiting carbohydrates in the diet, the glycogen stores decrease and we also lose a lot of moisture.

But ketosis not only causes weight loss in the short term, but you will also benefit in the longer term.

Various studies have shown that a strict low-carbohydrate diet works better for weight loss than a low-fat diet ( sourcesource ). An important advantage is that it reduces appetite, which means you consume fewer calories.

“How many pounds can I lose?”

This question is difficult to answer because everyone is different. It also depends on several factors. Hormones, body weight, diet, fat percentage, lifestyle, sleep quality and a whole range of other factors play a role.

People with extreme overweight can lose tens of kilos, while others lose less weight. If you follow a low-carb or ketose diet, you should lose weight stably within the foreseeable future.

Possible dangers of ketosis

The state of ketosis remains controversial. Some people believe that ketosis is the best way to lose weight, while others find the diet dangerous.

What is the truth?

Ketose is certainly not suitable for everyone. A ketogenic diet can have a number of very beneficial health benefits, but can also have unpleasant (and sometimes dangerous) side effects if it is ‘done’ in the wrong way.

Let us, therefore, look at the most common mistakes that are made when trying to reach the state of ketosis.

Danger # 1: not drinking enough water

A good fluid balance is always important, but especially if you decide to start with a keto diet.

When we drastically limit our carbohydrate intake in food, many things happen in our body. The blood sugar level and insulin level decrease ( source ).

Remember that many people on a standard Western diet (with a lot of refined sugars) have become insensitive to insulin (also known as insulin resistance ).

Why does this matter?

Because a high insulin level causes the kidneys to store more sodium, which causes the kidneys to retain more fluid ( source ).

Because a keto diet strictly limits carbohydrate intake, the insulin level falls within the first few days. When the insulin level falls, our kidneys release large amounts of fluid. If someone does not drink enough water during this period, it may cause dehydration.

Many people who start with ketosis for the first time complain of headache in the first week. In addition to a disturbed electrolyte balance, this is one of the reasons why. Not drinking enough water is a common mistake that can easily be avoided.

Danger # 2: not taking enough magnesium

As I just told, our kidneys help flush out excess fluid during the ketosis adjustment period.

Unfortunately, that water contains high concentrations of sodium and electrolytes. Magnesium is one of them.

The disturbance of the electrolyte balance can cause various symptoms that people often call the ‘keto flu’.

All minerals are important, but magnesium plays an essential role in our body. In fact, it plays a role in more than 300 biochemical processes ( source ).

So it is not surprising that the loss of this essential mineral can cause problems. A long-term low magnesium level can cause various physical complaints. Think of muscle cramps, irritability, low libido, hypersensitivity, etc.

To get enough magnesium you will have to look for magnesium-rich foods that are also allowed in a ketose diet.

Consider foods such as:

  • Cocoa
  • Fish
  • Almonds
  • Avocados
  • Leafy vegetables (spinach, chard)
  • Brazil nuts

It may also be worthwhile to invest in a good quality magnesium supplement. You can order the magnesium supplements that I use myself here.

Danger # 3: not getting enough sleep

Let me state first and foremost that insufficient sleep is not only dangerous for ketosis users.

Getting enough sleep is crucial for everyone.

If you don’t get enough sleep, this puts your health at risk. Good sleep quality is just as important as our diet.

For example, some people choose to get into ketosis to achieve a constant blood sugar level. That is a healthy goal, but a lack of sleep harms blood sugar levels and insulin sensitivity ( sourcesource ).

If you use a ketogenic diet to improve these values, but then negatively influence them due to a lack of sleep, it is like stepping forward and then two steps back.

A healthy diet does not outweigh bad sleeping habits. A good night’s sleep is critical, whether you are following a keto diet, Paleo diet or a vegan diet.

Danger # 4: not eating enough fat

Not eating enough fat is a mistake that many ketosis users make.

As you know, our bodies can use both carbohydrates and fats to meet their energy needs.

The whole idea of ​​ketosis is to let our bodies switch to burning fat. Therefore, if we reduce carbohydrates, we must increase our fat intake.

Some people who start with ketosis reduce their carbohydrates but do not replace this lost energy with fat. One reason for this might be that people still feel a little uncomfortable when eating fats.

However, you don’t have to worry about fats in natural foods such as avocados, fish, olives, oils, etc.

While proteins can provide energy through the gluconeogenesis process, it is an inefficient energy source compared to ketones (fat) and glucose (carbohydrates ( source)).

Trying to live completely on proteins and vegetables will quickly cause fatigue and lack of energy and ultimately make the diet untenable.

Danger # 5: completely remove proteins from the diet

I sometimes hear ketosis users say that they do not eat too much protein because they would otherwise come from ketosis.

This is nonsense in my opinion. Proteins play an important role in our body and the effect on blood glucose is exaggerated.

This claim is based on the process of gluconeogenesis, in which glucogenic amino acids can be converted into glucose ( source ).

Simply put, this means that our bodies can turn proteins into glucose. This biological process is a protective mechanism that can help us survive in times of hunger or food scarcity.

For example, if we need energy, our bodies can convert amino acids (or muscle tissue) into glucose.

But it is not the case that eating more proteins leads to more gluconeogenesis and therefore more glucose. Higher protein intake may have an effect on the rate of gluconeogenesis, but not as much as you would expect.

Of the macronutrients, protein, like fat, has less influence on blood sugar levels than carbohydrates ( source ).

In healthy people, the process of gluconeogenesis only starts if it is necessary, then it is regulated by the availability of amino acids in the body.

Moreover, it is important to distinguish between healthy people and people with diabetes. The amount of protein we eat has a greater effect on blood glucose in diabetics, but not in non-diabetics ( source ).

Danger # 6: eating too many carbohydrates

You will only succeed in getting ketosis if your carbohydrate intake is drastically reduced.

Someone who eats fewer carbohydrates increases his fat intake and occasionally eats a cookie will hardly achieve ketosis.

Moreover, the induction phase (initial period) of ketosis can have some unpleasant side effects, so restarting (and stopping) the diet every time is unwise and possibly even dangerous.

A ketogenic diet requires dedication. Always starting and stopping again is not beneficial for your body.

Is Ketosis dangerous?

No, ketosis is in principle not dangerous for healthy people (if it is applied correctly, see the possible dangers that I have described in this article).

Being in ketosis for too long would not be that healthy, because of the increase in oxalic acid levels in the body. Oxalic acid can reduce the absorption of iron and calcium. But people with healthy kidney function do not have to be afraid of more oxalic acid.

Ketosis is a natural metabolic state of the body that can be achieved when the carbohydrate intake is very low for a certain period.

If you are in ketosis then you have a higher than normal level of ketones in your blood or urine. Ketones are chemicals that your body produces when the stored fat burns. 

In general, the biggest problem is the side effects that can occur in the short term, while the body adjusts to this new condition.

Personally, I think the ketogenic diet is too extreme to follow, but I don’t see the dangers of eating lots of fish, avocado, oils, etc.

In practice, a ketogenic diet means more butter, olive oil, cream, coconut oil, avocados, fish and meat. This is a shock to most people because for decades we have been wrongly told that eating fat is bad for our health.

But the real problems with fats come from:

  • Industrially produced trans fats
  • Vegetable oils (rapeseed oil, soy, corn)

You can compare it somewhat with the low carbohydrate diet because you mainly remove the processed carbohydrates. This leaves more room for protein and fat, and results in better appetite control.

A normal low carbohydrate diet is less extreme than the keto diet and in my opinion much easier to maintain. You omit processed carbohydrates from your diet, and still get around 30-40% of your calories from carbohydrates from natural sources.

Ketoacidosis

Ketosis is sometimes confused with ketoacidosis. Despite the similarity in name, ketosis and ketoacidosis are two different things.

Ketosis is the presence of ketones in your body. It is not harmful.

Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It is a life-threatening condition that results from a dangerously high level of ketones and blood sugar.

probably heard that glucose is essential for your body because it is used as a primary energy source.

However, this is not entirely true and the idea that carbohydrates are essential for energy is incorrect.

Ketose is a popular weight-loss method for weight loss.

When ketosis occurs, the body starts burning fat and the body produces ketones as an alternative fuel for glucose.

Understanding ketosis is very important for a ketogenic diet to succeed.

Following a ketogenic diet is only wise if you are willing to seriously limit your daily carbohydrate intake. Of course, there are exceptions that I will tell later.

In this article, you will learn everything you need to know about ketosis.

You learn among other things:

  • What you can and cannot eat during ketosis
  • The fastest way to get into ketosis
  • The most annoying side effects of the keto diet
  • How long your body needs time to adjust to ketosis
  • 6 possible dangers if you perform the diet in the wrong way
  • The redeeming answer to the question of whether ketosis can help with weight loss
  • And much and much more…

What is ketosis?

Ketosis (or ketogenesis) is a metabolic process in which the body breaks down fatty acids into ketones or ketone bodies.

In other words, when the body produces ketones, we are in ketosis.

Synthesis of ketones by ketosis occurs with severe carbohydrate restriction or fasting periods.

The moment our body no longer has sufficient carbohydrates at its disposal, an alternative energy source is used: body fat.

This physiological reaction is known as ‘ nutritional ketosis ‘, the primary goal of a ketogenic diet.

To bring your body into the state of ketosis, you should drastically limit carbohydrate consumption to a maximum of about 50 grams ( source , source ).

Most people will come in ketose with up to 50 grams of carbohydrates per day, while some have to limit their carbohydrate intake to less than 30 grams per day.

The best way to take advantage of the benefits of ketosis is to follow a strict keto diet for at least a few months. This is the only way for your body cells to adapt to this way of life.

How does ketosis work?

When we eat large amounts of carbohydrates, our body stores them as glycogen.

Glycogen is a form of stored glucose that is found in our liver and muscles. In the presence of sufficient glucose, the body burns this carbohydrate as a primary energy source.

However, if we limit carbohydrates considerably, our glycogen stores will become exhausted after a few days. As a result, our body has a need new energy source: fat.

To burn fat for energy, our body must first convert the fatty acids in our body into compounds known as ketones .

These molecules are produced by the liver in times of drastic carbohydrate restriction and they are also known as ketone bodies .

The term “ketosis” refers to the condition, or the process by which the body burns fat for fuel.

The body produces three types of ketones during ketosis:

  • Beta-hydroxybutyric acid
  • Acetoacetate
  • Acetone

What happens to your body in ketosis?

Several things happen when your body switches from burning sugar to burning fat.

As our body adjusts and starts to get into ketosis, enzymes begin to break down the fat molecules. This process takes place in the liver.

Our liver starts to convert fatty acids into ketones as fuel. Limiting carbohydrates has an effect on blood sugar levels (and insulin).

However, remember that it may take a while for the body to get used to these changes …

After years of following a diet with industrially processed food, our body knows no better than to burn glucose for energy. The primary energy source has been glucose for a long time, we cannot just turn a biological switch and immediately start burning fat.

Moreover, most of the population will never get into ketose because they are constantly exposed to processed carbohydrates. When the intake of (processed) carbohydrates is drastically restricted, either due to a lack of food or following a low-carbohydrate diet, our body can be put in ketosis.

While this sounds like a radical change for the body, it is a natural metabolic state . In fact, it is highly likely that mankind has been in a ketogenic state during the famine (ice age) or for longer periods of fasting.

Because we used to do something, it naturally does not necessarily make it good or healthy of course. But getting into ketosis actually provides certain health benefits that I will discuss later in this article.

How long it takes before you are in ketosis

Your body needs some time to adjust to the ketogenic state. We call this the induction phase .

During this adjustment period, carbohydrate intake is considerably reduced and the glycogen stores are depleted. Most people get into ketosis after 5 days.

It is important to realize that being in ketosis does not mean that your body has fully adapted to ketosis.

First of all, we are all different and this transition is not the same for everyone. Getting into ketosis means major metabolic changes, and the body needs time to get used to it. For some people, the adjustment period can be quick and painless, while for others it can take a little longer. The most difficult part of starting a ketogenic diet will always be the first week, due to the first flu-like symptoms.

During this adjustment period, many people do not feel so well or even sick until they can burn fat efficiently. The common side effects are also described as the ‘ keto flu ‘.

Until the body becomes efficient in using fat for energy, these symptoms of fatigue persist. For the majority of people, these side effects last 2 to 3 days to a week. 

How long it takes before you get into ketosis depends primarily on how closely you follow the diet.

Some people want to try a ketogenic diet, but eat carbohydrates immediately when they start to lack energy.

If you suffer from cravings in sugar then it is important to resist.

If you can’t resist the temptation and still grab something sweet, this will only delay the ketosis process.

To fully exploit the benefits of ketosis, it is important that your body adjusts well to ketosis. However, this can take longer than a month.

Therefore do not try a ketogenic diet if you are not prepared to drastically limit the daily amount of carbohydrates. After all, it makes no sense at all.

How you know if you are in ketosis

A common way is to test for ketosis. Some people want to know if they are in ketosis or not.

If you want to keep up with this, you can have a urine analysis done to find out. This is done with the help of ketose sticks and ketose strips.

After taking a urine sample, hold the ketosis strip in the urine until it changes color. The color in which it changes represents the amount of ketones in the urine.

Ketose strips are not a 100% watertight method to measure the concentration of ketones, but generally work reasonably well.

Ketosis symptoms and side effects

It can sometimes be difficult to know if you are capable of ketosis or not.

However, there are some signs and symptoms of ketosis that often occur during the adjustment period. These symptoms usually appear in the first five days. These symptoms are unfortunately not all pleasant.

Bad breath is a common side effect in people who get into ketosis. This creates a fruity odor that is caused by an increased concentration of ketones . The specific culprit is acetone, a type of ketone that leaves the body through urine and breath ( source ).

Although this breath odor is less ideal for the people around you, it is a positive sign that your body is adapting to ketosis.

You can brush your teeth several times a day or use sugar-free chewing gum to solve this problem. If you use chewing gum, check the carbohydrate packaging. These can increase your blood sugar level and lower the number of ketones.

Other common ketosis symptoms are:

  • Sudden weight loss (mainly due to loss of moisture)
  • Digestive problems and stomach upset
  • Headache (headache is a common side effect of low carbohydrate intake in the first few days)
  • Irritability (changes in diet influence hormones and can make people irritable)
  • Complaints of tiredness and sleepiness as the body adjusts to fat burning
  • Lack of focus
  • Decreased sports performance (less power, explosiveness)
  • Nausea (nausea is experienced particularly during the first few days)
  • Sleepiness (this feeling is due to a lack of energy because your body is less able to burn glucose)
  • Desire for sugar and carbohydrates (refined carbohydrates and added sugars can be very addictive, giving up can cause withdrawal symptoms)
  • Better satiety (reduced appetite and less appetite for food)

Known side effects that occur with the ketogenic diet are:

  • Constipation (blockage)
  • Stomachache and cramps
  • Fatigue
  • Headache
  • Brain fog
  • Bad breath

As you can see there are overlapping side effects with the symptoms of ketosis. They can be explained by the fact that the body has to adapt when using fats as a new energy source.

All of the above symptoms and side effects related to ketosis are generally only short-lived and disappear within the first two weeks (except for improved satiety).

What can I eat during ketosis?

To achieve ketosis you will need to follow a diet based on low carbohydrate foods.

The ratio is usually 65% ​​fats, 35% proteins and 5% (complex) carbohydrates.

A keto diet contains the following groups of foods:

  • Dairy: limit the milk and give preference to high-fat dairy products such as butter, cheese and sour cream.
  • Meat: all types of meat are allowed.
  • Fish: all fish is good in principle, but it is best to eat fatty fish to get a lot of omega-3 fatty acids . Think of salmon, trout, anchovies, sardines and herring, etc.
  • Eggs: eggs contain fats and proteins for the most part, and are packed with essential vitamins and minerals.
  • Nuts and seeds: most nuts and seeds are suitable for ketose, but eat cashews and pistachios in moderation because they contain a reasonable amount of carbohydrates.
  • Vegetables: you can eat green vegetables as much as you want.
  • Herbs and spices: feel free to use herbs and spices during cooking.
  • Fruit: only select fruits that are low in carbohydrates, such as berries, avocados and olives.

Which diet should I avoid or limit during ketosis?

In particular, foods with a high carbohydrate content and industrially processed fats (trans fats) must be avoided.

  • Vegetable oils
  • Breakfast cereals
  • Starchy vegetables
  • Rice
  • Pasta
  • Bread
  • Pastries and cookies

What can you drink during ketosis?

You might not think so, but many drinks are allowed in the keto diet.

You can drink all drinks on the condition that they are low in carbohydrates.

Then think of:

  • Black coffee
  • Water
  • Green tea
  • Black tea
  • Herbal tea
  • Red wine (in moderation)
  • Zero and light drinks

As you can see, red wine is also allowed in moderation.

Beers and sweetened alcoholic drinks (cocktails) should not be drunk. However, red wine and spirits are low in carbohydrates and are suitable for a ketogenic diet.

That said, you still have to be careful with alcohol. Although a small to moderate amount of alcohol can be healthy, excessive alcohol consumption is very harmful to health.

It goes without saying that persons with an alcohol addiction or dependency problems must completely avoid all alcohol.

Benefits of ketosis

Being in ketosis has several health benefits. In this article I will focus on the most important benefits.

# 1: May have a beneficial effect on Alzheimer’s disease

Alzheimer’s disease is one of the most terrible diseases and the most common cause of dementia.

The idea has been around for some time, but recent research suggests that Alzheimer’s disease can be a form of diabetes. Some researchers have already given it the provisional name of ‘ type 3 diabetes ‘ ( source , source ).

They refer to Alzheimer’s disease as insulin resistance of the brain. The idea is that the condition is similar to type 2 diabetes, where our body becomes resistant to insulin. The only difference is that with Alzheimer’s it happens in the brain ( source ).

Insulin resistance means that our body no longer responds well to insulin, and so our brains become ‘starved’ by energy (glucose).

As a result, glucose builds up in the brain (hyperglycemia) and causes oxidative stress and damage. Brain cells starve and die because they cannot use enough energy.

Can ketones be an alternative fuel for the damaged brain? That is now being investigated. Ketosis allows the body to produce ketones that are a source of energy that the brain can use.

This is not to be understood that an extremely low carbohydrate or ketogenic diet can cure Alzheimer’s, but ketones may play a role in the treatment of the disease.

# 2: It lowers blood sugar

The blood sugar level must be very low for the induction phase of ketogenesis. The moment the body makes ketone bodies, the blood sugar level will be very low.

A lowered blood sugar level also means that the amount of insulin (which the body releases) decreases.

source )

As the diagram above shows, a high-fat diet reduces insulin delivery in diabetics.

What are the benefits of regulating blood sugar levels and insulin sensitivity?

Firstly, there is a difference between insulin delivery in the short term (of course) and too high fasting insulin levels.

Higher fasting blood glucose and hyperinsulinemia (constantly elevated insulin levels) are associated with many chronic diseases:

Research shows that hyperinsulinemia increases the risk of cancer, independently of diabetes. In other words, higher fasting blood glucose and insulin levels are harmful to everyone – whether you have diabetes or not ( source ).

Higher insulin levels have a pro-inflammatory effect and there is a connection between hyperinsulinemia and cardiovascular disease ( source ).

There are different ways to lower your blood sugar.

Research shows that ketosis helps to lower fasting blood sugar and improve insulin sensitivity.

In addition to food, exercise, adequate sleep and stress reduction also play a role.

# 3: Ketones regulate mitochondrial metabolism

Mitochondrion plays a vital role in every cell of our body because it produces 90% of the energy that every cell needs ( source ).

The mitochondria break down carbohydrates and fatty acids and convert them into a usable form of energy (adenosine triphosphate, or ATP).

The mitochondria are essential for our overall health and play a crucial protective role in our cells.

For example, they control apoptosis (programmed cell death). This process is essential to keep the number of cells in our body in balance, especially for damaged cells.

Uncontrolled cell growth can lead to cancer, and recent research shows that mitochondrial disruption plays a central role in various chronic diseases ( source ).

It now appears that ketones may help protect against mitochondrial dysfunction.

As soon as ketogenesis starts and the body starts producing ketones, some important changes take place.

First, mitochondria prefer fat for energy because it is easier to convert into ATP.

Ketone bodies also play a protective role in protecting the mitochondria against dysfunction ( source , source , source ):

  • Ketones stimulate and improve mitochondrial respiration and function
  • Ketones exert an antioxidant effect in the mitochondria and help to inhibit oxidative stress (which can lead to mitochondrial dysfunction and other diseases)

Calorie restriction is known to extend the life span. In times of calorie restriction, our mitochondria begin to burn fat instead of glucose. Therefore, these benefits may also apply to the restriction of carbohydrates to get into ketose.

# 4: Probably helps to suppress appetite

Processed foods with fast carbohydrates (also referred to as refined carbohydrates) cause high spikes in the blood sugar level. We only become saturated for a moment and feel hungry again within a few hours.

For some people, it is a daily fight to resist the temptations of unhealthy food.

People who have experience with ketosis, however, claim that they are hardly hungry, which makes losing weight easier.

How come?

Can the presence of ketones in the body suppress appetite? Or is it mainly due to the satiating effect of proteins?

Several researchers have tried to answer this question, but have not yet been able to draw a clear conclusion ( source , source , source ).

What we at least know is that:

The hunger hormone ghrelin increases during weight loss and this fuels the desire for food. In a recent study, this increased concentration was suppressed in people in a state of ketosis despite a lack of calories.

In the same study, the saturation hormones leptin and amyline increased, although the participants in the study lost weight. When the subjects were allowed to eat carbohydrates again, the satiety hormones dropped and the hunger hormones increased rapidly.

A high presence of ketones in the body can send a signal to suppress the production of hunger hormones. A meta-analysis of available studies suggests that ketones can help directly suppress appetite. To achieve this effect, a minimal level of ketosis is required.

Personally, I think that the satiety benefits of low carbohydrate diets also stem from higher protein intake. The fact is that eating proteins increases the feeling of fullness and satiety, even more than fats ( source ).

# 5: Decreased triglycerides and increased HDL cholesterol

Ketones reduce triglycerides (type of fat in the bloodstream) and increase HDL cholesterol.

The ratio of triglycerides to HDL cholesterol is one of the most reliable predictors of cardiovascular risk.

You have probably heard of ‘good cholesterol’ (HDL) and ‘bad cholesterol’ (LDL). But these markers are not yet clear predictors of cardiovascular diseases.

In recent years, the triglycerides / HDL-cholesterol ratio has become a much more reliable marker ( source ).

A 2015 study found that the triglyceride to HDL ratio is the most important independent marker for cardiovascular death ( source ).

How can ketosis exactly influence this ratio?

A low HDL level and a high concentration of triglycerides often go together with a large amount of insulin in the blood ( source ).

In other words, when we keep our blood sugar levels under control, insulin usually falls and the triglycerides / HDL-cholesterol ratio improves.

Research generally shows that a ketogenic diet has a beneficial effect on cardiovascular risk:

In a study with obese participants, a ketogenic diet of less than 20 grams of carbohydrates 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 all measured health markers were found to be consistent during the seven different tests that were done every 8 weeks ( source ).

A 6-week study of men with a healthy weight showed that a ketogenic diet, where about 8% of the energy requirement was obtained from carbohydrates, significantly increased HDL cholesterol levels without affecting LDL or total cholesterol ( source ).

A lower concentration of triglycerides in the blood and a higher HDL value seem to reduce the risk of heart disease. When the body is in ketosis, the triglycerides / HDL ratio usually improves.

# 6: Ketosis improves mental health

After the induction phase of ketosis, the brain can switch to using ketones as the primary fuel.

A considerable amount of research suggests that this can lead to improvements in mental health and the reduction of depression complaints.

A randomized, controlled study concluded that a low-carbohydrate diet brought about a statistically significant improvement in mood in the participants. In comparison with a low-fat intervention group, participants on a low-carbohydrate diet also experienced fewer mood changes and irritability ( source ).

A rat study found that the rats following a ketogenic diet exhibited fewer symptoms of depression than those on a control diet. This group of rats also showed the same improvements in positive emotions as those treated with antidepressants ( source ).

Several randomized controlled trials with more than 280 participants show that ketogenic diets can be beneficial for epilepsy patients.

In short, the researchers think that ketosis offers benefits in the short to medium term in the management of epileptic seizures ( source ).

Losing weight and ketosis

Is ketosis good for weight loss? Hell yes!

People starting with keto will experience significant weight loss in the first week.

Why this rapid weight loss?

This is simply because the body also stores around 3 grams of water with every gram of glycogen. By limiting carbohydrates in the diet, the glycogen stores decrease and we also lose a lot of moisture.

But ketosis not only causes weight loss in the short term, you will also benefit in the longer term.

Various studies have shown that a strict low-carbohydrate diet works better for weight loss than a low-fat diet ( source , source ). An important advantage is that it reduces appetite, which means you consume fewer calories.

“How many pounds can I lose?”

This question is difficult to answer, because everyone is different. It also depends on several factors. Hormones, body weight, diet, fat percentage, lifestyle, sleep quality and a whole range of other factors play a role.

People with extreme overweight can lose tens of kilos, while others lose less weight. If you follow a low-carb or ketose diet, you should lose weight stably within the foreseeable future.

Possible dangers of ketosis

The state of ketosis remains controversial. Some people believe that ketosis is the best way to lose weight, while others find the diet dangerous.

What is the truth?

Ketose is certainly not suitable for everyone. A ketogenic diet can have a number of very beneficial health benefits, but can also have unpleasant (and sometimes dangerous) side effects if it is ‘done’ in the wrong way.

Let us therefore look at the most common mistakes that are made when trying to reach the state of ketosis.

Danger # 1: not drinking enough water

A good fluid balance is always important, but especially if you decide to start with a keto diet.

When we drastically limit our carbohydrate intake in food, many things happen in our body. The blood sugar level and insulin level decrease ( source ).

Remember that many people on a standard Western diet (with a lot of refined sugars) have become insensitive to insulin (also known as insulin resistance ).

Why does this matter?

Because a high insulin level causes the kidneys to store more sodium, which causes the kidneys to retain more fluid ( source ).

Because a keto diet strictly limits carbohydrate intake, the insulin level falls within the first few days. When the insulin level falls, our kidneys release large amounts of fluid. If someone does not drink enough water during this period, it may cause dehydration.

Many people who start with ketosis for the first time complain of headache in the first week. In addition to a disturbed electrolyte balance, this is one of the reasons why. Not drinking enough water is a common mistake that can easily be avoided.

Danger # 2: not taking enough magnesium

As I just told, our kidneys help flush out excess fluid during the ketosis adjustment period.

Unfortunately, that water contains high concentrations of sodium and electrolytes. Magnesium is one of them.

The disturbance of the electrolyte balance can cause various symptoms that people often call the ‘keto flu’.

All minerals are important, but magnesium plays an essential role in our body. In fact, it plays a role in more than 300 biochemical processes ( source ).

So it is not surprising that the loss of this essential mineral can cause problems. A long-term low magnesium level can cause various physical complaints. Think of muscle cramps, irritability, low libido, hypersensitivity, etc.

To get enough magnesium you will have to look for magnesium-rich foods that are also allowed in a ketose diet.

Consider foods such as:

  • Cocoa
  • Fish
  • Almonds
  • Avocados
  • Leafy vegetables (spinach, chard)
  • Brazil nuts

It may also be worthwhile to invest in a good quality magnesium supplement. You can order the magnesium supplements that I use myself here.

Danger # 3: not getting enough sleep

Let me state first and foremost that insufficient sleep is not only dangerous for ketosis users.

Getting enough sleep is crucial for everyone.

If you don’t get enough sleep, this puts your health at risk. Good sleep quality is just as important as our diet.

For example, some people choose to get into ketosis to achieve a constant blood sugar level. That is a healthy goal, but a lack of sleep has an adverse effect on blood sugar levels and insulin sensitivity ( source , source ).

If you use a ketogenic diet to improve these values, but then negatively influence them due to a lack of sleep, it is like stepping forward and then two steps back.

A healthy diet does not outweigh bad sleeping habits. A good night’s sleep is extremely important, whether you are following a keto diet, Paleo diet or a vegan diet.

Danger # 4: not eating enough fat

Not eating enough fat is a mistake that many ketosis users make.

As you know, our bodies can use both carbohydrates and fats to meet their energy needs.

The whole idea of ​​ketosis is to let our bodies switch to burning fat. Therefore, if we reduce the carbohydrates, we must increase our fat intake.

Some people who start with ketosis reduce their carbohydrates, but do not replace this lost energy with fat. One reason for this might be that people still feel a little uncomfortable when eating fats.

However, you don’t have to worry about fats in natural foods such as avocados, fish, olives, oils, etc.

While proteins can provide energy through the gluconeogenesis process, it is an inefficient energy source compared to ketones (fat) and glucose (carbohydrates ( source)).

Trying to live completely on proteins and vegetables will quickly cause fatigue and lack of energy and ultimately make the diet untenable.

Danger # 5: completely remove proteins from the diet

I sometimes hear ketosis users say that they do not eat too much protein because they would otherwise come from ketosis.

This is nonsense in my opinion. Proteins play an important role in our body and the effect on blood glucose is exaggerated.

This claim is based on the process of gluconeogenesis, in which glucogenic amino acids can be converted into glucose ( source ).

Simply put, this means that our bodies can turn proteins into glucose. This biological process is a protective mechanism that can help us survive in times of hunger or food scarcity.

For example, if we need energy, our bodies can convert amino acids (or muscle tissue) into glucose.

But it is not the case that eating more proteins leads to more gluconeogenesis and therefore more glucose. A higher protein intake may have an effect on the rate of gluconeogenesis, but not as much as you would expect.

Of the macronutrients, protein, like fat, has less influence on blood sugar levels than carbohydrates ( source ).

In healthy people, the process of gluconeogenesis only starts if it is necessary, then it is regulated by the availability of amino acids in the body.

Moreover, it is important to distinguish between healthy people and people with diabetes. The amount of protein we eat has a greater effect on blood glucose in diabetics, but not in non-diabetics ( source ).

Danger # 6: eating too many carbohydrates

You will only succeed in getting ketosis if your carbohydrate intake is drastically reduced.

Someone who eats less carbohydrates, increases his fat intake and occasionally eats a cookie will hardly achieve ketosis.

Moreover, the induction phase (initial period) of ketosis can have some unpleasant side effects, so restarting (and stopping) the diet every time is unwise and possibly even dangerous.

A ketogenic diet requires dedication. Always starting and stopping again is not beneficial for your body.

Is Ketosis dangerous?

No, ketosis is in principle not dangerous for healthy people (if it is applied correctly, see the possible dangers that I have described in this article).

Being in ketosis for too long would not be that healthy, because of the increase in oxalic acid levels in the body. Oxalic acid can reduce the absorption of iron and calcium. But people with healthy kidney function do not have to be afraid of more oxalic acid.

Ketosis is a natural metabolic state of the body that can be achieved when the carbohydrate intake is very low for a certain period.

If you are in ketosis then you have a higher than normal level of ketones in your blood or urine. Ketones are chemicals that your body produces when the stored fat burns. 
In general, the biggest problem is the side effects that can occur in the short term, while the body adjusts to this new condition.

Personally, I think the ketogenic diet is too extreme to follow, but I don’t see the dangers of eating lots of fish, avocado, oils, etc.

In practice, a ketogenic diet means more butter, olive oil, cream, coconut oil, avocados, fish and meat. This is a shock to most people because for decades we have been wrongly told that eating fat is bad for our health.

But the real problems with fats come from:

  • Industrially produced trans fats
  • Vegetable oils (rapeseed oil, soy, corn)

You can compare it somewhat with the low carbohydrate diet because you mainly remove the processed carbohydrates. This leaves more room for protein and fat, and results in better appetite control.

A normal low carbohydrate diet is less extreme than the keto diet and in my opinion much easier to maintain. You omit processed carbohydrates from your diet, and still get around 30-40% of your calories from carbohydrates from natural sources.

Ketoacidosis

Ketosis is sometimes confused with ketoacidosis. Despite the similarity in name, ketosis and ketoacidosis are two different things.

Ketosis is the presence of ketones in your body. It is not harmful.

Ketoacidosis refers to diabetic ketoacidosis (DKA) and is a complication of type 1 diabetes mellitus. It is a life-threatening condition that results from a dangerously high level of ketones and blood sugar.

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Fan of everything health and fitness related. My mission is to share my knowledge and experience with as many people as possible and help them to find their ideal path to perfect health.

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