Ketosis – What Is Ketosis, 7 Symptoms and Risks

Ketosis is a natural state the body finds itself in when it uses fat as its primary fuel. It happens when you are on a very low carb ketogenic diet and often during intermittent fasting.

Ketosis can be beneficial for several people but certain groups such as people with type 1 diabetes, need to be more careful. In these groups, very high ketone levels would lead to diabetic ketoacidosis, a dangerous situation caused by not having enough insulin.

Did you know?

Ketosis has become the most popular topic recently, and it has received its fair share of praise and criticism. Is it healthy or unhealthy to be in ketosis? And if this is beneficial, should everyone be doing it?

This guide provides all the information you need to know about ketosis.

including its benefits, potential risks, and tips for successfully entering and staying in ketosis.

What Is Ketosis and Can It Harm?

Ketosis is a term coined to describe the normal physiological fat burning process in which the body enters on an empty stomach or in a carbohydrate restrictive state.

The body will enter ketosis if the carbohydrate intake is kept very low. When the body burns fat, energy is released into all cells in the body, including the brain.

Ketosis can normally take anywhere from a few days to a few weeks.

There are methods for measuring ketones in blood, urine, and breath, for those interested in tracking.

Many people will go through a short induction phase where they may experience headaches, lethargy, nausea, confusion, brain fog, and irritability.

It usually lasts between 2 and 5 days and is most often caused by dehydration and/or salt deficiency resulting from a temporary increase in urination.

It is necessary to stick to a strict LCHF diet below 20-50g of carbohydrates per day to achieve ketosis and stay in ketosis. 

* Does the brain need carbohydrates?

There is a long-held but mistaken belief that carbohydrates are necessary for healthy brain function. If you ask some dietitians how much carbohydrate you should eat, they’ll likely say you need at least 130 grams per day to make sure your brain has a steady supply of glucose.

However, this is not the case. Your brain will remain healthy and functioning even if you don’t eat carbohydrates at all.

While it’s true that your brain needs high energy requirements and requires some glucose when you in ketosis that is plenty of ketones to provide a good chunk of its fuel.

Fortunately, your liver will still do the small amount of glucose your brain needs, even under conditions of total starvation.

This process, called gluconeogenesis (literally “making new glucose”), can also deliver glucose to other structures that need it, such as red blood cells and part of the kidneys.

This system allowed our hunter-gatherer ancestors to go long periods without eating because they had access to a source of fuel at all times: stored body fat.

The truth is, being in ketosis has no adverse effect on the functioning of the brain. On the contrary, many people reported that they felt more mentally nervous when in ketosis.

Is Ketosis The Same As Ketoacidosis?

Both involve fatty acids called ketones. But ketoacidosis is a dangerous condition that occurs when your body doesn’t have enough insulin and ketones build up too much.

But ketosis occurs at much lower levels and is safer than ketosis from acidosis.

Nutritional ketosis occurs when there is not enough carbohydrate in the diet to meet the body’s energy needs. In this situation, the body switches from burning sugar to burning fat as the principal fuel.

Fat, whether from diet or body stores, is broken down into ketones in the liver. These ketones are an efficient source of energy for multiple organs, especially the brain.

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Benefits Of Ketosis Diet

For most people, nutritional ketosis is beneficial.

Achieving nutritional ketosis has been associated with improvements in:

  • Weight loss
  • Blood sugar control in diabetes
  • Epilepsy
  • Overall metabolic health
  • Research also suggests that nutritional ketosis may have benefits for people with ( Parkinson’s disease,  Alzheimer’s disease) and may help reduce the risk of developing certain forms of cancer.

5 Tips For Getting Into Ketosis

There are some ways to get into nutritional ketosis safely and effectively.

  1. Reduce Daily Net Carbohydrate Intake To Less Than 20 Grams: While you may not need to be this strict, eating less than 20 grams of net carbs each day virtually guarantees that you will achieve ketosis nutritionally. How do 20 grams of carbohydrate look like? Use our visual guide to find out, or easily try our keto recipes and meal plans that limit carbs to less than 20 grams per day.
  2. Try Intermittent Fasting: Going 16-18 hours without eating can help you get into ketosis faster. It easy to do by just skipping breakfast or dinner, which can feel very natural on a keto diet which suppresses the appetite.
  3. Don’t Be Afraid of Fat: Eating lots of fat is a necessary and delicious part of the ketogenic diet! Make sure you include a source of healthy fat with each meal.
  4. Cooking with Coconut Oil: Besides being a natural fat that remains stable at high temperatures, coconut oil contains medium-chain fatty acids which can stimulate ketone production and may have other advantages.
  5. Exercise, if possible: When the transition to ketosis, you may not have enough energy to engage in strenuous physical activity. However, just taking a brisk walk can help you get into ketosis easier.

5 Effect Of Protein On Ketosis

While getting enough protein in any diet is important to prevent muscle loss, several questions have raised regarding the impact of protein on ketone levels.

During digestion, proteins are it broken down into individual amino acids, which trigger the release of insulin.

Although the quantity of insulin needed to transport these amino acids into the muscles is small, when large amounts of protein are it consumed, the increase in insulin could potentially reduce the production of ketones to some extent.

For this reason, ketogenic diets for epilepsy are it limited in protein and carbohydrate, which ensures that ketone levels remain high at all times.

However, the effect of protein on ketosis appears to be very different.

Some people report that their ketone levels are significantly lower when they eat more than a modest amount of protein.

On the other hand, others may be able to eat a little protein without experiencing changes in ketosis.

So far, the scientific literature does not support the concern that too much protein worsens blood sugar control in most people. For example, two studies have shown that a diet containing 30% calories from protein improved glycemic control 29.

If you want to stay in ketosis while eating a lot of protein and are concerned about the potential negative effects, it may be a good idea to conduct your own n = 1 experiments to determine your protein threshold. It might be much higher than you think.

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How To Know If You Are In Ketosis: 7 Signs and Symptoms

Whether or not you are experiencing the keto flu, how can you tell that your body has switched to fat as its primary source of fuel? Here are some common ketosis symptoms to look for, some desirable and some less positive.


As the production of ketones increases, the acetone is exhaled through your breath, producing a fruity scent. If you see this slight change, it could be a sign of ketones taking over.

If the smell bothers you, brush your teeth throughout the day or try peppermint and sugarless gum.


If you find that your cravings are waning and you can go a little longer between meals without feeling so hungry, you could be in ketosis.

Although the mechanism behind this phenomenon is still under investigation, it believed that fat provides a smoother flow of energy than carbohydrates and does not cause spikes in blood sugar. Additionally, keto foods are satiating, and ketosis can suppress hunger hormones.


While it believed that starting a keto diet may lead to a little brain fog from the ‘keto flu‘, initiating ketosis may help improve your mental clarity and focus.

While research is still in its early stages on ketosis and brain health, you may find that your memory is sharper and your mood a little brighter when following a keto diet.


Fat is a desirable sustainable source of energy for many endurance athletes, so it’s no surprise that the ability to metabolize fat more efficiently may support certain types of exercise.

Some research suggests that ketosis can provide athletes with more energy.

If you find that you have more gasoline in the tank when it comes to your gym routine, it could mean that you have become more fat suited.


As your body removes stores of glycogen, it can extract a lot of water from your muscles. Additionally, your kidneys tend to pump more fluid during ketosis.

Plus, to help counter dehydration, it’s often recommended that you increase fluids when starting a keto diet.
All of this combined can make you feel like you run to the bathroom more frequently.


Calorie restriction remains the only recognized approach to fat loss, but changes in body water weight can happen early on low-carb diets due to the fluid it losses mentioned above. [Strong Evidence]

If you suddenly feel less bloated or slightly thinner, you might be losing water weight.

Of course, going keto can also mean most dietary changes for some people. If you typically eat a lot of sugary foods before your keto diet, it’s also likely that you’re cutting back a lot of calories and losing body fat in addition to water.


Finally, the most definitive way to determine whether or not you are in ketosis is to test your ketone levels!
Ketone test strips are available for blood and urine. Although these tests primarily look at AcAc levels (not BHB) and cannot measure the exact amount of ketones in your blood.

Either way, they’re a good indicator of whether or not you’re in ketosis, especially when paired with other symptoms mentioned above.

Most sources recommend a goal of 0.5-3mM for weight loss on the ketogenic diet. Not believe that there is any benefit to going over 3mM and these higher levels can represent a state of starvation for some people (meaning you are not getting enough food)!

The dangerous state of ketoacidosis that occurs diabetics often involves much higher levels of ketones, usually over 10mm.

What If You Are Not In Ketosis Diet?

If you’re on a keto diet but don’t see any signs or symptoms of ketosis, here are some strategies that may help:

Track your carbohydrate intake. While we don’t recommend counting or tracking calories, it can be helpful to log your carb intake to make sure you’re eating less than 20 grams of carbs.

Use an online site or application, such as Cronometer, Senza, Carb manager and others.

Test for blood ketones in the late morning or afternoon. Blood and urine ketones vary during the day, as well as from person to person.

Several people find that their blood ketone levels are usually lowest right after waking up. Try to test later, preferably a few hours after eating.

Even if you’re only in ketosis for part of the day, there are still some benefits you get, as outlined in this talk by Dr Steve Phinney:Achieving and preserving Nutritional Ketosis.

Try to be patient. While some people get into ketosis relatively quickly, others can take a while. Sadly, people who are insulin resistant often seem to have a longer journey.

Have a solid month eating keto regularly, and try to increase your physical activity, if possible. Within four weeks, you should be in ketosis and feel the benefits.

Side Effects, Fears and Potential Dangers

Side effects usually occur within the first few days of starting a ketogenic diet and include ( headache, fatigue, dizziness, irritability, cramps, and constipation ). This is known Symptoms as the “keto flu”, which can be remedied by managing fluids and electrolytes.

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Is Ketosis Safe For Everyone?

Being in ketosis is safe for most people and can provide many health benefits, including weight loss, optimal blood sugar levels, and insulin, to name a few.

However, some people should only follow a ketogenic diet under medical supervision, and others are better off avoiding it altogether.

The situation requiring medical supervision and monitoring during ketosis:

  1. The people are suffering (Type 1 diabetes and Type 2 diabetes on insulin or oral diabetes medications)
  2. High blood pressure under treatment
  3. Liver, heart or kidney disease
  4. Gastric bypass surgery
  5. Pregnancy

Conditions for which ketosis should avoid:

  1. Breastfeeding women
  2. People with rare metabolic conditions that usually diagnosed in childhood, such as enzyme deficiencies that interfere with body ability to make and use ketones, or to properly digest fat

Final recommendations:

All of the above signs indicate that you are in ketosis and that you are about to take the next step and the ultimate goal of a ketogenic lifestyle: fat adaptation.

It can take from weeks to months to become “fat adaptation” or transition complete to addiction to fat for energy. But once you’re there, you’ll get the benefits of continued fat loss, sustained energy and focus, less hunger and irritability between meals, and better overall health.

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