Ketosis Done Right–Meet Anne

victory woman licensedToday we have an inspiring real world “n=1” example of how a ketogenic diet can be successfully used by a real woman to easily and happily lose weight!






I thought it would be nice to give you all a much-deserved break from my own dietary misadventures and stop to appreciate the beauty of a well-done ketogenic diet.  My recent experiment with Professor Seyfried’s dietary recommendations for cancer was one of extreme ketosis for the explicit purpose of cancer treatment.  However, most people who decide to try a ketogenic diet do so with the goal of losing weight, and they use a more moderate plan, such as the one recommended by Dr.s Phinney and Volek, in their book The Art and Science of Low Carbohydrate Living, or the one recommended by Dr. Ron Rosedale in his book The Rosedale Diet.  It is this kind of plan I intend to try myself soon, motivated in no small part by my friend Anne, who has successfully applied ketogenic dietary theory to her own life, and who has generously agreed to share her inspirational story here with us. But first, a bit of context.

On a beautiful autumn day last October, I was sitting on a beach in picturesque Rockport, Massachusetts with two friends, babbling incessantly about some of the talks I had heard at the 2012 Ancestral Health Symposium, and all the latest things I had been l learning about diet and health, as I am wont to do.  Most of my friends and coworkers have learned to deal with this annoying tendency by employing one of two common strategies:

  1. Nodding politely and feigning interest, while secretly thinking about far less important things, such as global warming, conflict in the Middle East, and the plight of the piping plover.
  2. Disagreeing with my unorthodox dietary philosophies by posing traditional counterarguments, such as “milk is good for growing children”, “losing weight is about calorie counting and exercise”, “the brain needs carbohydrates for energy” and “meat, fat, and cholesterol are bad for you.”

But these two friends are among the few who indulge me in my crazy fringe ideas, encourage me and support me in my endeavors, and sometimes even try applying some of my wacky notions to their own lives.  Anyway, there I was, waxing poetic by the seashore about Dr. Rosedale’s presentation about high fat/adequate protein/low carbohydrate diets being the key not only to weight loss but also to overall health, optimal function, and longevity.  When carbohydrates are restricted and protein is limited to daily requirements, the body has no choice but to burn fat for energy–this is what people who want to lose weight actually want to do–they want to burn fat.  While I personally had lots of positive experience with very low carbohydrate diets, I had reached a weight loss wall, and had never tried to limit protein before.  Dr. Rosedale’s logic seemed airtight and I was very intrigued–maybe protein limitation would be the key to my own weight loss challenges.

So, there I was, droning on and on about the virtues of nutritional ketosis to my friends. But did I start a ketogenic diet myself?  Nope…at least not right away. [Update: as of August 30, 2015 I have been back on a ketogenic diet for nearly 4 months]. But Anne did. Anne is the kind of person who embodies clarity and decisiveness.  She simply does things or doesn’t do things–if she’s on board with something, she launches into it. If not, she dismisses it and moves on, without any angst or regret. She’s also really good with data and technology, so she’s included some terrific graphics.

So, ladies and gentlemen, without further ado, I give you: Real Woman Anne.


Anne’s Story

I’m approaching almost 5 months on a nutritional ketosis (NK) diet.  But before I talk about NK, I’ll give you some background information about me.  I’m female, 46 years old, and 5 ft tall.  I was not an overweight kid, but my diet as a child was processed everything.  I loved Velveeta, canned ravioli, marshmallow fluff, boxed macaroni and cheese, etc.  You get the picture.  When I hit my 30’s, my metabolism changed and I began gaining weight. My love for processed foods and chips and dip were at an all-time high.  For emotional reasons I would turn to these foods to feel better, however briefly.  I have been dieting off and on for the last 6 or 7 years. The only other specific diet I have tried is Weight Watchers (WW).  I have had success with WW in that I do lose weight, but I struggle to stick with it. One of the reasons I loved WW was that I was able to eat anything I wanted–I just had to count it.  So I didn’t have to give up my favorite carbs, I just had to moderate.  Well, moderation is not my strong suit.  When low, feeling fat, whatever, I would go on a happy bender of a bag of chips with dip.

I have tracked my weight since December 2006 when I was at my heaviest (153.4 lbs).  On WW the lowest weight I reached was 126.4 lbs back in October of 2010, but I quickly gained weight again.  My weight has yo-yo’d ever since but never again coming close to the low 126.4 weight.  That is until now.  One afternoon in October 2012, Georgia mentioned Dr. Rosedale’s diet to me. Something struck a chord and I started the diet just a few days later.  With winter fast approaching and me almost at my heaviest weight again, something had to be done.  I weighed 149 lbs.  My BMI was 29.1.

So I began my NK diet October 15, 2012.  Interestingly Dr. Rosedale never mentions ketosis in his book, but his diet recommendations put you into ketosis.  Georgia had also mentioned Jimmy Moore’s Livin’ La Vida Low Carb Blog so I checked that out too and learned more about NK and ketone strips.  Since I was ready to diet again, and I had to strike while the desire iron was hot, I started the diet without blood ketone strips in hand.  So I do not have the before numbers or know when I first reached ketosis.  I followed Rosedale’s first 3 weeks pretty closely, avoiding any starchy vegetables, rice, flour, sugar, fruit, and fake sugars. I ordered my blood ketone strips and tester and began testing my ketones on November 6, 2012.  At three weeks on NK, my ketones were at 5.4, blood glucose 73 (testing always occurred first thing in the morning before breakfast).  That was the highest ketone measurement I ever had, and my ketones quickly came down to 2.8 in a couple of days.  I ranged from a high of 5.4 to a low of 0.3 blood ketones while I was testing.  I ran out of expensive ketone strips on January 4, 2013.  Since things were going great–I was losing weight, I was satisfied and not hungry for many hours–I no longer cared about my ketones.  Or at least not enough to keep spending the money.

Anne's NK ratios

Blue = Fat, Green = ProteinGold = Carbohydrates

I have written down my food, protein, fat, carbs, and calories each day and tracked my weight.  Upon review I see the first 3 weeks I was really trying to not eat many saturated fats, a recommendation from Dr. Rosedale.  I vaguely remember being tired for the first few days on NK but hung in there.  My target protein has been 66 grams/day and I try to keep the carbs down to 50 grams or less/day.  I have days when I do go over on one or the other, but for the most part I’ve been pretty steady.  Over these 5 months, I have averaged 1,160 calories, 42 g of carbs, 82 g of fat, and 73 g of protein a day. Anne's weight loss history As of today March 11th, 2013, I weigh 121.4 lbs, a loss of 27.6 lbs in less than 5 months. My BMI is 23.6.  I’ve gone from a size 12 to a size 8; a few pairs of pants are a size 6.  My initial goal is to reach 120 lbs.  I’m just 1.4 lbs away, but I’m not going to stop there. I’m thinking once I reach the 120 goal, I’ll go for a goal of 115 lbs and see how I feel at that weight. I still have more fat on me than I’d like.  I’ve never dieted without an intense desire to reach the end of the diet before.  Nutritional ketosis is so different for me.  I’m happy on this diet.  I don’t have the cravings for any of those foods that have been my comfort and my downfall.  My low level depression is gone.  I have energy.  I’m not hungry.  I don’t covet the foods other people are eating.  I find this diet just amazing.  I never thought any of this would be possible.  My impatience is only around my intense curiosity of what this old body could look like again.

Anne's weight loss graph As for exercise, I have been much more active in the past.  With a current hip problem, my activity level has slowed to a crawl.  I do a little biking (10-15 min/day and a little Pilates (5-10 min/day).  Two years ago when I reached 126 pounds, I was playing tennis 3-4 times a week, biking, and hiking. I have found that I can have ½ of an apple, berries with heavy cream or sugar free chocolate as my treats in the evening with no ill effects.  It hasn’t made me crave more sweets or carbs.  Life is good. Of course, what I don’t know is the sustainability of this weight loss.  What will maintenance look like once I’ve reached my weight goal?  How many more carbs and protein can I have without triggering the old cravings or gaining weight?  I’m going for blood tests tomorrow to make sure my cholesterol isn’t sky high.  I eat a lot of saturated fats now and hope I’m not hurting myself.   Stay tuned, I’ll keep Georgia apprised.

To see an update from Real Woman Anne, including her pre- and post-ketogenic diet lab results, click HERE

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  • Evinx

    Very informative – love the graphs. Interested in your blood work.I have been in NK with LC diet + weight stable for about 6-7 months (do not need to lose) but lipid profile (NMR) was not so great – high LDL with high particle count + with approx 25% small guys. But feel fine + eat well. so sticking with it but hope learn more from people like Anne.

  • Swimology

    Anne. What do you typically eat during one day.

    • Real Woman Anne

      Breakfast: 3 pieces of bacon, a pancake of an egg and ricotta cheese with laughing cow cheese smeared on top (still love me some processed food)
      Lunch: 1/2 can of tuna with mayo and hot pepper or leftovers from dinner
      Snack: macadamia nuts or slice of cheddar cheese
      Dinner: maybe some pork, chicken, fish, beef and sometimes a little non starchy vegetable but I usually like to save my carb usage for my evening treat
      Evening treat: 1/2 apple with an ounce of hard cheese, or 1/2 C of blueberries and 1/2 C of raspberries sautéed in butter served with 3T of heavy cream or 2 pieces of a Vosges Sugar-free Barcelona bar

      • Divadeb

        (Don’t have the meter/strips) Twice since September I have tried to lower my protein and up my fat and I just start gaining weight so quickly. I track protein, fat, carbs, sugars, etc. and even once felt like I hit the spot but kept gaining weight. I am doing something wrong.
        I will order Dr. Rosedale’s book right now. Does everyone agree that the meter and strips are mandatory?

        • Dear Divadeb,
          I am curious to know how many grams of protein and carbohydrate you went down to, and whether or not you used significant amounts of dairy fats in your diet? I personally gain weight when I eat dairy fats…and I’m not alone, I hear…

          Dr. Rosedale actually does not think that ketone testing is necessary at all. Most people can achieve a reasonable degree of ketosis if they reduce protein to the proper level and limit carbohydrates significantly. I found that the urine “ketostix”, which are much more affordable than meter strips, are pretty helpful–they are not very accurate, but accuracy is not very important.

          • Divadeb

            My second try (Feb 2013) I got my proteins down =/- 60gr and my carbs are generally always 50-60gr. I reviewed my foods quickly and don’t see much dairy (cheese or milk or cream) I do see eggs and butter. I tried your idea to lower my calories and was eating so very little food, and when I wanted more food and added fats, I would gain. Maybe I just didn’t give it enough time (only 2-3 weeks). I believe it is a very healthy way of eating and will help me maintain my 95lb weight loss, if I can just hold on long enough and eat correctly to get into fat burning. I just worked so hard for my weight loss, I have a hard time seeing gains.
            Gonna get the book. Thanks for this site. You have given me a real reason to continue working on this!

          • Hi Divadeb
            If it was only 2-3 weeks, then don’t give up hope–it can take longer than that (up to 5-6 weeks in some people, I’ve heard) to become good at burning fat. I would keep an eye on the butter, though, since that’s a dairy fat, and can cause weight gain in some people. And congratulations on your 95 lb weight loss–phenomenal! Also, I should mention that Dr. Rosedale maintains a professional facebook page where people can post questions about his diet.

          • Divadeb

            Thank you so much. I am in this to win and won’t give up until I figure it out. I am halfway there. Will follow here as well as Rosedale’s book and sites.

  • Great info, thanks Anne. Been on Atkins for 7 months and losing at a snails pace which has never happened before and excersizing more than ever before. I’m not completely complaining, I love that I’m never hungry, but I have been feeling like eating a pound (16 ozs) of protein a day or slightly more was the culprit and now you’ve confirmed it. I just ordered Dr. Rosedales book and will decrease protein substantially beginning right now in preparation of the books arrival. Thank you. Betsy

    • Real Woman Anne

      You are welcome Betsy. I hope it works for you.

  • Charles Grashow

    Anne – Do you feel cold? Have you measured your body temperature? Will you have your thyroid tested (TST, Ft3, Rt3, Ft4,etc) along with your cholesterol? Might I suggest a NMR test to measure your LDL-P to see if your particles are mostly large and buoyant or small and dense? Is your meat and dairy grass fed/finished?

    • Real Woman Anne

      Charles – I don’t feel cold. My body temp is 98.7 Not sure my doc checked the thyroid box on my blood work order. Sadly I don’t think I’ll be getting the nitty gritty details of my LDL. I’m at the mercy of my doc and HMO. I’ll share whatever I get when I get it. When possible I eat grass fed meat but by no means is that the majority.

  • Mariet Hoen

    Anne, Great result ! I’m on the ketone diet for a year now. Lost 46 pounds till now, but have to do more. I am DM T2, so there’s a lot of advantage for me. This is the best I have ever found. Hang on, you are almost there 🙂

    • Real Woman Anne

      Good for you. Thanks for the encouragement Mariet. No trouble hanging in there, I find this the easiest diet I’ve ever done! I’m more worried about the tweaking I’ll have to do when I reach my ideal weight. I don’t want to go down that slippery slope of my old carb ways.

      • Mariet Hoen

        The good thing about this diet is that if you’re heavier a little bit, you can always return to this way of eating. Don’t worry. It is a tool, that remains available.
        I think, my whole life I keep eating this way 🙂

        • Real Woman Anne

          Thanks Mariet. That’s a good tip.

        • Marijke

          Hi Mariet,

          Nice to see you here. I started on the way to NK about a month ago. I just adapted my diet (GAPS) to ketogenic and that was easy. I do not measure anything. I had a period of adaptation where I was not feeling well, but now more energy is coming. I lost a little weight which does not please me at all. Do you feel more energy on this diet?

          • Mariet Hoen

            Hi Marijke,

            Yes, my energy is much better. I had to lose weight a lot. The main result was that I could reduce my diabetes.

            I stopped with two pills (Actos, from which where I had become very fat, and a blood pressure pill) I also put my insulin usage by about half.

            I sport now with much more fun and book there too, progress.
            End of this month I am 70 years. Now I dare again to believe in being 100 years Another 30 years to go, at least. 😉

          • Go Mariet!!! On your 100th birthday we will celebrate with a lovely meat cake:)

          • Mariet Hoen

            Thank you Dr.Ede,

            I send you a message on my 100 birthday, so we can celebrate together 😉

          • Marijke

            Hi Mariet,

            These are great gains. Funny as it is, I would actually like to gain some weight. I am 68 now and I second going to 100 but not above.

            Yesterday I felt the energy coming (somewhat).

          • Mariet Hoen

            Hi Marijke, Thanks. Yes funny 😉 I wouldn’t know, how you can get a little more weight. Except in an unhealthy way. But if you’re healthy, your body you will find proper weight, I hope for you. We are all different.

  • Factotum

    Excellent effort Anne! Thanks for sharing your experience. I’ve been on NK for about a year now, not to lose weight, but because I am convinced it is the best sustainable anti-inflammatory diet for a 71 YO active lean male. I found it easy to give up bread and potatoes if you focus on what you can eat (e.g. salads, fiber veggies, meat and fat!) rather than dwell on the negatives. One conundrum bugs me, however: my fasting triglycerides have gone way up (like 400) when I expected them to easily drift down to below 100. This gives my cardiologist & PCP reason to tell me to cease and desist the NK diet. Most of my fat is some combo of olive oil, coconut oil, MCT oil, macadamias, almonds, avocado, with some heavy cream and some animal fat. Ketones before breakfast are typically in the range of 0.8 to 2.0 and glucose hangs around 100. I don’t understand what is happening and I really want to stay with this, but I MUST find out why TGs are out of whack! Any thoughts???

    • Real Woman Anne

      Thanks for your info. I wish I had thoughts to share with you. I’m a lay person and very new to all this. Let’s call on Georgia and other readers for ideas. It’s hard for me to believe that something that makes me feel so good on so many levels could be bad for me, but data is needed to figure all this out.

    • Real Woman Anne

      And you are right, it’s easy for me to pass up bread, potatoes, cakes too. I’m eating stuff that really satisfies me. And I don’t like all that comes with eating those kind of carbs, so its easy for me to stay on this.

    • Hello, Factotum
      High triglycerides are usually not a good sign. Insulin is a major regulator of triglyceride production in the liver. The fact that your blood glucose levels are approximately 100 and your triglycerides are quite high may mean that some of the foods you are eating are raising your insulin levels. Dairy products can raise insulin levels, as can avocados. You may want to try a dairy-free/avocado-free month and then have your TG’s rechecked. I would also keep an eye on your blood glucose levels and see if they come down a bit. Ideally you’d want to see them at 90 or below. I am not a cardiologist and not a ketogenic diet expert, and cannot provide you with official medical advice; these are just simple suggestions based on what I do know about food and diets. Please be sure to consult in person with a physician who is knowledgeable about low-carbohydrate diets and who can make recommendations based on your specific medical situation, as high triglycerides may be putting you at considerable risk, depending on various other factors in your health profile. If you were healthier before you started this diet, you may be better off going back to whatever worked best for you. I wish you good luck going forward, and please feel free to keep us posted along the way.

  • Kitty


    Thanks for an inspiring story to show it can be done, I wonder is she is an exception having such an easy time and what was her secret as I read most people, including myself have a difficult month adjusting body wise, not food wise

    Any chance Dr. Edes can tell is what happens to her weight now she is no longer in Keto and does one indeed put on weight that fast when eating normally again?

    I think this point is as important as taking the weight off in the first place and may warn us not to go the yo-yo route (at least be warned)

    • Hi Kitty

      I’ll let Anne answer your first question, but as for weight maintenance after a ketogenic diet, the experts I’ve read (primarily Rosedale and Phinney/Volek) recommend staying in ketosis long term. Dr Rosedale recommends that everyone stay on the diet for life–not just for weight loss but for overall health, and therefore does not discuss what alternative approaches would look like.

      Drs Phinney and Volek suggest that SOME people may be able to inch up on their carbohydrate intake after they have achieved their weight loss goals and find a new daily minimum without gaining weight, but that this new number is very different from one individual to the next. I personally know that I can’t get away with more than about 30 grams of carbohydrate per day without starting to re-crave and re-gain, but my carbohydrate metabolism is pretty bad compared to most people. Anne’s metabolism may be better than mine–I suspect it is, mainly because she did not have any weight problems until she was in her 30’s, whereas my weight problems began in the 3rd grade.

      Drs Phinney/Volek write that once a person finds their new carbohydrate minimum, he/she may need to increase fat calories in order to maintain their new weight and not continue to lose weight. They do not recommend increasing protein at the end, because protein requirements do not change. I will be writing up a comparison of various experts’ recommendations in the coming weeks, but I should mention now that Drs Phinney/Volek recommend somewhat higher protein intakes than Dr Rosedale does.

    • Real Woman Anne

      If I had a secret I’d share it with you! We are all different and some may adapt easily and some may not. That first week I was tired and physically weak but then I was fine. As you can see from the gram chart, I ate a lot of fat in the beginning to make it through until I adjusted. Unfortunately I can’t say when my body went into ketosis. Was it quickly? Did it take those 3 weeks? I’ll never know.

      As an aside, I redid my measurements per Dr. Rosedale’s formula to see if my protein intake should change. Since my weight and waist had reduced from the initial time I did the calculations, I thought I better run the numbers again. But as with Weight Watchers, I knew I was probably going to be punished for my success, rewarded with less points to eat. Sure enough the reward was similar. If I did the calculations right my protein intake should be about 50 grams (down from 66 g). But I’m still losing weight eating about 70 g/day so I’m not reducing my protein.

      That is just to say we are different and we have to tweak to make it right for us.

      • Commando

        I fully agree, each body is different as far as ratios that work for them, as is if and when they establish ketosis in full or trace. I think many folks get caught up on seeing other’s results and what they have done and believe if they blueprint it, they will produce the same results. I think the good doctor’s journey establishes this perfectly.

        In my body laboratory, higher fat equates more loss. I also am giving into days where I seem very hungry and I may eat two or three more small meals than usual.

  • NancyM

    I’m not so sure that “Ketosis done right” is the best name for this. I think perhaps how we respond to diet is a genetic thing. Maybe “Ketosis done right for the right genes”. It seems like people either have wonderful experiences on low carb diets, or they have so-so experiences. And some, like me, eventually start gaining weight on a LC diet.

    I see this happen all the time on Some folks magically melt, some melt very, very slowly, some not at all.

    • Hi Twin Nancy

      I agree completely with your criticism of the title–hard to make short catchy titles that are nuanced and precise:) I was just hoping to present some hopeful real world data about someone who has had easy success with NK in case my unusual experiment of last month had been discouraging for people. I have yet to try a basic NK experiment to see whether it will work for very broken people like you and me, but I do plan on giving it a try very soon…as you may have seen from my Ketosis Week Zero post, my thyroid gland may be part of what makes it hard for me, and I believe you had mentioned you have thyroid issues as well…Anyway, I didn’t want people to think that they should go solely on my experiences, because my system is so strange:) Between the food sensitivities and metabolic challenges, I feel as though I may not be the most helpful example for everyone…

      • NancyM

        I’ve done NK, with the ketosis metering and everything. I was very good for 8+ weeks. It was great for maintaining my weight. Sadly, I couldn’t really lose on it either. The only reason I objected to the title was the implication that you’d done ketosis wrong, which I don’t think is true.

        I’m going to try a lower fat — not low fat — diet with lots and lots of low carb veggies and somewhat limited protein. I think this is probably the one thing I haven’t tried so far. Oh, yes, I haven’t tried doing what you did to get so deeply into ketosis. It seemed to work for you for weight loss. Not sure if I could stick with it as long as you did if I felt that miserable.

        Anyway, here’s to N=1 experimentation!

        • Thanks for the support, Nancy–I wish you luck with your own n=1! I think some of us are unlucky enough to have metabolic challenges not only with carbohydrate… and protein…but also with fat as well:( I will be interested to hear what you discover, should you wish to keep us posted here…

  • Susan M.

    Hello Georgia,

    My husband was recently diagnosised with a GBM brain tumor and we are implementing NK to try and keep this beast at bay. Our oncologist is not happy about it, but we are committed to giving it a good shot. We have already been low carb for the past four years, so going into ketosis should not be terribly hard for my husband as he really has no other options. This tumor is a terminal diagnosis, and the only thing I have found that may stem the tide is a keto diet reaching at least 3mmol.

    We have our meter and the strips. My question is when to test – in the morning in a fasted state? An hour after meals? At night before going to bed? When?

    Any help would be appreciated. We already test for blood sugar, is testing for blood ketones the same?


    Susan M.

    • bjjcaveman

      I’ve found that testing first thing in the morning works best for me. And most others I come across also do so. Some people also add in blood ketone tests at night, but in my experience I haven’t found them to be helpful.

    • Hello, Susan
      I’m so sorry to hear that you and your husband have to contend with this beast. Prof Seyfried recommends in his book that people test both ketones and blood sugar 3 times per day–before breakfast, 2 hours after lunch, and 2 hours after dinner. I wish you both the best going forward.

  • Scott

    I had a question. I am in the healthcare field ( Nurse now teacher). I have been testing my urine daily through use of a digital analyzer and chem strips which test for 10 different items
    specific grav
    my prob is when i’m burning ketones i’m testing positive for blood, usually trace to moderate sometimes lysed and not. When I do not test positive for ketones there is none and alll tests wnl
    Any ideas? have you heard of this ? also when positive for blood urobilinogen is pos though not much.

    • Hello, Scott

      This is an interesting question. I looked into this today to see what I could learn. To the best of my knowledge, ketosis in and of itself should not cause blood to appear in the urine. However, there are reports in the ketosis literature of kidney stones as a very uncommon potential side effect of ketogenic diets, and blood in the urine could perhaps be an early warning sign of kidney stone formation–I really don’t know; I would recommend that you run this question by your physician to see what he/she thinks…I wish I could be more helpful. If you learn anything that may be helpful to others, please feel free to let us know.

      • Scott

        Thank you for the quick reply, I didn’t even think of that as a side effect, I will notify my Dr and schedule an appt as well as increase my water. I will let you know if I find out anything. Thank you as well for taking the time to look and continue doing an awesome job—Scott

  • Des

    Hi Dr. Ede, great post. I have been doing an experiment myself for the past week. I have been keeping my carbs at or around 50 grams, give or take. This is the only thing that has helped keep my acne away. But upon reading what the paleo community is saying about being low carb for a long time, I begin to get worried. Staying on a very low carb diet for a long time can have negative effects on the thyroid. People sometimes lose their hair, or they become fatigued and basically lose the positive effects ketosis has to offer. My question is: should I continue? I eat but one sweet potato and get several breakouts, so I really benefit eating this way. What do you think?

    • Hi Des

      First a clarification–very low carb diets are not necessarily ketogenic, so if you are following a simple very low carb (nonketogenic) diet–meaning you are not limiting protein and not measuring ketones–there is no evidence I’m aware of to suggest that your health is in any danger. As for ketogenic diets in particular, I will be posting a review of the science behind ketogenic diets very soon, so I’ll be sure to include information about potential side effects. I will also be posting separately about hypothyroidism and the thyroid debate (safe starches argument, etc.), partly because of my own thyroid lab tests (which I really wish I had thought to check before starting the ketogenic diet).

      One confounding variable to consider when examining low-carb and ketogenic diets is the composition of the diets–my hunch is that many of the side effects of ketogenic diets may be due to the strange types of foods that people eat in order to make the diet sustainable and enjoyable–high amounts of dairy products, nuts and nut oils, and artificial foods, for example.

      However, the best measure of a diet’s worth is how you personally respond to it. So far, it sounds as if your skin is happier on your current diet.

      • Des

        Thank you so much for your thoughtful response.

  • Kitty


    May I clarify something. Maybe it is somewhere hidden in the text. Are we talking here about NET CARBS or just Carbs?

    Anybody experienced heart palpitations and how it get solved besides the usual recommendations of salt, potassium, magnesium/calcium supplmenente and advise as per Dr. Phinney’s books and other?
    I am very slim, I eat around 2000 calories a day, leisure bike only when good weather and not snowing or to cold, eat natural foods only etc
    Is there such a thing as being to low in carbs for ones constitution?
    Any input is welcome as I battle with this issue

    Thanks a lot,

    • Hi Kitty

      I’ll let Anne answer as to whether she is counting net or total carbs, but the standard recommendations are to count net carbs (i.e. total carbs minus fiber).

      I’ll be writing a post soon about ketogenic diet science and side effects, so I hope to learn more about palpitations–

      As far as I know, it is not theoretically possible to eat too few carbs, but you are clearly not feeling quite right on the diet you are currently eating. How many carbs do you eat per day, and how many protein grams? Do you measure blood sugar or ketones?

    • Real Woman Anne

      I’m just counting total carbs, not net carbs.

  • TonyK

    I am writing this in hopes that others may benefit from my experience with trying to attain nutritional ketosis. Since I have had experience with the Atkins diet since about 1980, I did not think that reaching for higher levels of ketosis would be a problem. But I ended up in the hospital emergency room in severe pain, with blood in my urine. A CT scan confirmed that I had a very large kidney stone. With the help of morphine and a lot of water, I was able to pass the stone. Not being interested in filtering my urine to determine the type of stone, I can’t tell for certain what the composition may have been. Since the majority of the kidney stones are of the calcium oxalate variety, I can assume that is most probably what I had.

    After looking over my food choices on this diet, I discovered that many of the things that were Paleo approved turned out to be high in oxalates. Those wonderful low carb vegetables, like spinach, and the nuts, etc. Even those great sources of antioxidants like tea contained oxalates. As a result, I have changed my diet and have cut down on the high oxalate foods. Most of the vegetables I was eating were done primarily to add fiber to my diet to fight constipation, especially after cutting out coffee. Now, I eat mostly meat and do not worry about trying to achieve nutritional ketosis. Plain old ketosis is good enough for me, especially since I don’t need to lose weight.

    • Dear Tony,

      Oh no, that must have been an awful experience–I’m so glad you made it through ok… I really appreciate your sharing your tale of woe as a helpful warning to the rest of us…along with the hard-earned lessons you took away having gone through it.

      Those vegetables…you just can’t trust ’em as far as you can throw ’em…I have often wondered whether the potential side effects of ketogenic diets are related simply to the ketogenic nature of the diet itself or to the types of foods people resort to eating in order to make the diet interesting, palatable, and sustainable. My hunch is that most side effects are due to food choices, as you have determined for yourself must have been the case. I’ll be writing an article soon about the science of ketogenic diets, including potential side effects–one of them being kidney stones…

      In the meantime, yes–words to the wise–careful with nuts, dairy, and crucifers (constipation a common side effect of each) and careful with those high-oxalate veggies…

      Thanks again, Tony–be well!

    • Carolyn Wilson Morales

      Tony K
      I am auto immune hypothyroid. I have had rare bouts with kidney infection for no reason and not accompanied with UT.I….I started a ketogenic diet with extremely low carbs as I am extremy sensitive. I used a lot of coconut oil and coconut milk, and I started to pass tiny kidney stones.
      In further research I found coconut oil is attributed to loosening up kidney stones. I added an herb and lime juice and vinegar and stuff that is suppose to help crush and pass stones along with copious amounts of water. It is just something to consider…..

  • Ellen Davis

    Hi Kitty, I had the same symptoms when I began a low carb diet and in my opinion, it is the single scariest symptom. I finally figured out it was what I call reactive hypoglycemia. I wrote it about it on my website here:
    I hope that helps. It took several months of slowing sliding into a lower carb diet until I finally could eat truly low carb without a reaction. I attribute that to severe insulin resistance in my case.

  • Natalya

    Hi Dr Ede,

    I had a random OT thought about R.W. Anne’s hip issue. Maybe you can mention it to her. Somewhere you said what the MRI showed, but I forgot. Also that she was getting a shot. Cortisone maybe? Hopefully it is much better, since it’s been a little while.

    I was talking to a man, about 40 yo, the other day about Cold Therapy, CT. He had broken the bone between his elbow and his shoulder into 19 pieces. Motorbike racing, in the UK. Lots of the pieces were small. The Doc told him they could open it up and try and screw it all together, but it didn’t look good. Or he could leave it like it was and try CT. He opted for the latter. I do not alas know the details, only that he has a fully functional ‘normal’ arm w only a tiny range of motion issue, through a few degrees. The little pieces were absorbed and the big bits knitted themselves back together.

    I was just wondering if RWA has tried using the curative power of cold? I know the hip is a little awkward, and maybe deep. But these days it sounds like it is a lot less deep! 🙂 I have also recently heard about professional athletes using it.

    I like that, RW. Sounds like a badge, of honor. I wonder if one can just adopt it, or does it have to be given?

    • Dear Real Woman Natalya:)

      I don’t know whether Anne has tried cold therapy, but I will certainly pass this along to her. I’m sure she will appreciate your thoughtfulness. I know that she has received cortisone injections and that she is finding NSAIDs helpful while awaiting surgery.

  • Mara

    Awesome Anne!! I am also trying to hit 120 (115 being ultimate goal) I am 5′ 3″. I have been on paleo for the last few weeks and have followed it to a T and have kept carbs low (under 50) but I am not seeing the results I want. I also workout 5 times a week, cross fit and weight lifting with cardio. So I am going to try Ketosis for a couple weeks and keep my net carbs at 30. Are your carbs based on net carbs or total carbs?

    • Hi Mara

      In Anne’s response to Kitty a while back, she noted that she was counting total carbs, not net carbs. I personally counted only net carbs and had good results. Either way, good luck!

  • Damon

    I’m hoping you have a better answer than “hmm that’s strange.” I’ve tested blood ketones on myself and my mother (who has stage 4 cancer) while eating a diet that is about 85% fat, with fewer than 40g protein and fewer than 20g carbs daily. Neither of us can get our blood ketones above .3mmol/L. I desperately need to know what is preventing us from getting our blood ketones up to be in nutritional ketosis. No other expert has been able to give me an answer better than above. Do you have any ideas or know anyone that might know? Thanks.

    • Hi Damon

      The most common culprits I have found are: caffeine, artificial sweeteners, alcohol, and dairy products (especially whey protein and dairy foods that are high in whey protein). If your mother is taking steroids as part of her cancer treatment, they could also be interfering with ketosis.

    • Marc Brenner

      There is something off ,IMHO with your Macros.By virtue of you and your mother having the same issue….I recommend that you visit Dr Westman food list and follow it without variation and use a Macro calculator.Google Dr Westman Duke University. On a side note here ..I think you and your Mother are eating more than 20 carbs a day…..Also you may want to check your Blood Sugar levels with a meter three times a day and eat to your meter………

  • Chrissie

    How do you know how many calories, grams of fat/protein/carbs to be consuming daily?

  • E.G.

    Hey Dr. Ede,

    Thank you for all your work, it’s really appreciated. I’ve been binging on all the information on your site.
    One thing that I haven’t found, or missed, is the potassium/magnesium concern with Keto. I’m convinced and have started the plan but I know that is something that needs to be planned for.
    What is your recommendation? I know to increase salt and drink plenty of water. Anything else?
    A final question: do you see any issue with me eating my daily allotment in one meal. It’s purely out of convenience. Any drawbacks in one meal per day?
    Thanks 🙂

    • Hey, E.G.,

      So glad you find the information helpful!

      You’re right, you haven’t come across the potassium/magnesium topic on the site, because I had discussed it in a series of posts that I temporarily took down for editing and re-formatting. I’ll be re-posting them in the next month or so. The series was a chronicle of my own experiments with ketogenic diets back in 2013. In the meantime, here is some information from those posts that you may find useful:

      In Phinney and Volek’s book The Art and Science of Low Carbohydrate Living, they recommend 2-3 grams of sodium per day. When I first started keto, I aimed for a minimum 1 tsp sea salt per day (2.4 g sodium), Magnesium 200 mg per day, Potassium 99 mg per day. However, on this combination I felt lightheaded. So, I wrote to Dr. Rosedale and he recommended I take Mg 200 mg twice per day and Potassium 200 mg twice a day (perhaps to double this to 400 mg twice a day during the first 2 weeks). When I tried this, it felt very weird…it’s hard to describe exactly what was happening, so I cut the doses back and it seemed more comfortable, but I still didn’t feel right.

      Then, a reader who goes by the name of Cyn wrote in:

      My first comment is on your “potassium supplement” of 99mg – compared to the RDA of 3500mg is woefully inadequate – *especially* on a low carb way of eating. I realize that you can’t buy potassium supplements in sizes larger than 99mg but you can buy salt substitutes which are potassium chloride.

      Ketogenic diets and physical performance
      Stephen D Phinney

      daily intakes for sodium at 3–5 g/d and total potassium at 2–3 g/d


      Lately, I’ve been taking 1-2tsp each of UNrefined salt, potassium & ascorbic acid (vit.C – which helps cut the saltiness) and adding this to my drinking water jug & drinking this all day long. I have noticed a difference & plan to continue.

      Potassium – 1tsp = 2440mg = 68%RDa
      Salt —– 1tsp = 1560mg = 68%RDa

      I recommend dissolving half teaspoon each of UNrefined salt, potassium & ascorbic acid (vit.C) in 6-8 oz of water & drink every morning to replenish electrolytes. This can be done up to 3x a day if necessary. I buy a salt substitute (NuSalt, NoSalt, Morton’s Salt substitute, etc) for a cheap form of potassium. This should alleviate fatigue, headaches, dizziness or constipation caused by dehydration. Make sure you drink lots of water.

      So I tried her salt solution and it helped a lot! I seemed to only need it in the early phases of adaptation–for maybe a month or two, then I was fine without it.

      As for the (excellent) question of how many meals to eat per day, there are pluses and minuses to eating once a day. The plus is that your body spends many fewer hours in the “fed” state, which is hormonally stressful and distracting to the rest of the body if you’re trying to do other things besides eating and digesting (thinking, exercising, etc). The minus is that if you are insulin resistant, you’re likely to get a much bigger blood sugar and insulin spike if you eat all of your protein in one sitting.

      Sorry for the long answer–hope it helps!

      • E.G.

        Well noted Dr. Ede, and your long answers are appreciated as are your great articles. Thanks again.

  • Aleen

    This is awesome and very inspirational. I just started and it’s been tough but oh so worth it. This is like the only thing that works for me! Thank you for your story!

  • Bobcat1234

    I was intrigued with the RW Anne post, but the update seems to have gone missing. I’m new to NK, in my sixties. I’m especially interested in chatting with folks who follow NK rather longer term. I’ve only been doing this a bit over one month, but am getting very bored with eating this way. Hope to see all the cravings really evaporate. They’re much more manageable, today, than when I began, but, I find it really, really hard to break the idea that a bit of chocolate or some fruit sound good after dinner. Looking for real recipes, too, that do something kind of interesting with the basic keto food ideas. Tired of reading about the virtues of string cheese, I guess!!

    • Hello, Bobcat,

      I apologize for the missing ketosis posts. Some time ago I took them down for editing and then a variety of time-sensitive opportunities arose that took me away from the task. However, on my to-do list for this month is to finish editing all of them and re-post them. If you write to me on my contact page I’ll send you the post directly so you won’t have to wait until later this month.

      Yes it can take more than a month for some people to adjust to ketosis, but if you are still having cravings, it is possible that there are aspects of your diet that are keeping the cravings alive. The most common culprits are:

      low/no calorie sweeteners (both artificial and natural)
      dairy products
      eating too much protein per day for your metabolism

      Good luck in your journey!

      • Cooper

        Hi, been on your Disqus page but can’t find any way to write you a direct message, etcetera… did you ever finish /post the RW Anne update? I was interested in seeing how it turned out!


  • Lj Thomas

    What an amazing article! Thank you, Dr. Ede! I have been on a ketogenic diet for a couple months, and I already feel like a new person. It took me a while to get into this lifestyle because I had been so brainwashed for so many years by the low fat movement. But I had an epiphany when I finally realized that although everything in my house was lowfat or fat free, I was getting fatter and fatter day by day. I always knew that sugar was my number one enemy, but I honestly never imagined that a diet of 75% fat would be the key to reducing all the inflammation in my body and losing weight. My BMI was 43, I was pre-diabetic,and my C-ReactiveProtein hs level was 12.9. My doctor was sending me for all kinds of heart tests and to several bariatric specialists, nutritionists and endocrinologists (I also have hypothyroidism.) only to realize that most of that inflammation was from all the visceral abdominal fat in my body and the chronic arthritis flare-ups that the excess weight was aggravating. ALL my issues were weight related. My doctor even suggested lap band surgery (God forbid!)

    I am no longer hungry all day long, I have so much more energy, I am steadily losing weight, my fasting glucose level is normal, my cholesterol numbers are optimal, and my pleasant mood is consistent and motivating. I appreciate the opportunity to have discovered the miracles of ketogenic dieting. Best wishes to all! LJ