Category: Articles

The article”Dangers of the Keto Diet Debunked” was originally published at HVMN.
Authored by Nate Martins

Is the Keto Diet Dangerous?

The ketogenic diet gained popularity through the weight loss community, and among runners. It’s a low-carb (often 25g per day), high-fat diet triggers the body to burn fat for energy instead of carbohydrates.

With increased popularity, there has also been an increase in keto-naysayers; they think it’s a dangerous fad fueled by the common desire to lose weight.

“It’s unhealthy and unsustainable,” they say. “How can a high-fat diet help you lose weight? It’s dangerous for the heart, increases the risk of ketoacidosis, and leads to poor mineral intake and electrolyte imbalance,” they say. 

However, the ketogenic diet has a well-established history of aiding in disease treatment. It has been used to help people with epilepsy (especially children) since the early 1900s, and more recently, it has been used to manage type-2 diabetes (since it lowers the need for insulin therapy).

With all the noise surrounding the ketogenic diet, it’s difficult to know what to believe. So we’re here to set the record straight and provide information to help make well-informed decisions about the keto diet.
Below, we’ve gathered some common misconceptions about the ketogenic diet and provided answers to help cut through all that static.

1. “If I eat so much fat, won’t I get heart disease?”

The short answer is “no.” It’s important to note there are several different groups of fats, including trans, saturated, and unsaturated.

Old-school dietary conventions suggest eating fatty foods increases the risk of heart disease and leads to high cholesterol levels.

The keto diet requires ample fat to provide energy and compensate for the reduction in energy from carbohydrates. Foods that are rich in fat include meats, cheese, oils, fish, butter, cream, and eggs.

Saturated Fats

These are commonly found in animal products and oils (coconut oil, palm oil, palm kernel oil, olive oil). For years, saturated fat was believed to be a key cause of heart disease. The opinion was primarily based on the result of public health studies which had many methodological flaws and biases that were neglected during the studies.

A recent, more comprehensive study found that people who ate more saturated fat had an overall lower mortality rate and no increase in death from heart disease.
So, incorporating saturated fat while following a ketogenic diet doesn’t appear to be the health risk it was pegged as.

Below we have provided a brief description of fat types. If you’re still confused between good and bad fats this will help you:

Unsaturated Fats

Avocados are the poster child of “good fats.” This type of fat, often found in plant-based foods, can be separated into polyunsaturated fats (found in fish and walnuts) and monounsaturated fats (found in avocados, flaxseed oils, nuts, and seeds). There’s evidence that replacing saturated fats with “good” unsaturated fats can lower the risk of heart disease and help prevent insulin resistance.

A recent study illustrated that switching from a carb-rich diet to a diet higher in unsaturated fats reduced cardiovascular risk, lowered blood pressure, and improved cholesterol and lipid levels.

Trans Fats

These are harmful fats, found mostly in vegetable oils when they’re partially hydrogenated through heating. They’re also found in processed snacks, baked goods, and margarine–foods to avoid on the ketogenic diet.

Interestingly, partially hydrogenated oils (PHO), which are the primary dietary source of artificial trans fat in processed foods, aren’t GRAS (generally recognized as safe) by the FDA.

Cholesterol

Produced by the liver, cholesterol is also derived from our diet. People often assume that eating foods rich in cholesterol will raise cholesterol levels and increase the likelihood of a heart attack. But it’s more complicated than that. Cholesterol-rich foods feature heavily in the keto diet (butter, eggs, red meat); but there are two types of cholesterol. “Bad” LDL cholesterol (think L = lethal) is linked to clogging of the arteries. “Good” HDL cholesterol (think H = healthy) clears cholesterol from the blood.

Research shows there is a weak relationship between levels of dietary cholesterol and blood cholesterol. The effect isn’t the same for everyone either. There are “responders” and “non-responders” to dietary cholesterol; some people experience higher fluctuations in blood cholesterol levels according to the amount of cholesterol they eat, while others are more stable regardless of diet.

Regarding the keto diet, experts recommend focusing not on the total cholesterol levels of the food, but instead on the impact food has on LDL and HDL ratios. Consuming plenty of polyunsaturated fats increases blood HDL levels while reducing LDL. Since saturated fats and trans fats increase LDL levels, these should be reduced.

Still, it’s important to keep track of blood biomarkers when starting on a ketogenic diet to help ensure the diet isn’t increasing risk factors for heart disease.

A macronutrient calculator for the ketogenic diet

Keeping track of your macronutrients can be a chore. Here’s a link to the “Ruled.me” Ketogenic Calculator that can help you calculate how much you should eat. It uses the information you provide to create an accurate keto nutrition profile for you. https://www.ruled.me/keto-calculator/

2. “You’ll get fat eating all that fat!”

It may seem counterintuitive: how can a diet high in fat not lead to weight gain?

Often the biggest misconception about the keto diet: eating fat leads to weight gain or obesity.

That’s likely because we’ve been conditioned to believe eating a low-fat diet leads to weight loss. But all dietary fat doesn’t end up as belly fat.

Metabolism

When we eat proteins and carbohydrates, the pancreas releases insulin into the blood. Insulin is a hormone that signals to our cells to absorb nutrients (such as glucose) and to start using glucose for energy. Any excess glucose is stored as glycogen or converted into fat by the liver or specialized fat storage cells.

Insulin isn’t released when fat is consumed. Fat is absorbed in the intestines and enters the bloodstream circulation as lipoproteins. Fat is a major source of energy for the body, so much of the fat consumed in food is used to keep us alive.

Excess fat is broken down and stored as fatty acids in the liver or as body fat. This shows that even though proteins, fats, and carbohydrates may be metabolized differently, in both mechanisms the excess food energy is stored as body fat.

Dietary Fat Doesn’t Immediately End Up as Body Fat

Instead, it should be recognized that excess food in general–whether carbohydrates, proteins, or fat–can become body fat.

Low-calorie, low-carbohydrate diets are increasingly recognized to be more satiating than low-calorie mixed diets (meaning, overall calorie intake is reduced to promote weight loss). Many people on the keto diet commonly experience the feeling of being more satisfied after eating, and this could contribute to weight loss–but scientists have yet to find a clear advantage of keto for weight loss when compared to any other calorie-controlled diet.

3. “Doesn’t the keto diet cause dangerous shifts in electrolytes and water levels?”

Drinking enough water, especially in the first few days of the diet, is imperative to help the body’s water levels reach a new steady level.

A keto diet causes a substantial shift in body water and electrolyte levels in the first few weeks. Decreasing the number of carbs consumed means glycogen stores in the liver are depleted. Water is stored alongside glycogen (for every gram of stored glycogen, three grams of water are stored).

As glycogen stores are depleted, the body loses water.

Experiencing Keto Sickness or (Keto Flu)

As excess water is expelled in urine, it takes with it important minerals the body needs to function properly.

Electrolyte imbalance can cause a range of side effects, including muscle cramps, constipation, brain fog, and low energy. This contributes to the “keto flu,” a phenomenon people commonly experience as the body adapts to the new, low-carbohydrate diet. You can read here about the keto flu and how to mitigate its symptoms.

It isn’t healthy to have long-term electrolyte imbalance–but it’s easy to prevent, through the adequate supplementation of electrolytes and consumption of nutrient-rich whole foods. Eating things like salmon, nuts, avocados, broccoli, and leafy greens can ensure an adequate intake of magnesium, sodium, calcium, and potassium.

Dehydration and electrolyte imbalance are inconvenient and uncomfortable, but they can be easily rectified and are an unlikely danger to health.

4. “The keto diet is dangerous for athletes and people doing exercise.”

Athletes on a ketogenic diet become more efficient at using fat as fuel during exercise (through beta-oxidation). But it does require some training to tap into the huge amount of energy stored as fat.

Diet and Exercise

Usually, when exercising at a higher intensity, the amount of fat burned goes down, and the amount of carbs burned goes up. Athletes will always use some carbs to fuel moderate/high-intensity exercise. For athletes eating a mixed diet, peak fat burning occurs at about 55% of max intensity.

However, a study of keto-adapted athletes found that these individuals reached peak fat burning at 70% of max intensity. These athletes needed to burn far fewer carbs than athletes eating a traditional diet.

In theory, this means keto-adapted athletes can tap into a huge amount of energy stored as fat, needed to assume less fuel during training and racing to have greater endurance.

There isn’t any clear evidence yet of a boost in endurance performance for athletes in ketosis through diet. Exogenous ketones like HVMN Ketone have been shown to increase endurance, presumably because the body can take advantage of burning ketone bodies, carbs, and fats.

Carbs as Fuel

Carbs are still the primary fuel for the body during high-intensity exercise. A ketogenic diet may be better suited to athletes performing endurance sports (like marathon running or cycling). Athletes engaged in more intense cardio (like sprinting, hockey, and football) may perform better with a higher percentage of carbohydrates. These athletes may experience a decrease in high-intensity output while following a ketogenic diet, but ultimately, a lowered carbohydrate intake isn’t “dangerous” for athletes.

Muscle Catabolism

“Catabolism” means the breakdown of muscle tissue. A common misconception is that athletes switching to a keto diet could trigger muscle catabolism.

There’s no evidence suggesting athletes experience muscle catabolism when eating enough calories on the keto diet. In a meta-analysis, looking at low-carb diets, it was found the diet resulted in greater weight loss and muscle maintenance than diets higher in carbs.

More long-term studies are required, but from existing literature, it seems the keto diet may even be protective against muscle protein catabolism as long as the diet contains a sufficient amount of protein. For those wanting big gains in muscle size or strength, the ketogenic diet isn’t the best option to help achieve that goal.

5. “Keto diets aren’t ‘complete’ and lead to nutrient deficiency.”

Balance is important in any diet, and a proper keto diet should incorporate nutrient-rich foods.

Losing essential micronutrients is another concern raised by keto diet skeptics. People say eating a diet based on fat and protein from animal sources means losing those micronutrients found in higher-carb grains, legumes, fruits, and vegetables. Some also claim low-carb diets contain too little fiber and thus may cause long-term constipation. That’s inaccurate.

Nutrient-Rich and Keto-Approved

There are many options for nutrient-rich, low-carb foods, and they should be frequently incorporated into the keto diet.

Examples include non-starchy fruits and vegetables such as leafy greens, mushrooms, bell peppers, and berries. The trace minerals and vitamins found in grains can also be obtained at higher percentages in good-quality meats and dairy products. Moreover, compounds such as phytates and tannins in grains hinder the bioavailability of several minerals.

A properly constructed keto diet may even be higher in nutrients than a standard American diet, especially when things like candy, refined flour, soda, and processed carbs are eradicated.

A well-formulated keto diet should feature plenty of whole, unprocessed foods and shouldn’t lead to nutritional deficiencies.

6. “Doesn’t the keto diet cause dangerous ketoacidosis?”

These are two very different terms, but ketosis and ketoacidosis are often confused. The keto diet doesn’t cause ketoacidosis.

Ketosis

Ketosis indicates the presence of ketones in the blood at > 0.5 mM. Achieving ketosis can happen through diet or fasting.

When people reach ketosis through fasting, ketone levels naturally plateaued at ~8 mM after 41 days of starvation. This is far lower than ketone levels during ketoacidosis. A ketogenic diet should only result in ketone levels that fall within a natural and safe range.

Ketoacidosis

This is a condition typically seen in type-1 diabetics, where ketones and blood sugar levels are both dangerously high (ketone levels at 20+ mM). The key factor in the development of ketoacidosis is a lack of insulin. The cells cannot shuttle in glucose from the bloodstream for energy use and the body has no signal to stop releasing fats (which are converted into ketones). Those who have even a small amount of insulin secretion or signaling do not often reach this metabolic state.

When ketone levels get too high, the blood becomes too acidic, which could potentially become life-threatening. Other medical problems linked to ketoacidosis include alcoholism, overactive thyroid, and infections such as pneumonia or drug abuse.

Ketoacidosis isn’t a danger directly associated with the ketogenic diet.

7. “Could the keto diet cause hormonal imbalance?”

The hormonal response between individuals on the keto diet varies widely (including between men and women). A careful keto dieter should be able to maintain a healthy hormonal balance.

Hormonal imbalance is a hot-button topic when it comes to the keto diet. There’s a discrepancy in the scientific results, which may stem from differences in the exact dietary protocols used, and the cohorts studied.

Cortisol

This is one of the first hormones most people think will suffer via the ketogenic diet. Cortisol is called the “stress hormone” in the body due to its role in stress response, and several other functions like breaking down fat and protein to make glucose. It also controls sleep and wakefulness as well as the regulation of blood pressure.

Chronically high cortisol levels are detrimental to health and may increase the risk of heart disease. Are these levels possible to attain while on the keto diet? Only if you aren’t careful.

A lack of sodium on the ketogenic diet can cause the brain to send signals to the adrenal gland to increase the release of hormones responsible for water balance. Cortisol is released alongside these other hormones.

If sodium consumption is enough to maintain a normal water balance, then cortisol levels should stay stable. Few studies have measured cortisol levels of people on keto and the results are inconclusive. One study found that cortisol increased over time in subjects given a ketogenic diet with a low/inadequate sodium intake.

Another study showed no change in cortisol after six weeks of a well-formulated ketogenic diet. Cortisol is infrequently measured, which may be an indication that generally, doctors and scientists have few concerns about cortisol on a ketogenic diet.

Thyroid Function

A supposed danger of the keto diet is its negative impact on thyroid function.

The thyroid hormones have several functions, including control of the body’s metabolic rate, digestion, and muscle control, among others. The ketogenic diet is linked with a decline in the amount of active thyroid (T3) in the body, which is why it’s assumed the diet impairs thyroid functioning.

However, this is not backed by any solid studies. The body’s sensitivity to T3 has been hypothesized to increase as a result of the ketogenic diet, in a similar way increased sensitivity to other hormones occurs during the diet. As the body becomes more responsive to T3, it may function just as well or even better than before with lower T3.

Studies point to the beneficial effects of lowered T3 to assist in sparing lean muscle. Lowered T3 is even hypothesized to be an adaptive mechanism for increasing longevity.

Regarding metabolism: one study found when men on either the ketogenic diet or the low-fat diet were compared, their resting metabolic rates were not different despite lowered T3 on the ketogenic diet. Of the several studies done on the ketogenic diet, none have reported significant cases of hypothyroidism–essentially, the thyroid can function fine while following a ketogenic diet

8. “I’ve heard that the keto diet causes kidney stones and gallstones.”

The unfounded association between the ketogenic diet and kidney stones is perhaps due to the supposed link between dietary protein and kidney stones–there’s a common confusion between the ketogenic diet and a high-protein diet.

Can Keto Cause Kidney Stones?

Kidney stones are mineral deposits in the kidneys. They can be caused by multiple things–including dehydration, high sodium intake, family history, and excessively high consumption of protein (> 200g per day). A true ketogenic diet is low-carb, moderate-protein, and high-fat. So there’s no solid evidence that protein consumption at levels seen in a typical ketogenic diet could cause kidney stones.

Gallbladder Issues

Another common false connection exists between the keto diet and the increased risk of gallbladder issues. Why?

The main role of the gallbladder is to store bile (which is made in the liver), and in turn, the role of bile is to digest fat. People assume that eating a lot of fat is somehow linked to an increased risk of gallstones, which are solid deposits of cholesterol and bile that can form in the gallbladder. But most of the cholesterol in the bloodstream is made inside the body (as part of a tightly regulated process inside the liver), not derived from the diet.

None of the common causes of gallstones (including inherited body chemistry, body weight, low gallbladder motility, and low-calorie diet) is linked to the keto diet.

Comparing those who lose weight on a low-fat diet versus a low-carb diet, studies show those on the low-fat diet are more at risk of developing gallstones. Eating high fat is thought to stimulate gallbladder emptying, which could be even protective against stone formation.

9. Is the Keto Diet Right For You?

It’s important to survey the information available and sift facts from the myths. Many of those myths are covered in a cloud of confusion surrounding the relevance of the research, inadequate facts, and media hype.

Many of the perceived dangers of the keto diet are minor inconveniences that can be overcome by careful diet and lifestyle management. These “dangers” are also issues present in any calorie-restricted diet (including low-fat diets) and are not unique to just the keto diet.

It’s obviously important to keep in touch with a doctor for health-related lifestyle changes. But feel confident embracing a properly formulated ketogenic diet–rich in whole foods, adequate hydration, and electrolyte consumption–to help avoid any of these dangers.

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Keto Diet Frequently Asked Questions

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References:

1.	Volek, J.S., Sharman, M.J., Love, D.M., Avery, N.G., Gomez, A.L., Scheett, T.P., and Kraemer, W.J. (2002). Body composition and hormonal responses to a carbohydrate-restricted diet. Metabolism 51.
2.	Kose E, Guzel O, Demir K, Arslan N. Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. J Pediatr Endocrinol Metab.2017 Apr 1;30(4):411-416.
3.	Kaptein EM, Fisler JS, Duda MJ, Nicoloff JT, Drenick EJ. Relationship between the changes in serum thyroid hormone levels and protein status during prolonged protein supplemented caloric deprivation.Clin Endocrinol (Oxf). 1985 Jan;22(1):1-15.
4.	Rozing MP, Westendorp RG, de Craen AJ, Frölich M, Heijmans BT, Beekman M, Wijsman C, Mooijaart SP, Blauw GJ, Slagboom PE, van Heemst D; Leiden Longevity Study (LLS) Group. Low serum free triiodothyronine levels mark familial longevity: the Leiden Longevity Study. J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):365-8
5.	Meckling K, O’Sullivan C, Saari D. Comparison of a Low-Fat Diet to a Low-Carbohydrate Diet on Weight Loss, Body Composition, and Risk Factors for Diabetes and Cardiovascular Disease in Free-Living, Overweight Men and Women. Nutr Metab (Lond). 2004; 1: 13.
6.	Stokes CS, Gluud LL, Casper M, Lammert F. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2014 Jul;12(7):1090-1100.e2; quiz e61.

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“The Ultimate Keto Shopping List” article was originally published at HVMN
Authored by Ryan Rodal

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Many people say diet success starts in the kitchen, but it actually starts somewhere else — the grocery store.

Making the wrong choices at the grocery store might lead you to make bad decisions in the kitchen as well. This is particularly true if you plan on following the ketogenic diet. Just like any other diet, keto requires adherence to certain macronutrient breakdowns for success.

But before exploring what you’ll need to fill your shopping cart with, let’s dive into the background of the keto diet to illustrate why it might be useful to you.

1. What is Keto?

Unless you have been hibernating for a period of several years, chances are you’ve heard of the keto diet. Especially as the ketogenic diet is gaining popularity among runners and other people involved in physical activities.

The word “keto” comes from the term “ketogenic.” Keto is a low-carb (<50g/day), high-fat, moderate protein diet that forces a metabolic adaptation where the body relies on fat stores for energy, resulting in the production of ketones.

Ketones exist almost like a safety mechanism for the body. When our cave people’s ancestors went days without food, the body needed the ability to tap into stored energy; our bodies store seemingly infinite amounts of fat compared to carbohydrates. But the brain can’t use fat for energy (it loves carbs).

So, when the body began turning to fat stores for energy, it resulted in the production of ketones to fuel our brains.

Ketones are a fundamentally different energy source than the carbohydrates your body is typically designed to utilize for energy. Ketones are produced through a process known as ketosis. The body achieves ketosis when blood ketone levels exceed 0.5mM.

Tapping into that evolutionary adaptation, the main goal of the keto diet is, above all else, to trigger ketone production.

The body can produce its own ketones through diet or fasting (endogenously) or through external means (exogenously) such as H.V.M.N. Ketone Ester.

Exogenous ketones are ketones that are consumed, meaning ketone production does not occur within the body. Exogenous ketones provide the body with fuel and allow us to enter a metabolic state that wouldn’t occur naturally because you don’t need to fast or diet to be in ketosis.

The body’s metabolism is not black and white. Most people don’t go straight from using carbohydrates as a fuel source to immediate ketosis at the drop of a dime; there’s a period of adaptation which sometimes results in the “keto flu” (flu-like symptoms while the body learns to tap into fat as fuel instead of carbs).

2. Benefits of Keto

From weight loss to cardiovascular health, there are several potential benefits to ketogenic dieting. The diet isn’t a one-size-fits-all solution (despite what you’ve maybe heard, with all the keto hype). And no matter what diet, it’s important to consider your own personal needs before embarking on a lifestyle change.

Let’s take a closer look at what the keto diet may be able to do for you.

May Increase Weight Loss

A reduction in carbohydrate consumption usually leads to weight loss. This is especially true of those consuming a Western diet, in which you may consume 50% of your calories from carbs.

In a meta-analysis performed on low-carbohydrate diets, individuals were assigned to either a low-carb diet (less than 50g per day) or a low-fat diet (less than 30% of calories from fat). Five different studies showed decreased body weight, lower diastolic blood pressure, and increased HDL (good) cholesterol for patients using the low-carb diet when compared to low-fat diets.

A second study followed 120 overweight people who were assigned an extremely low-carb diet (less than 20g per day) or a low-fat diet (less than 30% calories from fat with a 500 calorie deficit). Both groups also exercised regularly as part of the diet plan. The results showed patients lost on average 4.8kg on a low-carb diet vs. 3.3kg on a low-fat diet.

Both of these versions of low-fat diets illustrate that for weight loss purposes, a low-carb diet might be better than a low-fat diet (all other factors being equal).

Can Help Improve Satiation

Many people believe high-fat, low-carb diets are better for satiation purposes. This can result in fewer overall calories consumed, which might result in weight loss.

In one study, 119 overweight volunteers were assigned either a low-carbohydrate ketogenic diet or a low-fat diet. The study sought to assess weight-loss diets on mood, food cravings, and other self-reported symptoms, including negative effects, fatigue, somatic symptoms, physical effects of hunger, insomnia, and stomach problems. The results showed those following a low-carbohydrate ketogenic diet experienced less hunger compared to those following a low-fat diet. It’s likely the high-fat content of the ketogenic diet that plays a role in keeping you feeling fuller for longer. In turn, people may eat less food and potentially lose weight as a result.

May Help Diabetic Patients

Maintaining blood glucose levels at a healthy level is imperative for diabetics (type 1 and type 2). The lower intake of carbohydrates on a ketogenic diet can help reduce the large spikes in blood sugar, and thus, reduce the need for insulin.

A study was performed on 49 diabetics who followed a low-carb diet (less than 20g) or a reduced-calorie diet (-500 calories). Both groups also exercised regularly.

The low-carb group experienced greater improvements in hemoglobin (1.5% vs. 0.5%), body weight (11.1kg vs. 6.9kg), and HDL cholesterol (+5.6mg vs 0). The results of this study lead us to believe that lower-carb diets may help improve glycemic control and lowering risks associated with type 2 diabetes.

May Lessen Cardiovascular Risks

Cardiovascular disease is often a result of a complex collection of symptoms: weight, activity level, and diet. These all might play a role in the risk of cardiovascular disease.

In relation to keto, fat consumption is usually a hotly debated topic in the medical community. For decades, low-fat diets were thought to be the answer; but now, it may seem like eating more fat is linked to weight loss. This is simply an example of the way we learn, how studies change, and how advice medical professionals may give based on those learnings will also, undoubtedly, change too.

All that said, let’s look at how the ketogenic diet may play a role in lessening the risks of cardiovascular disease.

A study was performed on 60 participants who followed either a higher-carb or lower-carb diet for 12 weeks. The lower-carb group experienced greater weight loss (13.6 pounds) compared to the higher-carb group (7.5 pounds). The lower-carb group also experienced better blood lipid levels compared to the higher-carb group. A separate study was conducted on 63 obese men and women who followed either a low-carb, high-protein, high-fat diet or a low-calorie, high-carb, low-fat diet. The results were clear; patients on the lower-carb diet lost more weight after a six-month period compared to the low-fat group (7 pounds vs. 3.2 pounds).

3. How to Use the Keto Food Shopping List

The grocery store may feel like a whole new world after using this shopping guide.

Although keto may appear simple in practice, choosing the wrong keto foods can take you out of ketosis or prevent you from ever getting there.

As you’ll see, we stress the importance of whole food purchases and staying away from processed goods.

This keto food list will provide several dietary options fitting within the confines of the keto diet, but keep in mind this is not a comprehensive list.

Before we dive into the keto food choices, let’s go over some basic fundamental steps before setting foot in the grocery store. This is like laying the foundation for a lifestyle change.

Set a Budget

When beginning a new diet, it’s easy to get carried away. You want to purchase every single product possible because you think it’ll help you reach your goals.

Before you max out that credit card, take a deep breath.

Assess your finances and try to set a reasonable budget so you don’t overspend. Many people buy too much food at the grocery store and much of the food expires before they ever get an opportunity to consume it. Maybe your budgeting will even involve shopping at different grocery stores. Many people will purchase all their meats from a local butcher, while getting other items, like fruits and vegetables, from big-box stores. Think about where you live and what the best option is for you.

Stick to the Basics

Many people tend to get caught up in new food items the moment they pop up on the shelves; has there been a new superfood announced this week? When it comes to keto food choices, you should always try to stick to the basics.

Most of the foods you purchase will include combinations of the following:

• Meats
• Veggies
• Eggs
• Dairy
• Healthy cooking oils
• Nuts

The key is shopping the edges of the grocery store and staying away from processed foods in the aisles. Once you have the basics down, you may be able to incorporate other keto food items.

The key is not to overcomplicate the minor details when starting.

Now that you have a firm grasp on the basics, you’re ready to go to the store. Grab that shopping cart and break out this list. To make this more user-friendly, we’ve broken the list down in the most logical way possible.

4. Meats to Buy

The keto diet is a high-fat, moderate-protein, low-carb diet at its most basic and fundamental level. So, consuming different types of meat is one way to ensure you keep your fat content high.

Some of the meats you should purchase include:

• Ground beef and ground turkey
• Chicken thighs and chicken breasts
• Bacon
• Pork chops
• Ham
• Sausage
• Steaks (we like the NY strip)
• Salmon and other fatty fish, like tuna
• Eggs

Meat selection should go beyond simple caloric values. While the caloric and macronutrient content may be similar, the quality of the meats can vary.

When possible, you should strive to purchase grass-fed beef, pasture-raised chicken and pork, and wild-caught seafood. Some of this will vary depending on season and location. Certain parts of the country may not have as many meat choices available.

Some meats also contain hormones and antibiotics so be wary of this as well. Consume higher-quality fatty meats if they fit within your budget.

4. Veggies to Buy

Most vegetables are considered healthy and fit within the ketogenic diet, although higher carb choices such as white potatoes, sweet potatoes, and carrots should be avoided.

Stick to non-starchy veggies such as:

• Spinach
• Asparagus
• Cauliflower
• Broccoli
• Kale
• Romaine lettuce
• Green beans
• Onions
• Bell peppers
• Celery
• Cucumber
• Mushrooms
• Olives
• Zucchini
• Spaghetti squash
• Peas
• Artichokes
• Cabbage
• Brussels sprouts
• Bok choy

Do not consider this an all-inclusive list as there are several other vegetables you may purchase that are also keto-friendly. You’ll be making many new dishes that may call for vegetables you’ve never heard of. Don’t be afraid to try something new.

5. Fruits to Buy

Most fruits are off-limits on keto due to their carb content. Cherries and berries are probably the most keto-friendly fruit, specifically, raspberries and blackberries. And since we’re in the fruit aisle, best to stock up on all the avocados to get a dose of healthy fat.

Some of the most keto-friendly fruit choices include:

• Strawberries
• Blueberries
• Raspberries
• Cherries
• Cranberries
• Blackberries
• Avocados

Generally, it’s best to consume fruit in moderation; we like to use them as dessert.

6. Dairy Products to Buy

The carb content of dairy products can vary depending on the item. Be sure to look at all the nutrition labels before making a purchase.

Some keto-friendly dairy options include:

• Full-fat yogurt
• Heavy cream
• Butter
• Sour cream
• Heavy whipping cream
• Cheese
• Parmesan
• Cheddar
• Swiss
• Mozzarella
• Feta
• Brie
• Colby
• Goat cheese
• Blue cheese
• Ricotta cheese
• String cheese
• Cream cheese
• Cottage cheese

Many dairy products will be keto-friendly while others not so much—just be sure to focus on those with full-fat content. If you consume dairy in moderation you should have no problem keeping it keto.

7. Nuts and Seeds

Some nuts are considered low-carb and keto-friendly, while others have higher carb content and should be avoided as snacks. Keto-friendly options to consider include:

• Almonds
• Macadamia nuts
• Hazelnuts
• Pecans
• Pistachios
• Walnuts
• Sesame seeds
• Pumpkin seeds
• Peanut butter
• Almond butter
• Flaxseed
• Chia seeds
• Nut butter
• Brazil nuts
• Sunflower seeds

Other nuts such as peanuts and cashews are higher in carbs, so stick to the ones we’ve listed.

8. Healthy Cooking Oils

High-quality fat sources are an important part of a diversified keto meal plan. Some of the best healthy cooking oils for keto include:

• Olive oil
• Avocado oil
• Coconut oil
• MCT oil
• Avocado oil

You should stay away from oils high in Omega-6 fatty acids, such as vegetable oil and canola oil. The healthy fats listed above are high in healthy Omega-3s and should be consumed regularly as part of the keto diet.

9. Baking Ingredients

When it comes to baking, there are high-carb options that should be avoided, such as white flour.

The good news is you can still create keto-friendly recipes by using lower-carb ingredients. And if you need to add a source of high-quality fat when baking, two great options of H.V.M.N.’s MCT Oil Powder and Keto Collagen+. Both of these powders contain C8, the world’s most ketogenic fat, with a base of the gut-friendly prebiotic, acacia fiber. They’ll settle right into your pantry as keto diet staples.

Some of the best low-carb keto food choices include:

• Vanilla extract
• Baking soda
• Sea salt
• Cocoa powder
• Coconut flour
• Almond flour
• MCT Oil Powder

If a recipe calls for traditional flour, you can substitute it for one of the alternative flours we’ve listed above.

10. Condiments

Condiments can oftentimes be a hidden source of carbohydrates. Be sure to stay away from sugary condiments such as BBQ sauce in favor of vinegar-based options.

The following condiments are safe to use on the keto diet:

• Mustards (yellow, grain, deli, dijon, etc.)
• Soy sauce
• Salsa
• Hot sauces
• Mayonnaise
• Worcestershire sauce
• Vinegar-based dressings, like an Italian dressing
• Sugar-free maple syrup
• Classic lemon and lime juices

People don’t realize that ketchup and BBQ sauce can add several hundred calories to daily caloric intake if unaccounted for. Try to use the options listed above to stay keto.

11. Snacks

One reason many diets fail is that people eat too many unhealthy snacks.

A handful of candy or a couple of cookies from the jar may not seem substantial, but just a few of these can wreak havoc on your ability to stay in ketosis.

Some of the best keto snacks include:

• Pork rinds
• Yogurt
• Beef jerky
• Low-carb nuts
• Hard-Boiled eggs
• Cottage cheese with diced avocado

This is not a complete list, as there are more low-carb snacks on the market than ever before. You should never take a low-carb item at face value but should read nutritional labels to be sure you’re adhering to a keto diet.

12. Foods to Avoid

Generally, these items are considered a big no-no. Anything filled with sugar or high-fructose corn syrup is definitely not considered keto food.

The foods to avoid include:

• Sugary snacks and desserts
• Soda
• Crackers
• Cookies
• Chips
• Processed goods
• Fruit juice
• Beer/wine

If you want to play it safe, simply throw these foods away to completely eliminate the temptations from sight. If these foods aren’t within arms reach, there’s less of a chance of you cheating on your diet.

13. Keto Shopping List – Things to Keep in Mind

Sticking to a keto diet doesn’t have to be difficult or overly complicated. Meats, starch-free veggies, full-fat dairy, and nuts should lay the foundation for most of your dietary choices.

Be cautious when shopping at the grocery store and check all nutrition labels if you aren’t sure of the carb content. Also, look at serving sizes to make sure you are adequately accounting for nutritional content. Consume carbs in moderation if you want to follow a strict keto diet.

The best diet is the one you can stick to long-term. No matter the diet always try to eat healthy to maximize your health and longevity.

Keto Food Shopping Frequently Asked Questions

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Scientific Citations

1.	Cahill, G.F., Jr. (2006). Fuel metabolism in starvation. Annu Rev Nutr 26, 1-22.
2.	Masood, W. (2019). Ketogenic Diet. Treasure Island, FL: StatPearls Publishing.
3.	Bueno, N. B., de Melo, I. S., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr, 110(7), 1178-1187.
4.	Yancy W, Olsen MK, Guytib JR, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia: A Randomized, Controlled Trial. Ann Intern Med. 2004;140(10):769-777.
5.	Mcclernon FJ, Yancy WS, Eberstein JA, Atkins RC, Westman EC. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring). 2007;15(1):182-7.
6.	Westman EC, Yancy WS, Mavropoulos JC, Marquart M, Mcduffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond). 2008;5:36.
7.	Aude YW, Agatston AS, Lopez-jimenez F, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial. Arch Intern Med. 2004;164(19):2141-6.
8.	Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348(21):2082-90.
9.	St-pierre V, Vandenberghe C, Lowry CM, et al. Plasma Ketone and Medium Chain Fatty Acid Response in Humans Consuming Different Medium Chain Triglycerides During a Metabolic Study Day. Front Nutr. 2019;6:46.

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The article “Ketosis Symptoms and Signs: What to Look Out For” was originally published at HVMN by Nate Martins.

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There are two paths to achieve ketosis.

The first is through the ketogenic diet or fasting, which can take weeks or months for the body to produce its own ketones.
The second is through exogenous ketones like HVMN Ketone, consuming ketones through an external source. On the map to ketosis, these are different roads–one more winding than the other.

But how do you know you’ve arrived at ketosis?
What positive things are you looking for?
What negative symptoms might you encounter?
Here, we discuss what signposts to monitor your ketosis.

1. Recapping Ketosis

Ketosis is a normal metabolic state marked by higher-than-normal levels of ketones (or ketone bodies) in the blood.

Endogenous ketone production denotes ketones produced naturally by the body. It’s the body’s natural adjustment to the absence or restriction of carbohydrates in the diet. Without enough glucose from carbs to fuel its cells, the body turns to fat to replace glucose as its primary source of energy.

In the liver, fat that is not burned for energy directly is converted to ketones. And, this means that you are in a ketogenic state.
Ketone levels increase in the bloodstream and provide an alternate and efficient fuel source for the body and brain. As a result, muscle protein is spared from being converted to glucose for energy.

Exogenous ketosis comes from an external source. Consuming exogenous ketones, like a ketone drink containing a ketone ester or a ketone salt, raises blood ketone levels. The body isn’t producing ketones in this state but remains in ketosis from having ketones introduced from an outside source. However, the body isn’t ketogenic–that specifically means the body is producing its own ketones.

Two paths, one destination. Here’s what to look out for to ensure you’re in ketosis.

2. Measuring Ketosis

A blood ketone level of 0.5 mmol/L is widely acknowledged as the threshold for entering ketosis. Using a measuring device is the best way to know you’re in ketosis, with different devices measuring the presence of ketones in the breath, blood, and urine, to provide an exact biomarker of your level of ketosis.

Measuring ketosis through blood is the most accurate. Blood testing is reliable for quantifying both endogenous (created by the ketogenic diet, fasting, and exercise) ketones and exogenous ketones such as HVMN Ketone. Urine and breath measurements are less reliable but can be useful as quick, noninvasive ways to approximate blood ketone levels.

3. Unwanted Symptoms of a Ketogenic Diet

The ketogenic diet remains the most common approach to trigger a state of ketosis. Low in carbs, high in fat, and low/moderate in protein, carbohydrates are typically reduced to less than 50 grams per day. It’s this depletion of carbs that results in the body becoming ketogenic.

Along with biomarker testing, subjective symptoms can provide an indication of your ketosis. Sometimes, early side effects of the diet result from carbohydrate withdrawal. This can be known as the “keto flu;” symptoms include nausea, fatigue, and headache. and dry mouth. They’re short-term, typically lasting about a week or less. Keep in mind, however, that we are all different. Our bodies react in different ways. Some of us may experience these symptoms later than sooner, to a lesser extent, or not at all.

Let’s dive into some of the other potential side effects of ketosis.

Gut Issues: Frequent Urination, Constipation, Diarrhea 

Glycogen is the body’s stored form of carbohydrate for energy. It’s found primarily in the liver and muscle cells. Each gram of glycogen is bound with 3 to 4 grams of water. On a low-carb diet, the body will burn through these glycogen stores, releasing a lot of water and causing frequent urination.

As insulin levels plummet from carb-cutting, more water is flushed out, along with excess sodium (in contrast, excess insulin from carbs causes sodium and water retention). In some people, dehydration contributes to constipation, which can also result from avoiding fiber-rich carbohydrate foods. While less common, diarrhea or loose bowels can be triggered by several factors including too much or too little fat, dairy intolerance, or changes in gut flora. 

Many people on the ketogenic diet never experience gut problems. Those who do can try combating them by drinking plenty of water and mineral-rich broths and eating more non-starchy veggies along with foods rich in fat and fiber (such as nuts, nut butter, and avocado).

Rapid Weight Loss/Long-term Weight Loss

As glycogen stores become depleted and water attached to glycogen is released, rapid weight loss in the form of “water weight” occurs.

Once glycogen stores run out, however, ketosis kicks in as body fat is burned. Strong evidence supports the use of ketogenic diets for long-term weight loss. The appetite-suppressant impacts of ketosis leading to decreased calorie consumption are considered to be the most plausible mechanism through which the diet works. 

Bad Breath

Surprisingly, low-carb diets may lead to bad breath (also called ketosis breath).

Acetone, the least abundant ketone, is present in the breath and is responsible for the unpleasant odor. Acetone is a solvent in nail polish if that gives you an idea of what it might smell like. But it’s not as bad as it sounds; acetone breath is a sign of ketosis and fat burning. It’s the ketone measured in breath tests used for detecting ketosis.

After several weeks of keto dieting, ketosis breath typically dissipates. To help, drink more water and use breath fresheners. If it’s unbearable, consider adding just enough carb back into your diet to avoid bad breath while still staying in the ketosis zone.

4. Positive Signs You’re in Ketosis

The positives of ketosis greatly outweigh the negatives when reaching a state of ketosis. Lowering carbohydrate intake is responsible for some of the side effects of the diet, but is also responsible for the positive effects (from the presence of ketones).

Increased Mental Focus & Decreased Brain Fog

Studies have shown ketones can improve cognitive performance. The brain uses ketones as a fuel source when carbohydrates are depleted. Beta-hydroxybutyrate (BHB), the major ketone body, is more efficient than glucose. It also stimulates the production of new mitochondria – the energy factories in our cells.

Increased mental clarity and focus, and less brain fog are often reported by healthy people in ketosis. HVMN CEO, Geoffrey Woo said, “After a drink of HVMN Ketone, it’s like I’m more behind my eyeballs.” Exogenous ketones can subjectively improve mental performance and clarity.

When HVMN Ketone was tested in mice, they performed 38% better on a maze solving challenge, so there may be a cognitive boost for humans also. While following a ketogenic diet, you avoid the energy peaks and troughs that come from quick-energy carbs. Producing ketones from stored body fat provides the brain with a steady, sustainable supply of fuel.

Decreased Appetite

One of the first symptoms you might notice when on a ketogenic diet is that it kills your appetite.

People on the diet report being significantly more full and satisfied. Even though you may be ingesting fewer calories on the diet, your hunger doesn’t increase. One possible explanation is greater consumption of satiating foods, primarily protein, and fat. However, multiple studies indicate that the state of ketosis itself (apart from effects from food) plays a role as well.

High levels of circulating ketones may have a direct appetite-suppressant effect. In fact, the exogenous ketone ester used in HVMN Ketone rapidly increased blood levels of beta-hydroxybutyrate and lowered appetite as well as levels of ghrelin – the hormone that increases hunger. While this still needs to be explored further, it is possible that exogenous ketones may be useful for appetite control as part of a holistic weight loss strategy. 

5. Symptoms of Dangerous Diabetic Ketoacidosis

In nondiabetics, ketosis (also called nutritional ketosis) is regulated and controlled in the body so that ketone levels never reach the harmful levels associated with diabetic ketoacidosis. Ketoacidosis is an acute, life-threatening condition that occurs in severely uncontrolled diabetes (mainly type 1) when ketones rise to massive, supranormal levels.

Since the body’s acid-base buffering system cannot neutralize the vast amount of acidic ketones, the blood pH drops significantly. This buildup of acids in the blood poisons the body and can lead to ketoacidosis. Breathing becomes deep and rapid as the body attempts to compensate for excessive acids. Other symptoms of diabetic ketoacidosis include:

• Extremely high glucose levels
• Nausea and vomiting
• High levels of both glucose and ketones in the urine
• This can lead to a coma

Importantly, this dangerous condition is rare in non-diabetics following a ketogenic diet, and in people taking exogenous ketones. Sticking to the recommended dose of max. 3 drinks per day of HVMN Ketone, there is no risk of ketoacidosis. 

6. Being Aware of Your Ketosis

Ketosis is the body’s normal physiological response to a shortage of carbohydrate fuel.

It is characterized by elevated blood levels of ketone bodies or ketones. Ketosis is a healthy, natural state that shouldn’t be confused with ketoacidosis, a dangerous and potentially life-threatening complication of diabetes.

Elevated blood ketone levels are the sign of ketosis, while certain subjective symptoms can also signal ketosis. Increased mental clarity, less brain fog, and diminished appetite are fairly common among people in ketosis.
The ketogenic diet specifically has its own assortment of symptoms. Fortunately, the negative symptoms such as constipation, diarrhea, and bad breath are often temporary and tend to fade as your body becomes better at fat-burning and naturally producing ketones. The positive symptoms of ketosis coincide with higher levels of ketones in the blood. This may occur after several weeks of adhering to the ketogenic diet or very shortly after ingesting exogenous ketones.

Scientific Citation

1. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition. 2013;67(8):789-796. doi:10.1038/ejcn.2013.116.

2. Stubbs, B.Cox, P.; Evans, R.; Santer, P.; Miller, J.; Faull, O.; Magor-Elliott, S.; Hiyama, S.; Stirling, M.; Clarke, K. (2017). On the metabolism of exogenous ketones in humans. Front. Physiol.

3. Olsson, K.-E. and Saltin, B. (1970), Variation in Total Body Water with Muscle Glycogen Changes in Man. Acta Physiologica Scandinavica, 80: 11–18. doi: 10.1111/j.1748-1716.1970.tb04764.x

4. DeFronzo RA, Cooke CR, Andres R, Faloona GR, Davis PJ. The effect of insulin on renal handling of sodium, potassium, calcium, and phosphate in man. Journal of Clinical Investigation. 1975;55(4):845-855.

5. Paoli, A., Bianco, A., Grimaldi, K.A., Lodi, A., and Bosco, G. (2013). Long term successful weight loss with a combination biphasic ketogenic Mediterranean diet and Mediterranean diet maintenance protocol. Nutrients 5, 5205-17.

6. Musa-Veloso, K., Likhodii, S.S., and Cunnane, S.C. (2002). Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. Am J Clin Nutr 76, 65-70.

7. Evans M, Patchett E, Nally R, Kearns R, Larney M, Egan B. Effect of acute ingestion of β-hydroxybutyrate salts on the response to graded exercise in trained cyclists. Eur J Sport Sci. 2018:1-11.

8. White H, Venkatesh B. Clinical review: Ketones and brain injury. Critical Care. 2011;15(2):219. doi:10.1186/cc10020.

9. Murray, A.J., Knight, N.S., Cole, M.A., Cochlin, L.E., Carter, E., Tchabanenko, K., Pichulik, T., Gulston, M.K., Atherton, H.J., Schroeder, M.A., et al. (2016). Novel ketone diet enhances physical and cognitive performance. FASEB J.

10. Gibson, A.A., Seimon, R.V., Lee, C.M., Ayre, J., Franklin, J., Markovic, T.P., Caterson, I.D., and Sainsbury, A. (2015). Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes. Rev. 16, 64-76.

11. Stubbs BJ, Cox PJ, Evans RD, Cyranka M, Clarke K, De wet H. A Ketone Ester Drink Lowers Human Ghrelin and Appetite. Obesity (Silver Spring). 2018;26(2):269-273.

12. Manninen AH. Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood “Villains” of Human Metabolism. Journal of the International Society of Sports Nutrition. 2004;1(2):7-11. doi:10.1186/1550-2783-1-2-7.

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Common Questions People Ask About Ketosis: