Top 3 Ways To Test For Ketosis

Measuring one's ketone levels is an excellent biomarker for tracking the effectiveness of fasting, ketogenic dieting, and exogenous ketones. But there’s more than one way to test for ketosis.


Why should you care about how high your ketone levels are?

Understanding blood ketone levels offers insight into where you might feel best, or help optimize diet to achieve personal goals.

Many people monitor blood ketone levels while on the keto diet or taking exogenous ketones like HVMN Ketone to verify that they’re actually in ketosis.
blood ketone levels
Blood Ketone Levels

Setting a baseline while on the keto diet is helpful, especially if you’re using the keto diet for weight loss and other health benefits like controlling metabolic syndrome.

For those on the low-carb, high-fat keto diet trying to lose weight, moderate ketone levels could be an indicator measurement of your dietary needs to reach those weight loss goals.

When on the keto diet, fat stores are broken down and fatty acid concentrations increase in the bloodstream. Those fatty acids are turned into ketones in the liver. When ketone levels exceed 0.5mM, that’s considered to be a state of  "ketosis".

Nutritional ketosis is defined as blood ketone levels ranging from 0.5 - 3.0mM by pioneering ketone scientists Jeff Volek and Stephen Phinney in "The Art and Science of Low-Carbohydrate Living".

There are three methods to measure ketone levels; with this data, you’ll have the power to optimize your biohacking protocol.


1. Blood Testing

Blood Ketone Meter

Pros
  • Most accurate way to measure ketosis in mmol/L (mM)
  • Measures BHB, the predominant ketone in the body, rather than acetoacetate or acetone
Cons
  • You need a handheld device (i.e., Precision Xtra or Keto Mojo) and test strips, which can be expensive relative to other techniques
  • You have to take a finger prick blood sample which can be bothersome and invasive at first until you get used to it

When testing blood using a BHB/glucose meter, you’re getting the most accurate measurement available. The meters measure glucose or ketone levels depending on which test strips are inserted.

Those with diabetes commonly use the same procedure and the same blood meters to measure their blood glucose levels. It's critical for people with diabetes to control blood sugar levels and also to avoid dangerously high levels ( > 20mM) of ketones, known as ketoacidosis.

Using a blood ketone meter device is simple. You’ll need the device itself, compatible test strip, a lancet device (to pick the finger), lancets (needs to prick the finger) and an alcohol swab for sanitation.

To take a reading, follow these steps:
  • Remove the cap from the lancing device and insert the lancet into the device
  • Rotate the tip of the cap of the lancing device and set it to the desired depth of puncture
  • Arm the lancing device by sliding the control button until you hear a click
  • Insert a strip into the reader
  • Swab the tip of your left index finger with a sterile wipe
  • Place the lancing device firmly on your left index fingertip
  • Press the button on the lancing device to puncture your fingertip
  • Gently squeeze your fingertip to extract a large drop of blood
  • Hold the reader and touch the bottom of the strip to the blood sample
  • Hold the reader in place and allow the strip to absorb the blood sample

Wait a few seconds for the reader to analyze the sample

All things considered, using a blood meter might seem like the obvious choice to measure ketone levels. But the finger prick and cost may lead you to explore other avenues for testing. Here are a couple more options.


2. Urine Testing

urine testing
Urine Ketone Testing

Pros
  • Relatively inexpensive
  • Widely available in pharmacies
  • Non-invasive

Cons
  • Less accurate than blood
  • Over time the body adapts to excrete fewer ketones in the urine

Urine testing was designed to measure acetoacetate – one of three ketone bodies. But it doesn’t account for BHB, so urine testing may not be the most accurate measure of ketosis.

Since urine is a waste product, what’s displayed on the ketone urine strips is what the body is excreting.

By nature, that may not be the best indication of how well the body is utilizing ketones as fuel. As you become more keto-adapted, you’ll excrete fewer ketone bodies through urine.  

Hydration status can also affect these ketone readings, and leads to inconsistent results as relative hydration level can dilute the concentration of ketones in urine.

It comes down to this: urine ketone stirps are a cheap and easy way to get an understanding of early ketone levels, but for long-term use, they’re not the most accurate option.


3. Breath Testing

Breath Ketone Meter

Pros
  • After purchasing the device, it’s free each time you test

Cons
  • You need a handheld device (e.g. Ketonix)
  • Less accurate than blood meter
Breath ketone meters are relatively new to the market for testing ketone levels. They specifically measure the amount of acetone excreted in breath, providing readings that relate well to blood ketone levels at low concentrations.

But the research is limited. There haven’t been enough studies done to confirm the accuracy of breath acetone meters at higher levels, such as the level achieved after drinking HVMN Ketone. Acetone is the simplest and smallest of the three ketone bodies.


Choosing the Right Ketone Meter for You

In general, we recommend testing ketone levels if you’re trying to achieve nutritional ketosis or using exogenous ketones like HVMN Ketone. Blood ketone levels after using HVMN Ketone can reach 6mM making it one of the most advanced ketone products on the market.

Fat burning mode via the ketogenic diet is tough to maintain, so it’s helpful to monitor ketone levels to make sure your efforts are worthwhile.

While ketone readings don’t paint the whole picture of ketosis, they’re a large piece of the puzzle. You’ll have more transparency into what’s happening inside the body, developing an understanding of how fast and the level of ketosis you’re able to achieve.

Over time, some people develop intuition around what diet or routines lead to a given ketone level, but it’s helpful to establish a periodic basis for using an accurate ketone measurement device to get reliable objective data.

Originally published on HVMN by Justin Liau, Michael Brandt and Nate Martins

How Long Should Cooked Food be Refrigerated?

Food spoils occurs fastest when food is cooked. This is because the nutrients are exposed to more of the spoilage bacteria in this state.

The rate of food spoilage is however not the same in all foods and is instead affected by different factors such as the type of food, environment, mode of cooking and preparation and duration since preparation.

To minimize the rate of spoilage, we often rely on various storage methods depending on the duration we intend to preserve the food.

For food that we don't intend to preserve for long (a couple of hours or so), we can prevent food spoilage in the short-term by:
  • covering the food properly after cooking to prevent it from contamination
  • using clean utensils for storing and serving the food
  • storing utensils to be used in clean dry places

While not a storage method, cooking food amounts that will be finished at a specified meal time goes a long way in preventing spoilage and the wastage that comes with it.

On the other hand, we often have to rely on the refrigerator for food that has to be stored for a couple of days or weeks.

However, we often forget that food in the fridge is not entirely safe from spoilage and thus we end up storing it for longer than it should.



Duration that Food is Supposed to Stay in the Fridge

fridge

The refrigerator provides a low temperature environment below the room temperature. This however does not kill the food spoilage bacteria but merely slows the rate at which they grow.

The colder it is the better at curbing this growth explaining why the freezer preserves the food for longer than the lower compartment. This lengthened duration may however come at the price of  affecting the quality of the food.

Food is likely to go bad if its stored in the fridge for more than four days. Some shorten this down to two days in the case of leftover foods.

The problem however is that many of us are not able to tell whether the food has spoiled. The assumption is that, if it looks good and doesn't smell, then it’s safe to be consumed.

This explains why sometimes we observe the leftover food is spoiled only after warming or putting the food in a room temperature for a short while.

Therefore, consider disposing leftovers if they have been refrigerated for longer than four days. Fresh foods that haven't been cooked can stay for longer.

Disposing seems like too drastic a measure, however it’s necessary if one is to avoid the potential food poisoning or food intoxication.

The difference between these two is that, food poisoning occurs when we eat food with the bacteria while intoxications occurs when the food has toxins released by the bacteria.

Their effects however vary across individuals and will ultimately depend on factors such as one's immunity, age and the bacterial load (extent of contaminated food consumed).

With that said, the duration of storage is just one of many factors that contribute to food spoilage in the fridge. Other things to consider are:
  • keep your fridge hygienic by cleaning it regularly
  • store food in clean containers that are well covered
  • don't re-refrigerate/refreeze reheated food (i.e. reheat foods only once)

Keto Diet Fundamentals

You’ve probably heard of the keto diet, a low-carbohydrate, high-fat diet people are adopting for reasons like performance and weight loss.

The goal of the keto diet is to get the body producing ketones– a fundamentally different energy source than the carbohydrates and fats your cells typically use for energy. It can take several days of ketogenic eating before the body starts to produce ketones. And the time it takes to get into ketosis varies between individuals.

“Keto” comes from the word “ketogenic.” This is a nuanced term meaning that the body is producing ketones from fat.1 When blood ketone levels exceed 0.5mM, the body has achieved "ketosis."

So ketosis can be achieved either through diet or fasting (meaning the body is producing its own ketones to be ketogenic), or also by consuming products that raise blood ketone levels (like HVMN Ketone or ketone salts or MCT oils).

Limiting carb intake and protein intake encourages the body to burn fat and thus produce ketones. Importantly, restricting proteins as well as carbohydrates limits the amount of substrate available for gluconeogenesis. This is the process of making glucose from non-glucose molecules such as lactate, glycerol, or protein.

Because the ketogenic diet is low-carbohydrate, it often gets confused with other low-carb diets out there. Just because a diet is low carb doesn’t mean it’s keto. It’s the subtle differences in the macronutrients provided in the diet that determine if a diet is ‘ketogenic.’

A macronutrient is something humans consume in large quantities to provide the bulk of energy to the body. The primary macronutrients are carbohydrates, fats, and proteins. For a diet to be ketogenic, it must be high in fat, low-moderate in protein, and very low in carbohydrates.


Low Carbohydrate Diets

low carb diets
Low Carb Diets

Here are some helpful definitions of diets with an element of reduced carbohydrate intake:

Ketogenic Diet
  • The aim is to trigger the production of ketones in the body
  • High fat, low/moderate protein, and low carbohydrate

Low-Calorie Ketogenic Diet
  • The aim is to severely restrict calories to a level below the basic metabolic needs (i.e., <800 kCal)
  • Even if this diet is relatively high in carbohydrates, the calorie deficit created can still lead to a state of ketosis
  • Not sustainable in the long-term

Low-Carbohydrate Diet
  • Defined in medical literature as a diet with < 30% energy from carbohydrates 2
  • May not lead to ketosis as the carbohydrate and protein intake could be too high

Atkins Diet
  • This diet has several phases
  • Initially, the aim is to restrict the carbohydrate intake to less than 20g per day. This degree of restriction is likely to lead to ketosis, although this is not an explicit aim
  • Subsequently, the diet reintroduces carbohydrates to a level “the body can tolerate” 3
  • Less restriction on protein compared to a ‘true ketogenic diet – high fat, moderate protein, low carbohydrate

Paleo Diet
  • The aim is to limit the diet to foods that would have been available to Paleolithic man 4
  • Wide variability in interpretations
  • Foods allowed include vegetables, fruits, nuts, roots, and meat
  • Foods excluded include dairy, grains, sugar, legumes, processed oils, alcohol, and coffee
  • No structured macronutrient target; however, following a Paleo diet results in higher protein and fat consumption than an average diet

Now you have a grasp of what makes the ketogenic diet unique but where did it all start?


The History of the Ketogenic Diet

Fasting and Early Pioneers of the Ketogenic Diet

The concept of fasting (taking in zero calories) predates the ketogenic diet as we now understand it. Many of the benefits of fasting are likely due to the presence of ketones in the body.

Since the earliest days of man, fasting has been used as a tool to physically and spiritually cleansing.

The Bible describes fasting as a treatment for convulsions. The ancient Greek philosopher Hippocrates said, “To eat when you are sick is to fuel your sickness.”

Early advocates of fasting were obviously unaware of ketosis as a crucial factor in the anticonvulsant effect of fasting. In the early 1900s, physicians at the Mayo Clinic observed a link between a low-carb diet and fasting.

They discovered that severely restricting dietary carbohydrates and increasing fat intake could decrease seizures in the same way as fasting.5 It was not until the mid-1900s, when scientists could measure ketones, that we understood fasting led to the presence of ketones in the body.

Epilepsy was not the only disease historically treated with a low-carbohydrate, high-fat diet. Low-carbohydrate diets were also advocated for patients with diabetes and obesity. Before the discovery of insulin in 1921, diabetes was managed through carbohydrate restriction.

William Banting, an obese British mortician, popularized the weight loss benefits of a diet “stripped of starchy foods” in a pamphlet called “Letter on Corpulence, Addressed to the Public.”


The Dark Ages for the Ketogenic Diet

To many, a low-carbohydrate and high-fat diet is a counter-intuitive approach to support health. There is a widespread fear dietary fat is linked to obesity, high blood pressure, high cholesterol levels and other associated health complications.

In 1953 Ancel Keys, an American biochemist published an epidemiological study that introduced the “diet-heart” hypothesis. The study claimed dietary fat was a key risk factor in developing heart disease.

The “diet-heart” hypothesis proposed blood LDL and cholesterol derived from dietary fat accelerates the development of atherosclerotic plaques.6

His work came at the time that US President Dwight Eisenhower, suffered a heart attack.
Following the advice of his physician, Eisenhower publicly cut back his fat intake. Nutrition was in the spotlight and Keys was able to further his hypothesis.

This led to radical changes in global food policy and public practice.

In 1977, the USDA Dietary Goals for Americans recommended a decrease in dietary fat intake, and a diet based on grains and cereals.7

At the time, there was still no clinical evidence supporting Keys’ “diet-heart” hypothesis. Subsequent large trials, including the Framingham Study and Women’s Health Initiative Randomized Controlled Dietary Modification Trial, failed to illustrate decreasing dietary fat lowered the risk of heart disease.8,9

Obesity rose following the adoption of the USDA guidelines. Some investigators hypothesized that increased dietary carbohydrates were responsible for the developing health crisis.

John Yudkin, a British physiologist and nutritionist, described this phenomenon in his book “Pure, White and Deadly”10 – the widespread fear of dietary fats caused scientists and nutritionists to overlook the role of sugar and starch.


Resurgence of ‘Low-Carbohydrate’ Diets

‘Low-fat’ dieting was widespread in the late 1900s. During this time, Dr. Robert Atkins became an infamous spokesperson for the keto diet.

Dr. Atkins brought his version of the ketogenic diet to the masses in his 1972 book "Dr. Atkins' Diet Revolution." In his 40 years of practice, he treated an estimated 60,000 patients for obesity and related conditions.

At that time, there were no clinical studies to validate the benefits of the diet. Many patients reported side effects while starting the diet, including fatigue, weakness, dizziness, headache, and nausea. This uncomfortable induction phase was labeled the ‘Atkins Flu.’

After Atkins’ death in 2003, others started to promote the ketogenic diet for health. The Atkins Foundation recently funded a group of scientists to study the effects of the Atkins diet formally. This group of scientists includes Jeff Volek, Stephen Phinney, and Dr. Eric Westman.

These scientists discovered that the Atkins diet outperformed a diet based on the 1977 USDA guidelines with respect to measured coronary risk factors, including decreased low-density lipoprotein-cholesterol and total blood saturated FFA alongside increased high-density lipoprotein cholesterol.11

This outcome may be due to the decrease in carbohydrate and concomitant changes in the hormonal milieu, or due to effects of ketone bodies on substrate metabolism.

The pendulum of public perception begun to swing in favor of diets higher in fat, thanks to the emergence of influential writers and speakers such as Gary Taubes, Robert Lustig, and Nina Teicholtz, and clinicians and scientists such as Professor Tim Noakes, Dr. Jason Fung, and Professor Thomas Seyfried. The work of these individuals exposed flaws in the ‘diet-heart hypothesis.’

These influencers helped expose corruption in the political decisions that resulted in the last decades of vilification of dietary fat. Evidence illustrating the role of high dietary carbohydrate intake in the development of obesity and diabetes has started to grow.

Much of the recent research suggests that low-fat diets may be harmful to health. This culminated with a recent meta-analysis of data from 18 countries, which linked increases in carbohydrate intake with increases in mortality.12

The fear of fat has continued to reverse. Over the last few years, the ketogenic diet has grown in popularity. Popular culture is starting to recognize and adopt the keto diet, and online searches have grown.

More and more doctors now encourage and prescribe the ketogenic diet to treat metabolic disorders and obesity. Large online communities bring thousands of people together to discuss research, share keto diet before and after photos, and encourage each other.


Keto Diet for Weight Loss

The ketogenic diet can be used to help with weight loss and also to treat some diseases. Recently, the number of positive keto diet reviews has increased. The rising popularity of the diet has led to a demand for further randomized control trials to study its long-term efficacy.

A key reason why the ketogenic diet helps weight loss is that it decreases hunger. This makes it easier to maintain a calorie deficit. It is important to stress that the overconsumption of calories will prevent weight loss, regardless of the macronutrient composition.


Macronutrient Composition of a Keto Diet

Macronutrients are food groups that humans consume in large quantities. They provide the bulk of the energy to the body. The primary macronutrients are carbohydrates, fats, and proteins.

The macronutrient composition of a diet can be described using the mass of each macronutrient, the ratio of macronutrients in the diet, or the percentage of each macronutrient in the diet. The variety of descriptions can make things a little confusing!

For example:
  • A ketogenic diet contains about 5% of energy as carbohydrates.
  • A ketogenic diet has a ratio of 2-4g of fat to every 1g of carbohydrates plus proteins.
  • A classical ketogenic diet contains 20-30g of carbohydrate per day

When starting off on the ketogenic diet, these are good target macronutrient ratios:
Macronutrient Ratios
Example of a Keto Diet Macronutrient Ratios

Examples of food rich in:
  • Carbohydrates: bread, pasta, potatoes, cereals, sugary food (sweets).
  • Fat: oils (olive oil, coconut oil), butter, fatty cuts of meat, brazil nuts, macadamia nuts, avocado.
  • Protein: beef, chicken, pork, fish, milk, cheese, yogurt, eggs.


Carbohydrates

carbs role
Role of Carbs in Keto Diet

The main function of dietary carbohydrates (‘carbs’) is to be a source of energy. Some say that dietary carbohydrates are not ‘essential’ as they can be made from dietary protein and fat.13

Carbohydrates are biological molecules that contain carbon, hydrogen, and oxygen, usually with a 2:1 ratio of hydrogen:oxygen. Carbohydrates occur as a collection of single units (monosaccharides, e.g. glucose), two molecules joined (disaccharides, e.g. sucrose), and chains of molecules (oligosaccharides and polysaccharides).

When following a ketogenic diet, the carbohydrate intake should be very low. This contrasts with the modern western diet, where most dietary calories come from carbohydrates.

Consuming carbohydrates causes insulin release which inhibits ketone production in the liver and thus ketosis. Therefore, monitoring and modulating your carbohydrate intake is an important part of following the ketogenic diet.

Dietary carbohydrates replenish the stores in muscle and liver (glycogen). It also maintains blood glucose concentrations to provide fuel for the whole body, but most importantly for the brain.

Blood glucose is easy to measure using a handheld blood glucose monitor. Normal blood glucose levels fluctuate throughout the day and vary between individuals. Therefore, it is useful to track over the long term and in response to different ‘challenges,’ such as a meal or exercise.

Ranges of Blood Glucose levels for clinical diagnosis are as follows:14
  • Fasting: healthy = 4-6 mM / 70-110 mgDl
  • Fasting: diabetic = ~ 7 mM / 125 mgDl
  • 90 minutes post-meal: healthy = < 8 mM / 140 mgDl
  • 90 minutes post-meal: diabetics = > 11 mM/ 200 mgDl

When you’re following the ketogenic diet, key concepts are the total amount of carbohydrates, the ‘net’ amount of carbohydrates (accounting for the accompanying fiber), and the speed with which carbohydrates raise blood glucose (glycemic index).

With a standard ketogenic diet, it’s recommended to keep the total amount of carbohydrates limited to less than 5% of energy intake.15 See the table above for a calculation of the advised carbohydrate intake grams for a 2000 kCal per day 4:1 ketogenic diet.


Dietary Fiber

Dietary fiber is carbohydrate-based material from plants that is not entirely broken down by the small intestine. Instead, it passes to the large intestine, and either undergoes fermentation (which supports the growth of beneficial bacteria) 16 or excretion.

Fiber is a significant part of a well-formulated ketogenic diet. It helps to maintain gut health, and also increases food bulk and helps with the feeling of ‘fullness.’ Green and cruciferous vegetables are rich in fiber and are helpful to include in a ketogenic diet.

Depending on how ‘complex’ the source of fiber is, it has different assumed caloric values. One approach is to treat fiber as having the same amount of calories per gram as carbohydrates: 4 kCal/gram.

However, as a proportion of fiber is not digested, other approaches use a lower value of 2 kCal/g. Digestion-resistant fiber does not contribute to calorie intake, as it is not broken down.

Net carbs refer to the mass of total carbohydrates, minus the total fiber, which could be a better metric to judge carbohydrate intake because:
  • Fiber is mostly digestion-resistant and so should not increase blood glucose.16
  • Studies have shown an increase in fiber does not affect blood ketone levels.17


Glycemic Index

The ‘glycemic index’ is a scale that ranges between 1 and 100, and it indicates how quickly food raises blood glucose after consumption. Pure glucose is the reference and is set at 100 (i.e. raises blood glucose quickly).

Other foods have a comparatively lower value as they raise blood glucose more slowly. Example values for the glycemic index of food are white potato: ~80, white bread: ~75, apple: ~35, peanuts: ~15.

Glycemic load’ accounts for both the speed of carbohydrate release and the TOTAL amount of carbohydrates in food.
Glycemic load = (total carbohydrates (g) x glycemic index) / 1000.

A food can have a relatively high glycemic index (eg. carrot = 47) but because the total carbohydrate amount is low (carrot = 5g per serving), the glycemic load of one serving is very low.


Proteins

Proteins are large molecules composed of chains of amino acids. The functions of dietary protein are:
  • Building structural and functional components of cells
  • Conversion to glucose via gluconeogenesis
  • Top up intermediates in other metabolic pathways, such as the Krebs Cycle
Role of Protein in Keto Diet

While it is possible for a protein to be used as a fuel, this isn’t its primary function.

When following a ketogenic diet, there must be a balance of sufficient protein to maintain muscle mass. If dietary protein exceeds 20-25% of calories, gluconeogenesis from protein can stop the ketone production.

Initially, target a protein intake of 0.8-1.2g per kilogram of body weight. This target balances the need for protein against the chance of excess gluconeogenesis.18

Some individuals (such as strength or endurance athletes) may have higher protein requirements. They might require a modified ketogenic macronutrient ratio of 2:1 fat:non-fat (where 65% of energy is fat, 30% is protein, and 5% carbohydrate) and can still be effective for therapeutic ketosis.


Fats

fat role
Role of Fat in Keto Deit

Fat gets a bad rap. In nutrition, fat is the dietary macronutrient made up of triglyceride molecules. The main functions of fats in the diet are to provide increased energy levels and makeup key functional and structural parts of the human system.

But we often misuse the word “fat.” There’s a difference between fat in cells and different types of fat molecules.
  • Adipose tissue: the tissue that stores energy as fats/lipid droplets inside adipocytes (fat cells). This is body fat.
  • Adipocytes: individual cells that store fats/lipids.
  • Lipids: the most general term for insoluble and polar biological fat molecules. The lipid class of molecules includes mono-, di- and triglycerols, cholesterols, and phospholipids.
  • Triglycerides: a lipid molecule made up of glycerol (that acts as a backbone) joined to three fatty acid molecules
  • Fatty acids: a molecule composed of a chain of carbon atoms bonded to one another with a carboxylic acid at one end.

To be specific, our diet includes many sources of lipids.

Lipids are digested and travel in the blood as triglycerides and fatty acids before being used as a fuel, or stored by adipocytes in adipose tissue.

Dietary lipids undergo many tightly regulated metabolic steps before storage in adipose tissue. Dietary fat does not equal stored body fat.

Triglycerides are the most important source of energy in a ketogenic diet. They account for >70% of dietary calories. For those following a ketogenic diet, it’s helpful to understand how the lipid source in the diet is processed in the body.


Types of Fats in Foods

Fatty acids can be saturated (no double bonds between carbons), or unsaturated (one or more double bonds between carbons).

Saturated fats are relatively stable and tend to be solid at room temperature (i.e. lard, butter, coconut oil). Historical guidelines recommended limited the intake of dietary saturated fats because fat consumption was thought to be associated with heart disease and high blood pressure.

However, emerging research has shown saturated fat can have beneficial effects on blood biomarkers (i.e. increase ‘healthy’ HDL levels).12

Unsaturated fatty acids can be further divided into monounsaturated fats (only one double bond between carbons) and polyunsaturated fats (multiple double bonds between carbons). The number of double bonds is important as it determines how the fatty acid behaves both inside and outside of the body.

They tend to be liquid at room temperature (i.e. vegetable-based fats such as olive oil). Unsaturated fats are thought of as healthier than saturated fats (also known as “healthy fats”).

Increased consumption of mono and polyunsaturated fats have been linked to improved blood biomarkers (i.e. lower blood triglycerides).19 Eating enough unsaturated fats is important when following a ketogenic diet.

Increased fat consumption is not associated with cardiovascular disease.20

Eating a moderate amount of saturated fat is unlikely to be as harmful as previously believed, and saturated fat consumption as part of a ketogenic diet is unlikely to increase the risk of cardiovascular disease.

Trans-fats are produced artificially when hydrogen is added to unsaturated fatty acids in order to solidify it and make it last longer. Because of associations with poor health outcomes, these artificial fats had their generally regarded as safe (GRAS) status removed in 2015 by the FDA. 21

Avoid high levels of trans-fat consumption by eating a diet based around whole foods.

Essential fatty acids are important to include in the diet because the body cannot naturally produce them. This group includes polyunsaturated omega 3, omega 6, and omega 9 fatty acids.

It’s believed the anti-inflammatory effects of essential fatty acids may have broad benefits for health and performance. Oily fish, such as sardines and mackerel, and seeds (i.e. flax) are good dietary sources of essential fatty acids.


Fat Metabolism

The number of carbons in the fatty acid chain also has an important effect on its metabolism. The carbon chain of fatty acids can be up to 28 carbons atoms long. If there are >13 carbons in the fatty acid, it is called a long-chain fatty acid, between 8-12 is a medium-chain fatty acid, and under 5 carbons is a short-chain fatty acid.

The body metabolizes fats differently according to chain length. Long-chain fatty acids are absorbed and go from the gut into the lymphatic drainage system and from there are released directly into the blood.

By comparison, medium and short-chain fatty acids do not go into the lymphatic system. They travel in the blood from the gut directly to the liver.22

If a large amount of these short and medium-chain fats are delivered to the liver at once, this can trigger the liver to convert them into ketones, even without dietary carbohydrate restriction.

Medium-chain fatty acids are highly ketogenic. They can be found in natural sources such as coconut oil or in an artificially purified form. However, for many people, consuming a high amount of medium-chain fatty acids can cause an upset stomach. This limits their use to raise ketones artificially.

When integrating these concepts into a ketogenic diet: target the majority of dietary calories as fat.
Aim to include a variety of fats from different animal and plant sources (i.e. red meat, poultry, fish, dairy, olive oil, coconut oil, nuts, and avocados).

Conversely, micronutrients must be obtained in the diet in small quantities, but are essential to health. Vitamins and minerals are examples of micronutrients.


Micronutrients in a Ketogenic Diet

micronutrients
Key Mirconutrients in Keto Diet

When following a ketogenic diet, it is important to be mindful of micronutrient intake because:
  • Reducing carbohydrate intake can lower consumption of micronutrient-rich foods (i.e. fruits and vegetables)
  • In the initial 28 days of following a ketogenic diet, the balance of some micronutrients (such as sodium, potassium, magnesium, and calcium) can become disturbed due to an increase in their excretion.23 The body resolves this issue naturally after adapting to the diet
Sodium is the principal cation in extracellular fluid. Its functions are related to blood volume maintenance, water balance, and cell membrane potential. Sodium is also essential for acid-base balance and nerve conduction.

The level of sodium can fall at the start of a ketogenic diet. Adding extra sodium to meals (like adding salt or consuming bouillon/ bone broth) can reduce the chances of feeling the common side effects associated with low sodium (like cramps).

Potassium is the principal cation in the intracellular fluid. Its primary functions are related to maintaining cell membrane potential and electrical activity in cells such as neurons and cardiomyocytes.

As with sodium, levels of potassium fall at the initiation of a ketogenic diet due to increased excretion. When starting a ketogenic diet, include sources of potassium like nuts, dark green vegetables, and avocados.

Magnesium is an essential element in biological systems, especially for nerve, muscle, and immune function. Levels of magnesium also fall at the initiation of a ketogenic diet due to increased excretion. When starting a ketogenic diet, include sources of magnesium like oily fish, dark green vegetables, and seeds.

Calcium has a role in muscle contraction and is important for cardiovascular and bone health. Calcium deficiency is less common during a ketogenic diet, as staples of the diet such as fish, cheese, and leafy greens are rich sources of the mineral.

Now that an understanding of the biology of the ketogenic diet has been reached, we’ve arrived at the fun part: how to start the keto diet.


How to Start a Ketogenic Diet

start keto diet
Starting a Keto Diet

Don’t try to start the diet gradually. If carbohydrate intake is moderately-low, blood sugar levels may not be enough to fuel the brain, and the presence of carbohydrate in the diet might still be enough to stop the body from making ketones.

The main objectives when starting the ketogenic diet are to:
  • Restrict carbohydrates to 20 digestible grams per day or less – a strict low-carb diet
  • Consume plenty of fiber
  • Restrict protein to moderate levels. If possible, stay at or below 0.45 grams of protein per day, per lb of body weight (1g/kg). So about 70 grams of protein per day if you weigh ~155 lbs (~70kg). If your goal is to lose weight, aim for 1 gram of protein per kg of your target weight
  • Consume fat until you are satiated


Tips for Starting the Ketogenic Diet

  • Make a keto diet menu. It’s a good idea to keto meal plan before starting the diet. Make a shopping trip to stock up on a range of foods that are low in carbohydrates and high in fat
  • Use an app to track macronutrient intake. Apps such as MyFitnessPal are great to get an idea of the macronutrients in common foods. There is also a range of special online keto diet calculators.
  • Search for a few keto recipes to adapt cooking methods. Due to the high-fat consumption required to get into ketosis, it may be beneficial to change daily staples or cooking methods. Keep an eye out for coconut oil, heavy cream, and lots of cheese.
  • Make an approved list of keto foods and eliminate carbohydrate-rich foods. It will be easier to follow the diet by throwing out any foods to avoid. It’s recommended to check the labels for hidden added sugars.
  • Consider starting the ketogenic diet within a short period (16-36 hours) of fasting (consuming zero calories). Fasting depletes carbohydrate stores and can accelerate ketone production. Click here to read more about fasting protocols.
  • Gentle cardio exercise (~30 minutes) or some short high-intensity intervals (10-second sprints) can deplete carbohydrate stores and speed up ketone production.


Cyclical Ketogenic Dieting and ‘Cheating’

At the moment, there is not a clear answer as to whether the benefits of the ketogenic diet can be achieved by cycling on and off the diet. It’s best to stick to the diet for 1-2 months minimum to see benefits. It can take several days to get into ketosis1 and 3-6 weeks to become “fat adapted.”18

Some research indicates ~40 days on the ketogenic diet interspersed with periods of healthy eating with more carbohydrates (Mediterranean diet) could maintain weight loss.24

“Cheating,” and consuming high-carbohydrate food, quickly stops ketone production by the liver. It can then take a considerable amount of time for the body to get back into ketosis.

Time taken to get back into ketosis will depend on many factors. These include the amount of carbohydrates consumed, how adapted the body is to produce ketones, activity level, etc.

However, cyclical ketogenic diets are a promising area of scientific investigation. Recently, scientists studied the effect of long-term cycling of the ketogenic diet (one week on, one week off the diet) compared to a normal diet in mice. Cyclical keto dieting reduced mid-life mortality and increased healthspan.25


Optimal Range of Ketosis

As with all processes in metabolism, the state of ketosis is a spectrum. Past a threshold (which varies from person to person), even a small increase in dietary carbohydrate intake can trigger enough insulin release to take the body out of ketosis.

Guidelines for target levels for blood ketones are:
  • No ketosis: under 0.5 mM BHB in blood
  • Low ketosis: 0.5 - 1.5 mM BHB in blood
  • Moderate ketosis: 1.5 - 3 mM BHB in blood
  • High ketosis: over 3 mM BHB in blood
  • Pathological ketosis: over 15 mM BHB in blood

ketone levels
Blood Ketone Levels

The level of ketosis required for different physiological benefits is unknown. For endurance sports, a higher level of ketosis (~4 mM) appears to be superior to lower levels.26,27

This is possible because ketones fuel athletes.

However, some other benefits of ketosis, such as reduced appetite may be seen at much lower levels (0.5 mM).28

The best way to know if you are in ketosis is to measure the levels of ketones (BHB) in your blood. You can also estimate blood levels by measuring ketones in your breath or urine.


Physiological Ketosis

The typical methods used to generate physiological levels of ketosis are fasting, the ketogenic diet, and consuming exogenous ketones like HVMN Ketone.

After an overnight fast, a low amount of ketones (0.1-0.2 mM) can often be detected in the blood. As the time spent fasting increases, blood ketone levels slowly rise until a plateau at 8-10 mM of BHB has been reached after many days. Scientist Hans Krebs described this plateau as "physiological ketosis."29

Fasting long-term is unsustainable, so following a strict ketogenic diet can be used to maintain a low level of continuous ketosis. Research suggests blood BHB levels between 0.4-1mM can be achieved while following a ketogenic diet.18 Anecdotal evidence suggests it’s sometimes possible to reach higher levels.

Using exogenous ketones can raise blood ketones to a physiological level without the ketogenic diet or fasting. The level of ketosis reached depends on the exogenous ketone supplement used.

Reported levels range from 0.6 mM with a ketone salt or a medium-chain triglyceride supplement (26, 30) and up to 6 mM with HVMN Ketone.27


Pathological Ketosis

Sometimes, the body starts producing ketones as a result of a disease (pathology). This can lead to dangerous levels of ketones in the body, though these high levels are very uncommon in healthy people following the ketogenic diet.

Alcoholic ketoacidosis (AKA) is a result of chronic alcohol consumption usually accompanied by malnutrition.

AKA is characterized by increased ketone production (levels > 15 mM) via liver alcohol metabolism, in conjunction with a mild elevation in blood glucose levels. Symptoms include nausea and vomiting, fatigue, altered breathing, and abdominal pain.31

Diabetic ketoacidosis (DKA) occurs most frequently in patients with type 1 diabetes.

DKA is the simultaneous occurrence of high blood ketones (> 20 mM), high blood glucose, and acidification of the blood.31 It develops when insulin is absent, or insulin signaling is no longer functional.

This means the physiological state of starvation is triggered, even in the presence of high blood glucose. As during starvation, lipolysis (fat release) increases. This causes the liver to produce a high amount of ketones and blood pH to fall (as ketones are an organic acid).

As glucose levels are very high, the excess is excreted in the urine. This draws water and electrolytes out of the body, causing dangerous dehydration.

Symptoms of DKA include nausea, vomiting, altered breathing, abdominal pain, and unconsciousness. The rapid onset and alarming nature of DKA is a reason why ketosis has a bad stigma in the medical community.


Who Should Avoid a Ketogenic Diet?

Following a ketogenic diet may not be suggested for people with the following medical considerations:
  • Pregnancy
  • Kidney failure
  • Impaired liver function
  • Impaired fat digestion (gallbladder disease, gastric bypass, pancreatitis)
  • Genetic defects in metabolism (CPTI/II deficiency, beta-oxidation defects, fatty acyl dehydrogenase deficiency)


Potential Side Effects of the Ketogenic Diet

When starting a ketogenic diet there can be a period of 2-3 days where blood glucose levels are low, but ketone production has not reached a sufficient rate to provide enough fuel for the brain.

This can result in a series of symptoms, known as the keto flu, which include:
  • Headache
  • Muscle cramps
  • Fatigue
  • Nausea
  • Dizziness

Exogenous ketone supplements, such as HVMN Ketone, and medium-chain triglycerides can be used to reduce symptoms of keto flu. They provide the brain with a source of energy without carbohydrate consumption.

These supplements increase the levels of ketones in the blood artificially. Exogenous ketones do not increase the body’s ketone production (called endogenous ketones) and can inhibit the release of fatty acids from adipocytes. 32

It can be initially tricky to adjust food intake to ensure adequate nutrition when following a ketogenic diet. Also, some people find the diet isn’t sustainable due to individual differences in metabolic state or lifestyle.

If the diet does not provide the correct balance of macro and micronutrients, some individuals develop other symptoms beyond the keto flu after the adaptation period. These include:
  • Constipation
  • Bad breath
  • Difficulty in maintaining physical performance
  • Hair loss
  • Gallstones
  • Elevated blood triglycerides or cholesterol

To treat these symptoms, ensure the diet provides enough calories and micronutrients. Many people reduce fruit and vegetable consumption on a ketogenic diet (due to carbohydrate content). This means it is easy to become deficient in vitamins and to under-consume fiber.

The ketogenic diet can alter the way that the kidneys excrete electrolytes (such as sodium), so electrolyte supplementation can reduce the side effects of an electrolyte imbalance.


Possible Clinical Applications of the Ketogenic Diet and Ketosis

Some of the earliest reports of the ketogenic diet describe its use in a clinical setting.

In the early 20th century, ketogenic diets helped treat drug-resistant epilepsy. Doctors also prescribed ketogenic diets to treat type 1 diabetes before the invention of insulin.

As analytical techniques progressed, scientists learned that ketones themselves might be a crucial part of the success of the ketogenic diet to treat disease. From this finding stemmed a field of research to examine the potential benefits of ketosis in a range of disease states:
  • Weight loss
  • Diabetes and metabolic syndrome
  • Neurological disease: epilepsy, Alzheimer’s disease, Parkinson’s disease, migraine, concussive disease, and traumatic brain injury
  • Cancer
  • Inflammatory diseases

While the ketogenic diet is not yet a first-line treatment recommended by doctors for any of these diseases, it’s a relatively easy and tolerable step that patients with these conditions can take to improve their health.

Emerging research suggests there may be beneficial effects of ketosis for some people, and further studies are required to confirm how best to use the diet in these clinical settings.

Originally published on HVMN by Dr. Brianna Stubbs and Nate Martins.


SHOW/HIDE REFERENCES
1. Cahill, G.F., Jr. (2006). Fuel metabolism in starvation. Annu Rev Nutr 26, 1-22.
2. Arora, S.K., and McFarlane, S.I. (2005). The case for low carbohydrate diets in diabetes management. Nutr Metab (Lond) 2.
3. Atkins, R.C., Mandell, F.G., and Monica, H. (1972). Dr. Atkins' diet revolution: The high calorie way to stay thin forever. (D. McKay Company).
4. Loren Cordain: The Paleo Diet: Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat
5. Wheless, J.W. (2004). Chapter 2- History and Origin of the Ketogenic Diet. (Humana Press Inc).
6. Keys, A. (1953). ATHEROSCLEROSIS: A PROBLEM IN NEWER PUBLIC HEALTH*‘. Atherosclerosis 1, 19.
7. McGovern, S.G. (1977). Dietary Goals for The United States. (U.S Government Prniting Office).
8. Howard, B.V., Van Horn, L., Hsia, J., Manson, J.E., Stefanick, M.L., Wassertheil-Smoller, S., Kuller, L.H., LaCroix, A.Z., Langer, R.D., Lasser, N.L., et al. (2006). Low-fat dietary pattern and risk of cardiovascular disease: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 295, 655-666.
9. Anderson, K.M., Castelli, W.P., and Levy, D. (1987). Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA 257, 2176-2180.
10. Yudkin, J., and Lustig, R.H. (2013). Pure, White, and Deadly: How Sugar Is Killing Us and What We Can Do to Stop It. (Penguin Group USA).
11. Forsythe, C.E., Phinney, S.D., Fernandez, M.L., Quann, E.E., Wood, R.J., Bibus, D.M., Kraemer, W.J., Feinman, R.D., and Volek, J.S. (2008). Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 43, 65-77.
12. Mente, A., Dehghan, M., Rangarajan, S., McQueen, M., Dagenais, G., Wielgosz, A., Lear, S., Li, W., Chen, H., Yi, S., Wang, Y., Diaz, R., Avezum, A., Lopez-Jaramillo, P., Seron, P., Kumar, R., Gupta, R., Mohan, V., Swaminathan, S., Kutty, R., Zatonska, K., Iqbal, R., Yusuf, R., Mohammadifard, N., Khatib, R., Nasir, N.M., Ismail, N., Oguz, A., Rosengren, A., Yusufali, A., Wentzel-Viljoen, E., Puoane, T., Chifamba, J., Teo, K., Anand, S.S., and Yusuf, S. (2017). Association of dietary nutrients,with blood lipids and blood pressure in 18 countries: a cross-sectional analysis from the PURE study. The lancet. Diabetes & endocrinology 5, 774-787.
13. Westman, E.C., Yancy, W.S., Edman, J.S., Tomlin, K.F., and Perkins, C.E. (2002). Effect of six-month adherence to a very-low-carbohydrate diet program. Am J Med 113.
14. Diabetes UK Website: Blood Sugar Level Ranges
15. Kossoff, E.H., and Rho, J.M. (2009). Ketogenic Diets: Evidence for Short- and Long-term Efficacy. Neurotherapeutics 6, 406-414.
16. Slavin, J. (2013). Fiber and Prebiotics: Mechanisms and Health Benefits. Nutrients 5, 1417-1435.
17. Pfeifer, H.H., and Thiele, E.A. (2005). Low-glycemic-index treatment: a liberalized ketogenic diet for treatment of intractable epilepsy. Neurology 65, 1810-1812.
18. Volek, J.S., and Phinney, S.D. (2012). The Art and Science of Low Carbohydrate Performance. (Beyond Obesity LLC ).
19. Volek, J.S., Gomez, A.L., and Kraemer, W.J. (2000). Fasting lipoprotein and postprandial triacylglycerol responses to a low-carbohydrate diet supplemented with n-3 fatty acids. J. Am. Coll. Nutr. 19, 383-391.
20. Dehghan, M., Mente, A., Zhang, X., Swaminathan, S., Li, W., Mohan, V., Iqbal, R., Kumar, R., Wentzel-Viljoen, E., Rosengren, A., Amma, L.I., Avezum, A., Chifamba, J., Diaz, R., Khatib, R., Lear, S., Lopez-Jaramillo, P., Liu, X., Gupta, R., Mohammadifard, N., Gao, N., Oguz, A., Ramli, A.S., Seron, P., Sun, Y., Szuba, A., Tsolekile, L., Wielgosz, A., Yusuf, R., Hussein Yusufali, A., Teo, K.K., Rangarajan, S., Dagenais, G., Bangdiwala, S.I., Islam, S., Anand, S.S., and Yusuf, S. (2017).,Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet.
21. FDA Website: Final Determination Regarding Partially Hydrogenated Oils (Removing Trans Fat)
22. Bhavsar, N., and St-Onge, M.P. (2016). The diverse nature of saturated fats and the case of medium-chain triglycerides: how one recommendation may not fit all. Curr. Opin. Clin. Nutr. Metab. Care 19, 81-7.
23. Rabast, U., Vornberger, K.H., and Ehl, M. (1981). Loss of weight, sodium and water in obese persons consuming a high- or low-carbohydrate diet. Ann. Nutr. Metab. 25, 341-349.
24. 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.
25. Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice Newman, John C. et al. Cell Metabolism , Volume 26 , Issue 3 , 547 - 557.e8
26. Rodger, S., Plews, D., Laursen, P., and Driller, M. (2017). The effects of an oral β-hydroxybutyrate supplement on exercise metabolism and cycling performance.
27. Cox, P.J., Kirk, T., Ashmore, T., Willerton, K., Evans, R., Smith, A., Murray, Andrew J., Stubbs, B., West, J., McLure, Stewart W., et al. (2016). Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes. Cell Metabolism 24, 1-13.
28. 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.
29. Krebs, H.A. (1966). The regulation of the release of ketone bodies by the liver. Adv. Enzyme Regul. 4, 339-354.
30. Vandenberghe, C., St-Pierre, V., Pierotti, T., Fortier, M., Castellano, C.-A., and Cunnane, S.C. (2017). Tricaprylin Alone Increases Plasma Ketone Response More Than Coconut Oil or Other Medium-Chain Triglycerides: An Acute Crossover Study in Healthy Adults. Current Developments in Nutrition 1.
31. Laffel, L. (1999). Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab. Res. Rev. 15, 412-426.
32. (D)-beta-Hydroxybutyrate inhibits adipocyte lipolysis via the nicotinic acid receptor PUMA-G. Taggart et al J Biol Chem. 2005 Jul 22;280(29):26649-52.

Does Purple Mangosteen Really Help in Weight Loss?

Purple Mangosteen is a tropical fruit native to South East Asia that has in recent times become the basis for a new weight loss supplement.

Before it took up this extra role, the purple fruit often called the "queen of fruits" for its sweet flavour was enjoyed like any other fruit and used as a traditional medicine for treating diarrhoea, skin infections among other ailments.

The fruit is a rarity outside parts of Asia where its grown. As a result, to the rest of the world it's more popular as a supplement than a fresh fruit. Its rather pricey supplement is sold in the form of a "health drink", powder or capsule.

As far as its weight loss claims go, by far the most interesting I have come across is that it "will melt up to 10 kg of fat in 2 weeks!".

While it's highly improbable that it melts anything, we set out to investigate whether it aids in weight loss. Here's what we found out.



Health and Medicinal Properties of Purple Mangosteen

Purple Mangosteen Fruits

Currently there is little literature available that is conclusive regarding the health and medicinal benefits of Purple mangosteen. However, those that exist all agree on one thing: it's a rich source of Xanthones that have antioxidant and anti-inflammatory properties. 1

Other studies have also suggested that the Xanthones possess anti-cancer, anti-allergic, anti-microbial, and anti-malarial properties. 2

These Xanthones are however mostly concentrated in the inedible purple pericarp (peel) of the fruit. It's this part that has been used for traditional medicine explaining the fruits medicinal properties.

The edible white interior pulp of the fruit is however not as impressive nutritionally with its micro-nutrients falling below 5% of the average daily amount considered adequate to meet the needs of most healthy people. (i.e. Dietary Reference Intake (DRI)) 3

Another study concludes that Mangosteen extracts could be beneficial in the treatment of insulin resistance. 4


Mangosteen Weight Loss Properties

One study found that a herbal blend containing extracts of a flower called Sphaeranthus indicus (East Indian Globe Thistle) and Mangosteen contributed to weight loss in participants that took the blend compared to those that did not. 5

The study subjects however had to walk 30 minutes 5 days per week during the duration of the study.

A different study using a similar blend but under the brand name Meratrim came to a same conclusion. 6

However, it's worthy that both studies were funded by nutraceutical companies that produce and sell these supplements. 

Another study done on a proprietary mangosteen juice blend called Xango Juice suggests that this product may assist in weight loss however notes that further investigation is needed to confirm this. 7

This study was also sponsored by the company behind the juice i.e. XanGo LLC.



Investigating the Weight Loss Claim

The various Mangosteen supplements out there capitalize on its Xanthones content to back its weight loss inducing power.

This is in addition to claiming it reduces the risk of various lifestyle dieseases such heart attack, diabetes and hypertension though some go as far as to mention that the product could cure some cancers.

To quote the sellers of these Mangosteen supplements, apparently it achieves weight loss as it:
"Effectively degrades FAT due to fruit alpha-acid Mangosteen" and "Reduces appetite"

According to them, these alpha-acids breakdown fat once absorbed in the blood.
"...alpha-acids of Mangosteen are absorbed in the blood and harmlessly break down fat in only couple of minutes!"

These so called aplha-acids are in reference to alpha-mangostin which are the most abundant xanthones in the mangosteen pericarp along with gamma-mangostin. 2

Therefore, for the supplements to have any of the suggested health benefits of the Mangosteen fruit it’s necessary that they contain a significant amount of Xanthone extracts from the fruits pericarp.

Now here's the problem: as is stands, it's a fair assumption to make that a significant proportion of the content of Mangosteen juices and concentrates comes from the flesh of the fruit.

Additionally, the juices and concentrates are usually blended with other fruits such as blueberry, cranberry, raspberry, strawberry and grape to improve the antioxidant activity of the supplement. 3

However, antioxidants on their own have no direct influence on weight loss. The effect is only indirect as foods rich in antioxidants tend to be low in calories i.e. vegetable and fruits.

Thus, while the antioxidants in Mangosteen supplements may provide some health benefits, cutting weight is hardly one of them.

Further, in the two studies that observed weight loss in the participants, Mangosteen was not the only "active" ingredient as is the case with most Mangosteen supplements.

It’s should also be noted that the few studies that support this weight loss claim all seem to be funded by interested parties. While this doesn't take away from their evidence, it's good to note that these studies are carried out over short periods and under controlled conditions which consumers may not follow through in the real world. e.g. exercising daily

Case in point is that the supplements are marketed as "magic pills" that bring about weight loss on their own. Hardly is there any mention of there being a need to adopt appropriate lifestyle changes that can foster weight loss in the long term.

Consequently, while small decreases in weight may be witnessed in the short term (as in the studies), poor weight management outcomes are to be expected in the long term due to the unfavourable lifestyle habits that persist.

Studies carried out with larger varied sample sizes and over longer periods are thus needed to establish whether Mangosteen extracts do actually aid in weight loss.

With regards to its other supposed health benefits, a 2013 study admits of there being insufficient evidence to support these claims. 8
"... there is insufficient scientific evidence at this time to support the use of mangosteen containing supplements as enhancers of health and useful adjuvants for treatment of various pathophysiological illnesses."



Losing Weight the Expensive Way

Diet fads come and go as do diet pills. The one thing that's common amongst them all is their fantastical claims of inducing weight loss over short periods and with minimal effort.

Despite the long line of failures from these kind of products, their market keeps flourishing with new formulations that promise even better results; better, for the rise in lifestyle diseases and their link to obesity makes weight loss a fertile ground upon which more unfounded health claims can be planted to reap maximal profits.

In spite of its potential benefits, Purple Mangosteen finds itself in a similar position. It's high proportion of Xanthones in its pericarp is behind its crowning as a "super fruit" and the basis for its exaggerated health benefits and weight cutting efficacy.

This factor combined with the fact that the fruit is a novelty outside South East Asia not only makes the other regions where it's not grown susceptible to its supposed health claims but also affords its sellers steep prices for their suspect formulations.

The various brands of Mangosteen supplements average prices of $30 to $50 for 114g/150g packets and this are apparently discounted prices.

To compound matters, midst the success of these supplements, counterfeits that carry with them none of the supposed health benefits are present in the market.


Losing Weight the Healthy Way

Quick results with weight loss almost always come with a high cost, and not merely to the pockets but often at times to even one’s health.

It's therefore a far wiser decision to invest one’s money and time in adopting a healthy lifestyle than expecting one substance, in this case purple mangosteen, to magically deliver numerous health benefits in a few expensive gulps.

We however recognize that weight loss can be a frustrating experience for some and its merely out of desperation that many turn to solutions that promise quick results.

A far much healthier way to lose weight is to adopt long term solutions.

This healthy route may mean spending more time losing weight however it's safe and it's easier to retain the formed healthy habits for the rest of one’s lifetime not to mention pass it on to one’s children.

As the first step, we always advocate one adopt a healthy diet and adequate physical activity levels through regular exercise.

A healthy diet would comprise of complex carbohydrates (e.g. whole-grains), plenty of greens, lean protein primarily from pulses and white meat. You can use the healthy eating plate as a simple guide to get you started on the types of foods to incorporate and their average quantities.

For a more personalized care plan, we recommend seeing a registered nutritionist or dietitian that can formulate a diet plan for you as well as advise you on other lifestyle changes you can incorporate into your weight-loss journey.

In the long run, this is a better and far cheaper investment to buying weight-loss supplements.


SHOW/HIDE REFERENCES

What is Keto Flu and How Do You Cure it?

You've decided to try the keto diet. The low-carb, high-fat diet can be great for performance and decreasing body weight, but the body needs a little bit of time to adapt to fat as an energy source. Often, there are some symptoms involved during this period of adaptation.

It's called the "keto flu," a commonly-experienced set of side-effects associated with carbohydrate withdrawal. This may sound like withdrawal from substance abuse; interestingly, recent studies have compared the effect of carbohydrates (particularly sugar) on the brain to that of addictive drugs like cocaine.1

Reported symptoms include: mood swings, irritability, fatigue, and dizziness. It can last anywhere from a day to a couple weeks.

Shortsighted dieters may allow keto flu knock them off the diet altogether–but after a period of metabolic adaptation, the body adjusts to the change and will reach a state where it's burning fat as a fuel source, a largely-stored, but for many, a largely untapped bodily energy source.

There are several ways to reduce, prevent or manage symptoms of the keto flu. We'll discuss some of the most common symptoms, the science behind them, and offer some solutions to nascent keto dieters.


The Science Behind Keto Flu

Top 10 Keto Flu Symptoms

Carbohydrates are the body's preferred energy source. When those are restricted, the body responds through a series of changes to transition from using glucose (stored carbs) for energy to using fat.
This gear-switching is a good thing; but it's also the reason for keto flu.

First, blood sugar drops and causes hypoglycemia,, which is low blood sugar < 55 mg/dL.2 In response, the body changes both the fuel it uses for energy and how neurons in the brain function.

Second, changes occur in other bodily systems that alter electrolyte, water and hormone levels–this can lead to dehydration from following the ketogenic diet.


Falling Blood Glucose

energu synthesis
Energy Synthesis

The physical consequences of sudden carb removal, we must first understand that our body generates energy using two main mechanisms: glycolysis (converting glucose to energy) and beta-oxidation (converting fat to energy).

Complying with a low-carb ketogenic diet means forcing the body to switch from using carbs as energy (via glycolysis) to using fats as energy (via beta-oxidation).

After a period of adaptation, the body usually begins to generate energy from the breakdown of ketones (via a process call ketolysis) instead of glucose. This switch occurs because the body breaks down fatty acids into ketones so the brain can use them for fuel.3

What happens when the body hasn't yet learned to burn fat and produce ketones? That's where hypoglycemia comes it. The result is a temporary energy deficit and low blood sugar.

Remember: this is a transient period of adaptation. Switching to using fats and ketones as energy varies by person, depending on a mix of genetics and habitual diet; some individuals demonstrate a greater metabolic flexibility than others. These lucky individuals may show far fewer symptoms or experience the flu for a shorter duration.

Research has found the same pathways of the reward system in the brain are activated in both high-carb foods and cocaine or heroin. Both cause the release of dopamine (a "feel good" hormone).

Regular carb consumption modifies gene expression and dopamine receptor availability in that reward system over time. This translates to a need for even more carbohydrates to have the same effect on those brain receptors.

So the sudden removal of carbohydrates can lead to withdrawn symptoms, both physical and psychological.


Electrolyte Imbalance and Dehydration

Electrolytes are the minerals in the body that are derived from salts, e.g. calcium, potassium, magnesium, chloride, and sodium. Electrolyte levels, controlled by the kidneys, are crucial for maintaining bodily functions such as heartbeat regulation and muscle contraction.4

Why does the ketogenic diet cause these imbalances? Carbohydrate restriction, and thus insulin release. With a lower carb intake, insulin levels drop.

Insulin signals cells in the body to absorb glucose in the bloodstream, and signals the kidneys to store more water.5 Lower insulin levels (as a result of decreased carb intake) means the kidneys now store less water. This results in dehydration and the flushing out of electrolytes in the process.6

Stored carbohydrates (glycogen) trap three grams of water per gram of glycogen – so this also causes a depletion while on keto, further contributing to the reduced amount of water and electrolytes in the body.


Hormonal Stress Response

hormonal stress
Hormonal Stress

A poorly-formulated ketogenic diet (one too low in calories or deficient in micronutrients) can trigger a starvation response in the body, thus raising levels of cortisol (stress hormone).7

Cortisol release is the body's attempt to product the brain by raising blood sugar, trying to compensate for the now low blood sugar caused by carb reduction. If excess cortisol is released, stress response and blood sugar stability can become deregulated.

Thyroid hormones are also something to consider. They have several function, including the maintenance and regulation of carbohydrate/energy metabolism.

The T3 (or euthyroid) is the most biologically active form of the hormone, and is linked to dietary carb consumption.

T3 levels have shown to decrease in response to carb restriction below a certain threshold (which varies from person to person).8 The result may be fatigue or difficulty focusing through the adaptation period.

Conversely, lowered T3 is also hypothesized to bring several benefits if thyroid function is normal. This includes improving longevity and preserving muscle mass. While discomfort may result during the transition, you can rest assured that lowered T3 does not appear to be indicative of hypothyroidism.9


Solutions to Common Symptoms

Solutions to Keto Flu
Solutions to Keto Flu Symptoms

Symptoms of the keto flu vary from person to person. But there are easy solutions one can leverage to help combat these symptoms.

If you're looking for a supplement to help with keto flu, try HVMN Ketone, our flagship product. HVMN Ketone can give you an energy boost without the need for carbs, while keeping your blood ketone levels elevated. Try it here.


Headaches

In ketosis, headaches can occur due to electrolyte imbalance and dehydration. With low insulin levels, the kidneys go into a diuretic state, so potassium, water, and sodium are excreted. A silver lining here is the loss of excess water weight (and thus weight loss) with the decrease in stored water.

Conversely, dehydration and electrolyte imbalance are the reasons for many keto flu symptoms. Monitor salt and water intake while on keto, and consider supplementing with electrolytes.

The necessity of electrolyte management is underestimated on low-carb diets. Even if macronutrient intake is monitored correctly, maintaining the correct balance of electrolytes often goes overlooked.

The cause of electrolyte imbalance? Usually, it's eating too few mineral-rich fruits and vegetables when transitioning to the keto diet.

Removing salt-laden, processed foods means the body is now cut off from the sodium or electrolyte sources it once had. While many keto dieters are weary of increasing sodium intake and raising blood pressure, removing processed foods from the diet and reducing carb intake already has a significant blood pressure-lowering effect.10

Supplementing other minerals is also vital. Magnesium is important for the body, contributing to muscle and nerve function, blood glucose control, and protein synthesis.11 Potassium is also helps proper functioning of the heart, digestion and muscle function.12

Foods rich in potassium and magnesium include tomatoes, avocados, salmon, nuts, leafy greens, and animal protein. Bouillon cubes, homemade stocks (like beef broth or chicken broth), and sea salt are all rich in sodium and minerals. One should consume these to minimize the risk of headaches.


Cramps

Cramping is the most common sign that electrolytes are out of balance.

The common mistake is not drinking enough water to compensate for water during the keto transition phase, which may result in low blood pressure and constipation, other than just cramps.6

Causes for cramps can also be caused by low potassium or low magnesium. Animal protein is an excellent potassium source, and the juices from cooking meats should be retained for this purpose. For magnesium, seek out leafy greens; the darker the better!


Constipation

This may be a result of the digestive system transitioning on keto. Any dramatic lifestyle changes impact gut microbiome, inevitably altering bowel movements.

Dehydration can worsen constipation (because of the increase excretion of fluids by the kidneys). Eliminating high-carb fruits and vegetables can also reduce dietary fiber and contribute to constipation.

Eat plenty of fiber-rich fruits and vegetables, exercise and drink plenty of water every day. But be warned–eating excessive fiber can also lead to constipation, so finding a balance is necessary. That balance is something that can only be determined from personal experience.13

MCT or medium-chain triglyceride oils are a solution. This may help to relieve constipation, as fat can help push bowel movements through. Finally, care should be taken to ensure your calorie intake is adequate, as not eating enough calories can also contribute to constipation.


Bad Breath

Some keto dieters experience bad breath, discerningly fruity or similar to nail polish remover. Besides the odor, this might be positive – it's an indicator of a body in ketosis.

However, it's usually reported to go away within a week or two, once the body adapts to the new metabolic state it is in. Maintaining good oral hygiene, increasing water intake, and using gum or breath freshener can help mask or reduce the smell in the interim while the body is still adapting.


Fatigue, Low Mood, and Cravings

As the body adapts to ketosis, decrease in energy levels and weakness are often reported, which can impair physical performance. Fatigue can last anywhere from three days to weeks as the body prepares new enzymes for the diet.

The tiredness may be caused by thyroid hormone and cortisol changes; the body is trying to compensate for the lowered carbohydrate intake by releasing more cortisol, which raises blood sugar.

The possible result? Irritable mood and reduced sleep quality.

Since cortisol levels are likely to reduce again when the body becomes keto-adapted, these symptoms should be temporary. To lessen fatigue, water and mineral intake should be carefully monitored (and likely increased).

B vitamins, particularly B5, are vital for helping with fatigue and lethargy. It's crucial to eat enough calories from fat for sustenance, as being under-fueled can also cause fatigue.

Removing glucose from the diet can affect mood and cause cravings. Replacing foods you crave with low-carb alternative or removing food "triggers" can help reduce the psychological (and thus physiological) symptoms of carb withdrawal.

While there are low-carb recipes for some of your favorite treats, many people who have successfully transitioned to the ketogenic diet say that just going “cold turkey” on sweet-tasting things and refined sugars helps to get rid of those nasty cravings sooner.


Summary

Keto flu systems are often transient, disappearing completely after keto-adaptation.

Lifestyle determines length and severity of the keto flu for the individual, with symptoms likely greater for individuals who ate a high-carb diet previously. Even during transition, the symptoms can be alleviated if treated smartly.

A well-formulated low-carb diet can progress without significant symptoms if the common mistakes of poor mineral intake, lack of fiber, electrolyte imbalance, and dehydration are addressed.

Avoid falling into the common trap of assuming your body is not suited to the low-carb diet after just a few days, and instead, consider careful monitoring of water and mineral intake particularly for the days/weeks it takes your body to adapt.

Have a look online for some keto support groups if you have questions, and perhaps think about trying exogenous ketones, like HVMN Ketone. Exogenous ketones can give you an energy boost as beta-hydroxybutyrate without the need to take in carbs.

Originally published on HVMN by Dr. Brianna Stubbs, Aarushi Bajaj, and Nate Martins.

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