[iv] Hussein M Dashti, MD PhD FICS FACS, Thazhumpal C Mathew, MSc PhD FRCPath, Talib Hussein, MB ChB, Sami K Asfar, MB ChB MD FRCSEd FACS, Abdulla Behbahani, MB ChB FRCS FACSI PhD FICS FACS, Mousa A Khoursheed, MB ChB FRCS FICS, Hilal M Al-Sayer, MD PhD FICS FACS, Yousef Y Bo-Abbas, MD FRCPC, and Naji S Al-Zaid, BSc PhD. "Long-term effects of a ketogenic diet in obese patients"
The hallmark of a ketogenic diet is being in ketosis for extended periods of time, and is achieved by carbohydrate restriction. While there isn’t a strict prohibition of artificial sweeteners, grains, and manufactured foods, there is a strong preference in the community to lean towards natural, whole foods. Keto is for overall health, and weight loss is a welcome side effect for many people.

This is an adaptation period, where we’re essentially re-training our muscles and our brain to use fat as the primary fuel source instead of glucose. This adaptation can take a couple of weeks to a couple of months. As a hallmark of being keto-adapted and not just in ketosis, the skeletal muscles are able to burn fat directly for fuel, and the brain relies on the higher volume of ketones in the blood as its main source of energy.
Ideally, your keto carb limit should be kept to under 50 grams a day, or 4 to 10 percent of your daily calories. This will help you transition to burning fat for fuel. However, this number may change depending on various factors. For example, if you have Type 2 diabetes, you will have to restrict your carb intake to as little as 20 grams per day. All in all, you will have to rely on your body's feedback to help you identify the ceiling amount for your carb intake.
If you do try the diet outside of medical supervision, Kizer says it’s important to test your urine with urinalysis ketone test strips to ensure your ketone levels don’t become dangerously high. Ketone urine test strips are also used by people with diabetes to determine if they’re at risk for ketoacidosis (DKA), a life-threatening complication that occurs when an individual doesn’t have enough insulin in their body. (Healthy ketosis is considered 0.5 to 3.0 mM blood ketones.)
The hallmark of a ketogenic diet is being in ketosis for extended periods of time, and is achieved by carbohydrate restriction. While there isn’t a strict prohibition of artificial sweeteners, grains, and manufactured foods, there is a strong preference in the community to lean towards natural, whole foods. Keto is for overall health, and weight loss is a welcome side effect for many people.

I’ve always heard that the brain functions well on ketones. Gluconeogenisis typically reduces ketosis, though as well? This is the first time I’ve heard anyone say the brain can’t use anything but glucose. I know there’s *preferred* sources of fuel over others, but I was also fairly certain other sources were fine.. or humans might be in a bit of trouble.

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