Focus on building and preserving as much muscle mass as possible, as it is considered the most important factor for healthy aging.
Avoid chronic ketosis or daily intermittent fasting unless managing a specific disorder; instead, practice cyclical ketosis or intermittent fasting (e.g., 2-3 times a week or a 5-day fasting-mimicking diet monthly) to maximize benefits and prevent losing too much weight or blunting adaptations.
Combine a modified ketogenic diet with intermittent fasting to leverage synergistic benefits from insulin and IGF-1 suppression, AMP kinase activation, and the drug-like signaling effects of ketones (e.g., anti-inflammation, epigenetic changes, BDNF induction).
To lose weight and sustain it, achieve and maintain a protracted calorie deficit, recognizing that calories absolutely matter, even on a ketogenic diet.
Understand that calories absolutely matter, even on a ketogenic diet, and do not disregard calorie counting, especially when aiming for weight loss or specific metabolic goals.
Prioritize consuming lots of fiber and phytonutrients, and ensure adequate micronutrient intake (e.g., selenium) through diet or appropriate supplementation to prevent deficiencies and support overall health on a ketogenic diet.
Enhance the anti-carcinogenic potential of a ketogenic diet by incorporating plant fiber and specific phytonutrients like curcumin, turmeric, and EGCG.
Consume leafy greens raw rather than cooked on a ketogenic diet, as cooking ruptures cell walls, making carbohydrates more accessible and increasing their glycemic impact.
Continuously suppress insulin and insulin signaling to effectively maintain a state of ketosis, which is crucial for therapeutic goals like managing cancer or seizures.
For better compliance and to avoid side effects like sleep disruption or lipid abnormalities, gradually titrate down carbohydrate intake over four to six weeks when transitioning to a ketogenic diet.
If using a ketogenic diet to manage a metabolically linked or brain disorder like epilepsy, start with a clinical ketogenic diet under the supervision of a registered dietitian and a neurological team.
When transitioning to a ketogenic diet for general health, gradually reduce carbohydrates, track and monitor progress, and get blood work (including glucose response) at the 4-6 week mark to check for hypoglycemia or other issues.
To confirm you are on a ketogenic diet, measure your ketone levels in blood, urine, or breath, as hyperketonemia (elevated ketones) is the objective biomarker defining the diet.
Select a ketogenic diet variation based on your goals, ranging from a classical 4:1 ratio (90% fat) for therapeutic purposes to a modified Atkins or low glycemic index therapy (1:1 ratio) for a milder, lifestyle-oriented ketosis.
For ApoE4 carriers, adopt a moderate-fat, moderate-protein, plant-based fiber diet, focusing on monounsaturated fats and MCTs over heavy saturated fats, and consider supplementing with exogenous ketones.
Consider a moderate Mediterranean-style low-carb/ketogenic diet, emphasizing monounsaturated fats, omega-3 fatty acids, and MCT oils, while limiting heavy saturated fats, especially if you are an ApoE4 carrier.
Supplement with carnitine on a ketogenic diet, as fat oxidation can lead to carnitine deficiency, and it can also help boost ketosis.
Take a standard multivitamin to ensure adequate micronutrient intake, especially if your ketogenic diet formulation doesn’t consistently provide all necessary nutrients.
Incorporate nutrient-dense foods like eggs, sardines, fish, and oysters into your ketogenic diet to obtain essential nutrition and prevent potential deficiencies.
Supplement with magnesium, potentially in multiple forms like magnesium threonate, as it is beneficial with a ketogenic diet and can help maintain adequate blood levels.
Regularly monitor your vitamin D levels, as even with sun exposure and supplementation, levels can be low; ensure your chosen supplement brand is effective, potentially by checking third-party testing.
If you have consistently low vitamin D levels despite supplementation and sun exposure, consider genetic testing for SNPs that affect vitamin D3 metabolism, as you may require a significantly higher dose.
While not optimal for maximizing muscle size, ketogenic diets are an ideal strategy to preserve muscle mass during a calorie deficit, while also improving metabolic parameters like glycemia and hyperinsulinemia.
Elevate ketones during calorie restriction or an energy deficit to provide better fuel flow to the brain, making the diet more tolerable and sustainable by preventing painful hypoglycemia.
Leverage the satiating effect of ketones, which provide alternative energy to the brain during low glucose, to reduce hunger signals and support weight loss.
For an optimized ketogenic lifestyle, follow a more liberal ketogenic diet (e.g., modified Atkins or low glycemic index therapy) and supplement with exogenous ketones.
Prefer ketone supplements where beta-hydroxybutyrate is ionically bound to electrolytes, as they provide needed minerals and avoid the potential liver enzyme elevation seen with high doses of 1,3-butanediol ketone esters.
Aim to keep exogenous ketone levels within an optimal range of 1 to 3 millimolar, unless managing specific severe conditions like epilepsy or glucose transporter type 1 deficiency syndrome where higher levels may be beneficial.
If managing conditions like type 2 diabetes, Alzheimer’s, or cancer, spread out ketone supplement doses rather than taking large single boluses.
To prevent a counter-regulatory insulin release that can shut down natural ketone production, avoid consuming large doses of ketone esters on an empty stomach, which cause rapid, high spikes in ketones.
To achieve a slower, more sustained elevation of blood ketones, combine ketone salts with medium-chain triglycerides (MCTs), as MCTs delay gastric absorption.
To control the duration of elevated ketones (1-8 hours), adjust whether you take ketone supplements on an empty stomach, with food, or combine different formulations like ketone esters with electrolyte salts.
Incorporate fasting to speed up metabolic switching, facilitating the transition into ketosis from primarily using glucose to utilizing fat and ketones.
To prevent being kicked out of ketosis by an insulin response from protein, incorporate fat and fiber with your meals, especially at the beginning, to attenuate insulin release.
Use a continuous glucose monitor to observe how the order and combination of foods impact your glycemic response, and adjust to attenuate insulin release.
Create a ketogenic salad with fatty fish (e.g., salmon), raw leafy greens (arugula, spinach, romaine), ample extra virgin olive oil, MCT oil, and a small amount of nuts like walnuts.
When following a low-carbohydrate or ketogenic diet, train under those conditions to induce metabolic adaptations, enabling your body to perform and maintain performance with insulin suppression and low glucose availability.
Practice ’train low’ (exercising in a semi-fasted state with low glucose and insulin) to induce metabolic adaptations and flexibility, allowing you to optimally use various fuel sources and strategically reintroduce carbohydrates for peak performance during events.
Do not radically change your dietary or supplement approach just before an event; instead, experiment methodically with new strategies like MCTs and ketone esters well in advance.
Consider combining ketones, caffeine, and electrolytes as a potentially powerful ergogenic aid to enhance exercise performance, especially in strength training.
Utilize exogenous ketones to preserve performance resilience in extreme environments like hyperoxia or hypoxia, as they can provide an alternative fuel source when carbohydrate metabolism is impaired.
Engage in some form of exercise daily, including outdoor activity and resistance training (at least twice, ideally four times a week), with bodyweight exercises like chin-ups, push-ups, and dips being effective for busy schedules.
Regularly use hot tub heat therapy (105-110°F for 15 minutes to raise core temperature to ~102°F) to significantly lower blood pressure and improve cardiovascular health.
Engage in high-intensity exercise, such as an hour-long spin class, to help negate glucose dysregulation, even during periods of sleep disruption or other stressors.
Aim to achieve and sustain a Glucose Ketone Index (glucose over ketones in millimolar concentration) of one for 24 hours, as this is believed to induce and potentially maximize autophagy, often achievable with a 72-hour fast.
For monitoring fat loss, use a breath acetone meter, as breath acetone levels are a stable and better correlate of fat oxidation compared to blood beta-hydroxybutyrate, which can fluctuate with activity and fuel utilization.
For convenient and cost-effective ketone monitoring, especially for fat loss and fasting, use a breath acetone meter like the Readout Health Biosense device, as it avoids expensive strips and finger pricks.
When starting a ketogenic diet, initially use semi-quantitative urine ketone strips to confirm ketosis, then invest in a more accurate blood ketone meter like the Keto-Mojo device for precise measurements.
Utilize a Continuous Glucose Monitor (CGM) to assess adherence to a ketogenic diet, as a flat glucose trace indicates proper adherence, while large excursions suggest otherwise.
Utilize the Levels Health app with a CGM to gain deep insights into your metabolism, track glycemic responses to food and exercise, and receive daily/weekly reports with minimal daily engagement.
Be highly skeptical and scrutinize the ingredients of products labeled ‘keto,’ as many contain hidden sugars or ingredients that can significantly spike blood glucose and kick you out of ketosis.
For a truly ketogenic bar, consider Keto Brick, which provides 90 grams of fat, 20-30 grams of protein, minimal carbohydrates, and 1000 calories, unlike many misleading ‘keto’ labeled products.
For daily ketogenic supplementation, consider Keto Start (exogenous ketones), Keto Brick (ketogenic bar), and Keto Brains (coffee creamer with alpha-GPC, theanine, lion’s mane, and C8).
Based on rodent studies showing improved healthspan, cognition, and suppression of spontaneous tumors, consider implementing a cyclical ketogenic diet, potentially combined with calorie restriction, for brain health and anti-aging benefits.
If considering a ketogenic diet for Alzheimer’s disease, screen for a metabolic phenotype using an FTG PET scan; if glucose hypometabolism is observed, a metabolic intervention like a ketogenic diet may be a beneficial approach.
Consider using a ketogenic diet or ketone supplements to manage chronic migraines, as they have been shown to help by potentially increasing GABAergic tone, brain blood flow, and reducing neuroinflammation.
Consider acute fasting or using ketone esters/salts to mitigate inflammatory cascades associated with conditions like shingles or herpes simplex, potentially stopping episodes.
If you experience headaches from a ketone supplement, change the brand or type, as it could indicate issues with electrolytes, contaminants, purity, potency, or gut tolerability.
Follow a ketogenic diet to augment the immune system, making it more hypervigilant and enhancing anti-cancer immunity.
When using therapies that kill cancer cells, such as ketogenic diets, metabolic drugs, or hyperbaric oxygen therapy, adopt a gradual approach to avoid adverse effects like tumor lysis syndrome.
For cancer therapy, use a ketogenic diet primarily for its efficacy in suppressing insulin and the insulin pathway, limiting glucose availability to cancer cells, rather than just relying on hyperketonemia.
To target aggressive, glycolytic cancer cells, limit glucose availability, as these cells primarily rely on fermentable fuels and may not be able to use ketones as an energy source due to damaged mitochondria.
If following a carnivore diet, monitor biomarkers like LDL and triglycerides, as they may elevate; consider adding fish, omega-3 fats, and plants back into your diet if blood work is concerning.
If following a carnivore diet, ensure you are creating a calorie deficit for potential benefits, as the amount and type of meat consumed can significantly impact results.
While not strictly necessary for survival, include fiber in your diet for optimal health, as excluding it entirely may not be beneficial given the strong data supporting its positive effects.