The ketogenic diet is a popular, healthy and effective way to lose weight (1,2,3). When followed correctly, this low-carb diet will enhance blood ketone level. Indeed, in the absence of circulating blood sugar from carbohydrates, the body goes into a process called ketosis, starting breaking down stored fat into ketone bodies (4,5,6). Hence, during ketosis, most cells will use ketone bodies to generate energy. The shift, from using blood sugar to breaking down stored fat as a source of energy, usually happens over two to four days of eating very few amounts of carbohydrates per day.

There are some signs which indicate that the body shifted to ketosis:
Bad Breath - This is caused by elevated ketone levels. Specifically, acetone is the responsible ketone for this, exiting the body though urine and breath (7, 8, 9).

Short-Term Fatigue - Initially, it is common to suffer from tiredness and low energy, also decreases in performance can occur. Since the body needs to becomes adapted to running on fat and ketones instead of sugar (10,11).

Frequent urination - During ketogenesis the body uses the glucose stored in liver and muscles, this process releases water. As carb intake and glycogen stores drop, kidneys will start eliminate this excess water (12).

Constipation - A ketogenic diet generally involves a major change in the types of foods eaten and this can cause constipation mainly due to dehydration and salt loss(13).

Gianluca Mech formulated the following dietary supplements to support ketogenesis.

1)Dashti HM, Mathew TC, Hussein T, et al. Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol. 2004;9(3):200-205.
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3)Westman EC, Mavropoulos J, Yancy WS, Volek JS. A review of low-carbohydrate ketogenic diets. Curr Atheroscler Rep. 2003 Nov;5(6):476-83. doi: 10.1007/s11883-003-0038-6. PMID: 14525681.
4)Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids. 2004 Mar;70(3):309-19. doi: 10.1016/j.plefa.2003.09.007. PMID: 14769489.
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6)Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789-96. doi: 10.1038/ejcn.2013.116. Epub 2013 Jun 26. Erratum in: Eur J Clin Nutr. 2014 May;68(5):641. PMID: 23801097; PMCID: PMC3826507.
7)Musa-Veloso K, Likhodii SS, Cunnane SC. Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. Am J Clin Nutr. 2002 Jul;76(1):65-70. doi: 10.1093/ajcn/76.1.65. PMID: 12081817.
8)Spaněl P, Dryahina K, Rejšková A, Chippendale TW, Smith D. Breath acetone concentration; biological variability and the influence of diet. Physiol Meas. 2011 Aug;32(8):N23-31. doi: 10.1088/0967-3334/32/8/N01. Epub 2011 Jul 1. PMID: 21725144.
9)Likhodii SS, Musa K, Cunnane SC. Breath acetone as a measure of systemic ketosis assessed in a rat model of the ketogenic diet. Clin Chem. 2002 Jan;48(1):115-20. PMID: 11751546.
10)Volek JS, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt PM, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism. 2016 Mar;65(3):100-10. doi: 10.1016/j.metabol.2015.10.028. Epub 2015 Nov 2. PMID: 26892521.
11)Volek JS, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci. 2015;15(1):13-20. doi: 10.1080/17461391.2014.959564. Epub 2014 Oct 2. PMID: 25275931.
12)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. J Clin Invest. 1975;55(4):845-855. doi:10.1172/JCI107996
13)Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3(2):175-192. Published 2018 May 21. doi:10.1002/epi4.12225

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