New Carnivore having ketone struggles


(Katie) #1

Hi All, I’m hoping you can help. A friend of mine started Carnivore about 2 months ago. He seemed to adapt to it really quickly. Didn’t suffer keto flu or anything. He went from a pretty well whole foods diet, but still some bread etc and low calorie to keto carnivore (eating plenty of fat). He wanted to lose a small amount of fat while maintaining muscle (crossfitter), but his main goal was for mental health improvements.

He’s struggled with pretty severe depression, anxiety and alcoholism for many years. Within a few days he was feeling great. Within a week he was having ketones of 1-2 and his mental health was so good he was crying tears of relief and happiness. But a couple of weeks ago his ketones dropped for no apparent reason. His blood sugars have always sat around 5ish mmol/L (90mg/dl) but now they’re at 5.7 (103) for no apparent reason but pretty stable. He doesn’t seem to have any blood sugar spikes throughout the day. Ketones have been 0.4 and occasionally getting to 0.6/0.7 but not much higher. He’s eating plenty of protein, plenty of fats, no carbs aside from cream in his coffee and the very small amount in meat. I got him to test his blood sugar pre and post meal today and it went down slightly but ketones came down as well. He fasted today for 18 hours and managed to get to a ketone of 1.

If this were anyone else, I’d say just keep going (which I am saying anyway), but for him the mental health benefits are not there unless he’s getting higher levels of ketones. He just can’t work out why his body could do it initially and now not. He stopped testing for a while as I was worried the testing was causing him stress when he wasn’t seeing the numbers he wanted, but that doesn’t seem to be it either.

Really hoping someone here might have some ideas. Thanks so much.

(KM) #2

Welcome to the forums!

Unfortunately, many well adapted ketovores don’t see particularly high ketones levels once we’ve been at this awhile. Our bodies apparently get very efficient at producing only what we need. Has he tried using exogenous ketones, or varying his macros - probably toward more fat, less protein?

(Robin) #3

Does he still drink alcohol? Wonder if that’s come into play.

(Bob M) #4

He could try some MCTs (medium chain triglycerides) to help raise ketones.

He could try higher animal fat (eg, suet, pork fat). That might help get ketones higher. But if he’s a crossfitter, he’d have to test to see the combination of fat/protein he’d need.

He could also try exogenous ketones, but note that some of these might not be able to be “seen” by ketone meters.

Higher morning blood sugar (and lower ketones) is normal, as the body – for reasons I don’t understand – implements glucose sparing then. Exercise (at least for me) also raises blood sugar, so that will cause an increase in blood sugar (and usually decrease in ketones).

Also, based on the data I’ve seen from continuous ketone meters, ketones are way more variable than I thought they would be. Here’s the meter (only available in Europe though):

The graphs from this are changing the way I think about ketones. This is from the original study:

It’s a tough situation, as he needs higher ketones, but the body naturally goes lower after a while. Then add the actual fluctuations during the day, and it’s complex.

(Bacon is a many-splendoured thing) #5

Simple: His skeletal muscles are healed to the point of being able to metabolise entire fatty acids instead of having to limp along on ketones (which are partially-metabolised fats, much as charcoal is partially-burnt wood), and so the liver no longer needs to flood the system with ketones in order to keep the muscles going.

This metabolic healing is called “keto-adaptation” by some people, and “fat-adaptation” by others. Once they are adapted, the muscles, in fact, actively pass up the ketones and glucose manufactured by the liver, so that the organs that truly need them can have them. They actually prefer to metabolise fatty acids.

In fact, the presence of ketones in the blood stream, which we can measure, is simply a marker for lowered insulin, which we cannot. (It requires a radioimmunoassay performed in a laboratory.) And as Professor Bikman points out, insulin has to drop if the body is not taking in glucose (also known as carbohydrate), or the brain would fail to receive enough energy and we would pass out or die. This is because insulin is the premier energy-storage hormone, and storing the glucose produced by the liver, when we aren’t taking in any in our diet, is counter-productive.

The simplest way to answer the question of whether someone is in ketosis is to ask two simple questions:

  1. Is the person eating less than 20 g of carbohydrate a day?
  2. Is the person still breathing in and out?

If the answer to both questions is Yes, then the person is in ketosis.

(Katie) #6

Thank you for your comment. He stopped drinking when he started carnivore so alcohol free almost 2 months.

(Katie) #7

Thank you. He’s tried MCT oil and it didn’t change anything. He’s increased his fat also and no change. He’s ordered another exogenous ketone supplement so waiting for that to arrive.

(Katie) #8

Thank you for your reply. That’s interesting the continuous ketone meter reading. he’s actually just messaged me to say he’s ordered one from Europe so fingers crossed this will give more insight

(Katie) #9

Thank you for that. Yes he’s eating well under 20g of carbs as he’s on carnivore and not consuming enough dairy etc to exceed the 20. Yes, I (and he) understand he will be burning ketones, and I have told him not to chase numbers, but it’s the higher level of ketones that is what really improves his mental health (as it is for epileptics).

(Bacon is a many-splendoured thing) #10

Okay, I lost track of that part, sorry. Yes, exogenous ketones might help, likewise MCT oil. Your friend might like to check out the work of Chris Palmer at Harvard, and the work of the Baszucki Brain Research Fund. There is also a video on YouTube, in which Matt Baszucki discusses how he uses a low-carbohydrate, high-fat, ketogenic diet to control his clinical depression and suicidal ideation.

(Alex ) #11

I’d be wary of using exogenous ketones to fix this because they are honestly more marketing hype than a necessary supplement.

The extra effect I had from them whilst following a full keto diet was little to none.

Nutritional ketosis is the way forward, not synthetic :+1:

(KM) #12

There is one other thing that at least for me reliably and significantly boosts my ketone levels even after years of ketovore / carnivore eating: extended fasting.

(Alex ) #13

This :ok_hand: :arrow_up:

(Bean) #14

He may need to explore “therapeutic ketogenic ratios”, which is hard to do strictly carnivore, unless he’s adding egg yolks (without whites) and basically drinking extra heavy whipping cream.

And +1 for extend fasting.

(Katie) #15

Thank you. We reviewed his ratios and he wasn’t quite up there with the fats. He’s increased it an it is working! He was reporting to me that he was eating plenty but when he sat down and really calculated it, it wasn’t high enough

(Bob M) #16

That is great news. I’ve always wanted to test that: add more fat and sees what happens to ketones.

Also, I BELIEVE (but don’t know why this is true) that fats higher in PUFAs increase ketones. So, maybe more chicken and pork fat and less beef fat and saturated fat like butter. Or at least, this is what Amber O’Hearn has implied.

I know that extended fasting increases my ketones, but there’s only so much extended fasting I can do. (In fact, I don’t do any extended fasting now, because I’m exercising too much. At most, I’ll eat one meal a day on some days I don’t exercise.)

(B Creighton) #17

I echo ctviggen’s suggestions… esp MCTs… they kind of force the body to make ketones no matter how “fat adapted” they may be. Goat yogurt has enough that I notice a ketone boost. Coconut oil has some. I make my own salad dressing with MCTs, balsamic vinegar, and Costco’s no-salt herbs.


A properly fatty meat can do… There are lots of options to get a high fat/protein ratio. I love cream and butter but I probably would use mostly fatty meat to get it :wink: Tomorrow I try to do a fat fast, 90% fat, okay, the low calorie intake (1000 kcal) helps, it’s very little fat (therefore food) but I will use fatty (processed this time) meat, scratchings, a rich fatty coffee and a tiny amount of butter as I love butter. No cream as I run out. It’s possible to do with only meat, even fresh meat but I don’t have that kind now and I love variety.
I eat pork, that may make things easier as I can choose the fattiness of my meat between a few and 100 % (100% isn’t called meat but still, widely available here).

(Bean) #19

Therapeutic is higher fat than regular keto. It is very hard to do with meat. Not impossible, but tricky without close attention to the numbers. A regular keto is 2:1 fat to protein. Therapeutic is 3:1 or 4:1. Even very fatty cuts of beef run 1:1. Pork… maybe 1.5:1, but that’s a stretch. ETA- I no longer eat pork, so I really haven’t run the numbers.

(Bob M) #20

Yeah, I think you’d have to add fat. I still eat lean pork from the store, but I save eating pork fat only from the local farm, which feeds their pork mainly on grass.