Ketosis & OMAD

Two Staples of the Eat Like A Bear Diet

What is Ketosis?


Ketosis is a metabolic state that occurs when your body burns fat for energy instead of glucose. The keto diet has many possible benefits including potential weight loss, increased energy and treating chronic illness. However, the diet can produce side effects including “keto” breath and constipation.

Ketosis is a process that occurs when your body uses fat as its main fuel source. Normally, your body uses blood sugar (glucose) as its key energy source.

You typically get glucose in your diet by eating carbohydrates (carbs) such as starches and sugars. Your body breaks the carbohydrates down into glucose and then uses the glucose as fuel. Your liver stores the rest and releases it as needed.

When your carb intake is very low, these glucose stores drain down. Since your body doesn’t have enough carbs to burn for energy, it burns fat instead. As your body breaks down fat, it produces a compound called ketones. The ketones, or ketone bodies, become your body and brain’s main source of energy.

The fat your body uses to create ketones may come from your diet (nutritional ketosis), or it may come from your body’s fat stores. Your liver produces a small amount of ketones on its own. But when your glucose level decreases, your insulin level decreases. This causes your liver to ramp up the production of ketones to ensure it can provide enough energy for your brain. Therefore, your blood has high levels of ketones during ketosis.

What is the ketosis diet?

The ketogenic (keto) diet changes the way your body uses food. Typically, carbohydrates in your diet provide most of the fuel your body needs. The keto diet reduces the number of carbs you eat and teaches your body to burn fat for fuel instead.

The keto diet is high in fat, moderate in protein and low in carbohydrates. The standard keto diet consists of 70% to 80% fats, 10% to 20% proteins and 5% to 10% carbohydrates.

Many nutrient-rich foods contain high amounts of carbohydrates. This includes whole grains, fruits and vegetables. Carbs from all sources are restricted on the keto diet. So you’ll have to cut out all bread, cereal and other grains and make serious cuts to your fruit and vegetable intake. The types of foods that provide fat for the keto diet include:

  • Meats and fish.

  • Eggs.

  • Nuts and seeds.

  • Butter and cream.

  • Cheese.

  • Oils such as olive oil and canola oil.

How many carbs do I need for ketosis?

You’ll need to stay under 50 grams of carbohydrates per day to enter and stay in ketosis. That’s about three slices of bread, two bananas or 1 cup of pasta.

How long does it take to get into ketosis?

If you eat between 20 and 50 grams of carbohydrates each day, it will usually take you two to four days to enter ketosis. However, the time it takes to enter this state varies based on several factors. It may take you a week or longer to get into ketosis. Factors that may influence how long it takes you to achieve this state include your:

If you eat a high-carb diet before starting a keto diet, it may take you longer to reach ketosis than someone who consumes a low-carb diet. That’s because your body needs to exhaust its glucose stores first.

You may be able to get into ketosis faster with intermittent fasting. The most common method of intermittent fasting involves eating all of your food within eight hours. Then, you fast for the remaining 16 hours of a 24-hour period.

What are the benefits of ketosis?

Research has shown that ketosis may have several health benefits. One of the biggest benefits of ketosis may be weight loss. The process can help you feel less hungry, which may lead to eating less food. It can help you lose belly fat (visceral fat) while maintaining a lean mass. Other possible benefits of ketosis include treating and managing diseases such as:

  • Epilepsy: Healthcare providers often put children with epilepsy on the keto diet to reduce or even prevent seizures by altering the “excitability” part of their brain.

  • Other neurologic conditions: Research has shown the keto diet may help improve neurological conditions such as Alzheimer’s disease, autism and brain cancers such as glioblastoma.

  • Type 2 diabetes: The keto diet can help people with Type 2 diabetes lose weight and manage their blood sugar levels.

  • Heart disease: The keto diet may lower your risk of developing cardiovascular disease by lowering your blood pressure, improving your HDL (“good”) cholesterol levels and lowering your triglycerides.

  • Metabolic syndrome: The keto diet may reduce your risk of developing metabolic syndrome, which is associated with your risk of heart disease.

Ketosis has also been shown to increase your focus and energy. The keto diet delivers your body’s energy needs in a way that reduces inflammation. Research suggests your brain works more efficiently on ketones than on glucose.

What are the side effects of ketosis?

The keto diet has many benefits, but it may come with some side effects. One of the signs of ketosis may include “keto flu,” which includes symptoms such as upset stomach, headache and fatigue. Other symptoms of ketosis may include:

Optimal Keto Stick Results

As you can tell from the picture on the left, you want to be between the 4.0 (moderate) and the Large 16 during this diet.

I use Keto Mojo Ketone Test Strips available on Amazon for $8.95. Follow the link to purchase.

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Optimal KetoBM Results

As you can tell from the info to the right, you want to be between the 1.0 and 2.0 from the blood test during this diet.

Understanding Your Ketone Readings

0.0: Valid reading, meter does not detect ketones. Try reducing your carbs further and make sure to avoid hidden sugars and carbs.

0.1 to 0.5: Your body is starting to produce trace amounts of ketones, but you are not in ketosis quite yet.

0.5 to 1.0: Nutritional ketosis starts. You may start seeing diet benefits and improved energy levels.

1.0 to 2.0: Optimal Nutritional Ketosis. This is the ideal target range for most people. Your body is burning fat for energy. Many people also experience optimal mental and physical performance at this level.

2.0 to 3.0: Post Exercise Ketosis. In this range, you will likely not notice any additional benefits or detriments compared to the previous 1.0 - 2.0 range.

3.0 to 5.0: Starvation or Fasting Ketosis. Maintaining these levels consistently should not be a long term goal for nutritional ketosis.

Above 5.0: It is an unlikely reading to result from the keto diet alone without fasting or supplements. Seek medical attention if you aren't feeling well.

I use the KetoBM Blood Ketone Motor Kit available on Amazon for $28.97. Follow the link to purchase.

I give this device *****

What is OMAD?

The “One Meal a Day” diet, or OMAD diet, claims to help you lose weight by forcing your body to burn fat. It’s a type of intermittent fasting, which alternates between periods throughout the day in which you can eat anything and periods in which you don’t eat at all.

OMAD is particularly strict because you don’t eat for 23 hours, then consume all of your calories in a single meal.

How It Works

Like other kinds of intermittent fasting, eating one meal a day is a way of manipulating how your body finds and uses fuel. When you eat in a more traditional pattern, your energy comes from the food that you eat.

When you take in carbohydrates, your body breaks them down into sugars. If you have more sugar in your blood than you need, a chemical called insulin will carry the extra into your fat cells.

When you don’t eat for extended periods of time, your body produces less insulin. Your cells still need energy for fuel, so your fat cells release energy to compensate. For this to happen, however, you have to avoid eating for long enough that your insulin levels drop.

The Pros

Research on intermittent fasting is promising. The OMAD diet isn’t a magic bullet, but it may help some people to achieve their weight loss goals.

It may help you to burn fat. Study participants who tried eating one meal a day ended up with less total body fat. This particular group of people didn’t experience significant weight loss.

That said, intermittent fasting in general has proven to be an effective weight-loss method. The typical weight loss is 7 to 11 pounds over 10 weeks.

It can improve your metabolism. In adult men with prediabetes and obesity, a 6-hour period of eating followed by 18 hours of fasting improved their blood sugar levels.

It's worth noting that these men followed a more general time-restricted eating plan, and not a strict OMAD diet. More research would be necessary to know whether eating one meal a day has the same effect.

You could feel more alert. When you fast during daylight hours, your body releases more of a chemical called orexin-A, which makes you feel more alert. This also isn’t specific to OMAD, and it wouldn’t apply if you ate your single meal in the morning.

Eating in the morning and fasting overnight can help you lose weight. The OMAD diet doesn’t tell you which meal to eat. That said, people who fast overnight and eat a larger meal in the morning tend to lose more weight than people who eat more at dinnertime.

The Cons

This diet is strict, and there’s no conclusive evidence that eating one meal a day works for weight control. Whether it’s worth the discomfort depends on your tolerance and body chemistry.

It can be difficult to sustain. Intermittent fasting regimens like OMAD have a dropout rate of up to 65%. It’s no easier to follow than other calorie restriction plans.

It may make you hungrier. When you eat one meal a day rather than three, your body produces more of a hormone called ghrelin, which makes you feel hungry.

It’s no more effective than calorie reduction. Even if the OMAD diet makes you feel hungrier, it’s unlikely to lead to more weight loss than if you simply reduced the number of calories you took in during the day.

Safety Concerns

For most people, there are no serious dangers involved in eating one meal a day, other than the discomforts of feeling hungry. That said, there are some risks for people with cardiovascular disease or diabetes.

Eating one meal a day can increase your blood pressure and cholesterol. This occurred in a group of healthy adults who switched to one meal a day to participate in a study. If you already have concerns in either area, eating just once a day might not be safe.

Eating one meal late can cause your blood sugar to spike. Some OMAD studies have asked people to eat their single meal between 4 p.m. and 8 p.m. These participants had morning blood sugar levels that were higher than normal, and their bodies were less able to deal with this extra sugar.

Fasting can cause blood sugar crashes. Fasting of any type increases the risk of extremely low blood sugar, also known as hypoglycemia, in people who have Type 2 diabetes.

The safety and effectiveness of any weight-loss plan are unique to each person. It’s best to speak with a doctor one-on-one if you have questions or concerns about trying the "One Meal a Day" diet plan.

I was worried about my blood analysis levels being over 3...I know, I worry when they are in the 1.0-2.0 range, and now I worry when they are in the 3.0-4.0 range, so I did more research, and here is what I found...

Ketones and Nutritional Ketosis: Basic Terms and Concepts

Published on

April 18, 2018

Stephen Phinney, MD, PhD

Jeff Volek, PhD, RD

Shedding light on these widely misunderstood primal molecules

Circa mid-19th century, ketones were discovered in the urine of patients with uncontrolled diabetes. This led to the negative connotation of ketones being indicative of metabolic dysfunction, a sentiment that persisted for the next 150 years. Despite pioneering work published more than 4 decades ago showing that ketones were highly functional metabolites, these fat-derived molecules are still considered by many doctors, dietitians, and nutritionists as toxic byproducts of fat metabolism. Adding to this, the concurrent misunderstanding and vilification of dietary fat, from which ketones are derived, has further perpetuated this negative perspective around ketones and nutritional ketosis.

But now the nutrition-metabolic landscape is changing dramatically. New research in the last 15 years has led to increased public support for dietary fat and ketogenic diets, owing in part to accumulation of a critical mass of scientific evidence that links ketones to a broad-spectrum of health benefits. Now scientists, healthcare professionals, and an inquisitive public are eagerly seeking to understand and translate this widely misunderstood area of science. A Pub Med search of papers using the term ‘ketogenic diet’ between 1980 to 2000 retrieves 215 results, compared to over 2000 citations from 2001 to present. Google Trends indicates that searches for the word ‘ketones’ skyrocketed in 2012 and continues to climb.

Even to the present, the objective information on the science of ketones has been absent from most academic nutrition or medical curricula, resulting in an abundance of misinformation. To help the reader overcome this, we will strive to explain key terms and concepts related to ketones to give you a solid foundation with which to distinguish fact from fallacy.

Ketogenesis and Ketosis

When we say ketones, we are referring to the primary circulating fatty acid metabolites beta-hydroxybutyrate (βOHB) and acetoacetate (AcAc).

Quick side note: the fad compounds called ‘raspberry ketones’ are a completely different topic. They are a different class of molecules with no basis in published human research for any of the popular health claims, and thus not relevant to this presentation.

Hepatic (liver) production of these 4-carbon molecules increases when insulin levels are low and glucagon is high enough to result in accelerated lipolysis (release of fatty acids from adipose tissue triglycerides) and their transport via the bloodstream to the liver. Ketones are synthesized from the controlled cleavage of fatty acids in the liver, a process called ‘ketogenesis.' Release of fatty acid-derived ketones into the circulation results in a metabolic state of ‘ketosis.'

The liver produces ketones all the time, but the rate of ketogenesis and magnitude of ketosis depends primarily on dietary carbohydrate and protein intake. If you consume enough carbohydrate and protein to elevate the hormone insulin to levels that inhibit fat breakdown (and make glucose the predominant fuel), then ketogenesis operates at idle, translating into blood ketone concentrations about 0.1 mmol/L. Most people following official dietary guidelines that emphasize carb-rich foods, be it ‘low fat’ or ‘Mediterranean,' rarely experience ketones higher than 0.3 mmol/L. Nevertheless, the ketogenic process is always idling in the background, so they are always present in the circulation. At these low levels however, ketones don’t have much of a role in providing fuel nor do they exert signaling effects.

Ketogenic Diet

A ketogenic diet that is restricted in carbs and moderate in protein results in increased production of ketones into a range we call nutritional ketosis (described below). The amount of carbohydrate and protein a person can consume while still promoting nutritional ketosis varies based on many factors, notably the degree of that individual’s underlying insulin resistance. A general range is 30 to 60 grams per day of carbohydrate (closer to 30 grams for those who are more insulin resistant) and somewhere between 1.2 to 2 grams protein per kilogram reference weight per day. There are many ways to formulate a highly palatable ketogenic diet using real foods. But for it to be safe, pleasurable, effective, and sustainable requires consideration of several important principles that extend beyond simply restricting carbohydrate. A well formulated ketogenic diet (WFKD) adequately addresses all these components. The basis of a WFKD is described in our ‘Art and Science’ books.

Nutritional Ketosis

A well-formulated ketogenic diet results in decreased insulin levels and limited glucose availability, which triggers the ketogenic pathway to go from idle to half throttle. This happens over the course of a couple days. This increase in blood ketones represents a perfectly natural, if not preferred, state of ‘nutritional ketosis.' This is characterized by concentrations between 0.5 and 2 mmol/L for most people consuming a WFKD, which typically consists of a variety of nutrient-rich foods with some carbs (e.g., non-starchy vegetables, olives, nuts/seeds). Ketone levels may fluctuate throughout the day depending on factors such as food intake and exercise. For example, ketone concentrations may transiently double after exercise hitting levels as high as 3-5 mmol/L.

Starvation Ketosis

During total fasting when there is complete absence of any caloric intake for several days, the resulting increase in ketones is referred to as starvation ketosis. The absence of any dietary carbohydrate and protein over a week or more raises ketone concentrations to between 5 and 10 mmol/L, significantly higher than nutritional ketosis, but lower than concentrations in keto-acidosis. Starvation ketosis is an important physiologic process that evolved millions of years ago, enabling humans to survive for prolonged periods on body fat when food was not available. Obviously starvation ketosis is not sustainable long term, nor is it advisable to intentionally induce it for shorter periods (i.e., intermittent fasting) because of essential nutrient deprivation, lean tissue loss, and other potentially dangerous side effects.


This is a distinct pathologic state that happens when insulin levels are extremely low, such as in a person with type 1 diabetes who cannot produce insulin. It is often called diabetic keto-acidosis or DKA. In this case ketone production redlines, resulting in dangerously high ketone concentrations that can exceed 20 mmol/L, an order of magnitude higher than typical values in nutritional ketosis. Except for type 1 diabetes or other conditions associated with insulin insufficiency (e.g., people with advanced type 2 diabetes who have lost most or all of their capacity for insulin production), a well-formulated ketogenic diet is associated with a built-in safety mechanism thanks to negative feedback inhibition that prevents ketones from exceeding 5 mmol/L.


When maintained for several consecutive weeks, nutritional ketosis fundamentally changes the way cells work. This includes switching the mix of fuels they use, as well as awakening genes that are silenced by high-carb diets. Over time the body refines its metabolism to run on fat and ketones, ultimately manifested by two-fold higher rates of whole body fatty acid oxidation. Meanwhile glycolysis, insulin concentrations, constitutive inflammation, and oxidative stress are all decreased. As a result, keto-adaptation can have prompt and potent therapeutic effects; most notable reversal of clinical signs of metabolic syndrome and type-2 diabetes. Many other disorders/diseases may be amenable to keto-adaptation. This is an early-stage but burgeoning area of scientific investigation.


This term is often used synonymously with keto-adaptation, and commonly used to describe low-carb adapted athletes. If you are fat-adapted, it implies you have restricted carbs enough to induce an increase in fat burning. Fat-adapted athletes, and sedentary folks, can derive up to twice as much of their energy needs from fat, while decreasing their dependency on carbs. Whereas fat adaptation can occur to different degrees and across a spectrum dependent on the degree of carb restriction, keto-adaptation represents a more comprehensive reshaping of many physiologic systems. Keto-adaptation only happens when carbs are restricted to a point that induces sustained nutritional ketosis. The nuances here are subtle, but meaningful. For example, moderately restricting carbs (e.g., adaptation to a Paleo diet) may induce some degree of fat-adaptation and perceived benefits, but falls short of maximizing fat oxidation and producing positive health outcomes specifically linked to nutritional ketosis. A keto-adapted person is by definition fully fat-adapted, but a fat-adapted person may not be keto-adapted.

Ketone Supplements and Acute Ketosis

There are multiple companies marketing various forms of ketone supplements (usually different forms of βOHB), each touting theirs as better than the competition. Depending on the dose, they do work to rapidly elevate blood ketones. The result is a transient ‘acute ketosis’ that does not require a ketogenic diet or any carb and protein restriction. Supplemental ketones are absorbed from the gut and rapidly appear into the circulation usually peaking within an hour. This acute ketosis does not involve increased hepatic ketogenesis unless the product also contains medium chain fats. In fact, ketone supplements likely decreases endogenous ketone production.10 The level of ketosis varies depending on the form and the dose, but concentrations can easily reach the higher end of nutritional ketosis if very high doses are consumed or ketone supplements are ingested while in nutritional ketosis (i.e., in combination with a WFKD or fasting). The effect of ketone supplements is short-lived lasting a few hours, thereby requiring repeated dosing to achieve sustained high levels of ketosis.‍

Acute ketosis does not equate to keto-adaptation. Keto-adaptation is a process driven by the decrease in carbohydrate availability and hepatic ketogenesis. The increase in ketones is a response to, not the stimulus for keto-adaptation. This is not to say ketones don’t have important biologic effects, they most certainly do. But the upstream stimulus is the decrease in carbs, which results in nutritional ketosis and other parallel responses (e.g., enhanced fat oxidation). Thus, don’t expect to experience the full spectrum of benefits associated with keto-adaptation by simply consuming ketone supplements. Both approaches elevate circulating ketones, but without the carb restriction there is no net increase in hepatic ketone production, no decrease in insulin, and no net increase in fat oxidation. In other words, when ketone concentrations are elevated acutely from ketone supplements, but without decreasing carbohydrate intake, the only likely effects are those directly attributed to βOHB. That may include availability of an alternative fuel for the brain and certain signaling effects attributed to βOHB such as increased protection from oxidative stress and decreased inflammation. As of now, this is mostly speculation since we don’t have a lot of published science to evaluate how ketone supplements affect people.


The ability to achieve keto-adaptation is an elegant metabolic blue print hard-wired into our genetic code and our metabolism that sustains optimum fuel flow to all organs when dietary carbohydrates are limited and protein consumed in moderation. Emerging research indicates that keto-adaptation has transformative disease-fighting and performance-enhancing effects. Ketone supplements can produce acute ketosis in keto-naïve individuals or augment ketone concentrations in those who are keto-adapted. We don’t yet know under what conditions this is good, bad, or neutral. Scientific inquiry into the application of ketone supplements is underway, but for now there are more questions than answers. In short, nutritional ketosis and keto-adaptation are natural, if not preferred, metabolic states for humans. With proper education about a well-formulated ketogenic diet and ongoing support, most people can adapt their pattern of eating to induce sustained nutritional ketosis with significant perceived benefit.