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M.D. Anderson on the Keto Diet and Cancer

I first became curious about the keto diet and cancer in 2015. I am a medical doctor that specializes in internal medicine. That means I focus on patients’ ‘long game.’ I think about questions like:

  • What are the consequences of 20 years of high blood pressure?
  • What happens when you have been overweight for 15 years?
  • What are the risks of smoking marijuana for ten years?

I aim to help patients prevent disasters before they ever become aware of a symptom.  Thankless in many ways, but rewarding strategically. I specialize in assisting patients in achieving behavioral changes that add years to their lives.

I also like to study chronic brain problems like Parkinson’s, depression, bipolar, seizures, addiction, anxiety, high blood pressure, strokes, and brain fog. My practice displays a calico pattern of brains that don’t work correctly.

However, if you have one of the ‘bad boys’-I’m talking about cancers that kill people within six months- even Mayo Clinic will refer you to the crown jewel of all cancer treatment centers: M.D. Anderson. This organization leads innovation worldwide in treating cancer.

Releasing Their Cancer Protocol

When M.D. Anderson releases a cancer protocol, the medical world should sit up and pay attention. Strangely, M.D. Anderson did not announce their newly implemented ketosis protocol at any medical conference. I did NOT read about this update in any medical journal.

Nope. Instead, a patient whispered this information to me as if she was worried about how I would respond. This earth-shattering information, shared via my patient’s small hushed voice, has since changed my whole approach to patient care.

Her mother was diagnosed with a glioblastoma, one of the worst forms of brain cancer. Her mother lived in Texas, near M.D. Anderson. Accordingly, she landed in the hands of the most respected cancer treatment scientists today. When my patient heard that her mother couldn’t receive the first dose of radiation until she’d been in ketosis for two weeks, the daughter did what I would have done: she asked questions.

When she squeezed out all the information she could get from her mom’s medical staff, she hit the library. Still skeptical whether her mother was getting the very best care, she brought her questions to me-her primary care physician.  My response: a blank stare over the rims of my glasses as I processed the word ‘ketosis.’ Not one of my stellar moments.

keto diet and cancer

This happens a lot. Patients bring me a multi-level-marketing-hyped super weird chemical. They ask me what I think. Most of the time these chemicals are a waste of their money. Usually, those products’ effects are so minor they won’t hurt anyone. But that’s not always the case, so I take the time to check them out. This patient’s ketosis question kicked my brain into high gear.

For starters, when she said ‘ketosis’ my brain automatically heard ‘ketoacidosis.’ Fifteen years had passed since I last encountered a ketoacidosis patient. Back in medical school, every time I took a test, they asked about this super scary syndrome of ketoacidosis. When I mistakenly heard ketoacidosis instead of ketosis, I reflexively answered, “Hell no, that sounds scary!”

Except, this woman’s mother was at the crown jewel of all global cancer treatment centers. Why would they be asking this woman to pee ketones before they zap her brain with cancer-killing radiation?  Every single day they delayed the radiation therapy made her survival chances worse. There had to be more to this situation.

I bought myself some time and asked the patient for a week to research the question. My trusty researcher flooded my inbox with ketosis research linked to M.D. Anderson. Her research led to the articles that changed my whole practice philosophy.

What I Found

I found the information referring to the new ketosis protocol at M.D. Anderson. It was very technical, advanced biochemistry chatter. I got the essence of the message that cancer cells used blood sugar or glucose for fuel. Cancer cells don’t use ketones for fuel. They don’t have the cellular goods to use ketones.

For starters, ketones are fuel? Hmmpt. Interesting. Ketones are not the super scary, acidic molecules known to send patients to the intensive care unit.

I’m sure we covered this in medical school. But that was so long ago it felt like new information to me. I had lost that fact many brain cells ago.

The articles went on to discuss that when we fed cancer-filled-animals only ketones, certain cancer cells starved. It sounded a little too good to be true. Still, I was not reading the latest self-published update from hucksters selling salts that change your eye color. It was straight from one of the world’s leading cancer research institutions.

I scanned the report for side effects. Patients in ketosis undergoing radiation treatment run the risk of killing off too many problem cells at once. It can clog their filtration system with dead cancer cells. What?

What a fantastic problem for terminally ill patients to have?!  Let me pick THAT problem for my patients any day. We kill cancer TOO WELL?  Awesome!

Department of Defense Studies on Ketosis

My gem of a researcher didn’t stop the search there. She sent me several other articles. One item from the Department of Defense caught my eye. As a doctor, this one resource stood out to me because the Department of Defense does NOT usually take money from Big Pharma.

Medical research requires funding. Someone has to foot the bill. Usually, that someone has a good reason to spend their money. Figure out who funded the study-and you quickly know the results before even reading the report. Call me cynical, but this is how things typically work in the world of Big Pharma or direct-to-consumer industries.

Put it this way, if a multi-level-marketing company funds a study, don’t be surprised if the report concludes that their product saves the world. What a coincidence, right? That is the reason why I don’t get excited quickly when a new ‘groundbreaking study’ starts making the rounds. For me to get excited, I need something more, well, objective.

When it comes to objectivity, the DOD (The United States Department of Defense) does not play around. It is one of those sources where any potential bias is so small that you can almost believe every word you read.

How the DOD Described it

The Department of Defense released an article describing a study involving ketosis and their divers. At first, I thought, “How strange.” Why would a deep-sea diver need ketosis? The short answer: seizures. The resource explained that our Navy SEALS spend a lot of time underwater. They also pride themselves on stealth. SEALS are all about sneak attacks. Accordingly, they don’t use standard scuba equipment. Their breathing devices won’t leak out bubbles. Good idea, right?

If you’re trying to hide from the enemy by swimming underwater, you can’t leave a trail of bubbles. Talk about a dead giveaway.

A rebreather allows divers to breathe the same air over and over again without leaking bubbles. It calculates the gas concentrations of particles in the air. Their oxygen delivery remains steady while toxic gas levels remain low. What an awesome tool. Right? GO NAVY.

keto diet and cancer

The rebreather makes stealth diving possible without a bubble trail-except for one problem: Every single one of the Navy SEALS using this device started having seizures. Oops, that’s not going to work. There’s one thing worse than having a seizure: having one 30 feet underwater!

The DOD’s research team quickly set out to discover how to prevent the seizures. The first approach they used replicated what we kids having hundreds of seizures a day: anti-seizure medicine. They prescribed these meds to Navy SEALS.

The Results? Stupid Navy Seals. No,Really

The medicines slowed their brain processes down-by a lot. Their timing and reaction skills got super slow, and, worst of all it, didn’t prevent one stinkin’ seizure! Back to the drawing board.

After reading through some literature from the 1900s, research team members found that most of the seizure studies available focused on children. Sadly, most kids were prescribed medication that slowed down their brains. This effect, it turns out, was by design.

The most common anti-seizure drugs work this way. Since seizures are spread through the circuits in our our brain’s, slowing down electrical activity should hold the seizures at a standstill. This solution works for most kids at quite a substantial sacrifice of mental speed and performance.

What happens when the medication fails? The DOD Researchers Unearthed the Answer: The Ketogenic Diet.

The results were startling. The skeptic in me wondered about the chances of this DOD report containing your typical Big Pharma version of snake oil hype. I just could not put DOD in the same category as Big Pharma. The DOD is not in the business of getting the public excited about a new treatment for seizures. There’s no conflict of interest, at least, as far as I could see.

keto diet and cancer

Thanks to this study, ketosis remained stuck to the roof of my mind like hard to reach mental peanut butter. Still, I was looking for something more convincing. The DOD report was eye-opening, but something still held me back from recommending ketosis to my patients.

Autopsy Studies

I needed another data source. Something I know that offers little wiggle room for hyped up conclusions. I found it in the form of autopsies. Yes. Autopsy studies are beneficial. You set up a study selecting a set of patients who have a childhood problem and follow them all the way to death.

Once dead, look at their bodies under a microscope. That’s my kind of study. Remember: I am an internist whose job is to predict what crappy things await you in the future and the best strategies to avoid them.

There is just one problem with long-range childhood to autopsy studies: They are very very very RARE.

How come? That is not how most drug research is done. Drug companies hate these kinds of studies. They take too long and are quite expensive. For Pharma companies to keep costs down, they use animal studies.

They might do a 2-year study to see how well their medicine works. From that point, a statistician makes some long-term extrapolation about future effects based on the two-year data. Bla. Bla. Bla. What’s wrong with this picture? How trustworthy is data based on some goofy numbers twisted by a statistician on a drug company’s payroll?

That is why the hairs on the back of my neck stood on end when my researcher drew my attention to an autopsy study involving ketosis. Dead people don’t lie … as often. Who are the dead people we were inspecting? They were not cancer patients.

Nope, these were the kids from the 1950s and 1960s who were put on a ketogenic diet because prescription seizure drugs failed to make their seizures go away.

The Ketosis Kids

keto diet and cancerThose were the called the ketosis kids. When these kids were in their early teens and suffering from severe seizure disorders, their doctors had failed to control the seizures using medication. After running out of other options, they began a ketogenic diet. These kids were hospitalized and underwent ketosis transition.

Even their families were trained by doctors to keep these patients on a ketogenic diet for a lifetime.  Their compliance with the diet was nearly perfect.  Going out of ketosis caused the return of their seizures.

And now they were dying. Not from seizures mind you. They were dying of old age or health problems unrelated to seizures.

As the dead patients rolled back into the study 60 years later, a few striking findings appeared in the first few corpses. For starters, their brains were some of the healthiest minds the pathologist had ever seen. Wait. Stop.

That is entirely backward. These are seizure patients. The drugs failed them. They got put on this diet as a last resort because they had hundreds of seizures a day.

If you want to see the worst human brains, take a look at the autopsies of seizure patients who suffered decades of untreated and uncontrolled seizures. Seizure patients’ brains are known for being in terrible shape at autopsy. Why are the ketosis kids’ brains so different?

Even when we controlled the seizures, seizure patients’ brains aged differently from normal healthy brains. They tend to be smaller. The insulation coating the nerves throughout seizure patients’ brains are usually thinner. Instead of the smooth areas seen in normal brains, the brain circuits of seizure patients have a poke-a-dot pattern. Simply put, typical seizure patients’ scans look a lot like some of my drug-addicted patients’: broken. Yet, these keto kids’ brains were pristine.

Neurofibril Tangles

Neurofibril tangles, also called brain plaques, are one of the disease markers we see in brains at autopsy. If you’ve ever looked into the grey matter of people with Alzheimer’s, you’d know what a neurofibril tangle is. For those of you that haven’t heard this word before, here is your crash course in neurofibrillary tangles: think of it as ‘rust’ in your brain. It is a buildup of ‘gunk’ that is linked to many brain diseases.  Brains struggling with seizures, even low-level ones, reveal many of these tangles when autopsied.

So why do the grown-up, keto kids’ brains look so good?  It seems impossible. How could a seizure brain have no neurofibrillary tangles?

keto diet and cancerAt this point, I became extremely curious about ketosis. If the lack of brain damage among ketosis patients was eye-opening, my curiosity was kicked up a notch when the autopsies showed that the initial set of patients had no cancer. It was shocking to me because everybody has cancer.

Yeah, I hate to break it to you, but we all have some cancer floating around in our bodies. The real question is how well can we fight off that cancer and undo our body’s cellular mistakes. If you were to autopsy an old person and tell me that they don’t have cancer at all in their bodies, I wouldn’t believe you.

I’d insist that you look again. I’d think that you meant that they have a lower amount of cancer. I can’t imagine a human body at autopsy having no cancer. Everybody has little cancer.

In the 1920s, we learned that tumor cells don’t need oxygen to survive, but they certainly need glucose. Strange. Those cancer cells don’t like a high level of oxygen, but they need their sugar.

Here’s the clincher: cancer cells can’t use ketones for fuel. At this point in my research, only two words came to my mind: hot diggity!!

In 20 years of practice, I’ve never canceled my clinic to study. Studying always came in the extra hours of running a private practice. But I found myself canceling patients so I could better understand this phenomenon I’d stumbled upon. This was far too shocking to let another day go by without me understanding, “What’s the deal with ketosis?”

Learn more about what foods to eat through our FOOD GUIDE teaching you the good – better – and best options for ketosis eating.

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Keto Facts


2 months agoon

August 10, 2018

ketosis phase

Adapting your body to burn fat instead of carbs involves five specific phases. These phases happen in a predictable order that have been researched and studied. Scientists documented the body’s transitions by entering patients into a study where they fasted for forty days. Each phase marks changes in blood chemistry and occurs at specific, scientifically predictable times. With hopes of not overwhelming you, I used three blogs to cover all five phases. In each phase I reviewed where you are in the time since your last carbohydrate, and what fuel source your body is using: ketones versus glucose. I also take note of your brain-fuel in each ketosis phase.

This is the third article covering ketosis phases four and five. Check out part one and part two for the first three phases. This post takes us through keto-adaption.


  • STATUS: Your fuel is now a blend of ketones and glucose. Gradually more sections use ketones as fuel.
  • BRAIN: Powered mostly by glucose, but a few cells use ketones.

This phase focuses on converting stubborn parts of your body to burning fat for fuel. Your ketone resistant cells begin transitioning. By Phase 4 your liver is really good at making ketones from fat. Your blood abounds with these compounds because all liver cells turned on their ketone-producing engines. Slowly the rusty, unused cell parts that make and burn ketones have come to life. If we checked your blood, we would find a hearty amount of ketones ranging from 2-3 mMol/dl.

As the liver pumps out a steady stream of this fuel, the rest of your body is still getting used to processing ketones. Over the two weeks of Phase 4, your ketone efficiency catches up with your liver’s abundant production. By the end of this ketosis phase, your blood ketones will settle into the 0.5-1.5 mMol/dl range.

Now might be a good time to remind you why in the world those ketones are in your urine. Weren’t you supposed to make ketones to fuel your body? Why are they in your urine? Why didn’t we keep them all circulating in the blood?

When you are in Phase 4, the mismatch between how well your liver makes ketones and how efficiently the rest of your body uses them leaves you with too many. Your kidney closely watches your body’s chemistry. Too many ketones trigger the kidney to pass them into the urine. The kidneys and your lungs act as an overflow valve for the extra.

Before you get disappointed about wasting those valuable ketones, keep in mind, they used to be fat calories. You are literally peeing out extra calories! What a magical weight loss plan! Right?

By the end of Phase 4, nearly every cell has processed its own ketone. Your cells may not yet use this fuel steadily, but all of them activate their ketone burning furnaces. Even your most resistant organs have a few cells running on this fuel.

If you kept those carbs less than 20 grams per day, your storage tank is sure to be empty. Your body makes glucose less and less as more cells use ketones instead.

Wait a minute. If you’re not eating carbs and you burned through all the ones you had in storage, where is all this glucose coming from?

ANSWER: It is coming from your fat too. Your fat chains, called fatty acids, travel in groups of three. These three chains are held together by a little glucose-based molecule. Your liver clips off the fat to turn into ketones. A tiny amount of glucose is left over. This tiny source of glucose is saved for your stubborn organs that have a difficult time switching over to pure ketones.


  • STATUS: Your fuel is mostly ketones with a sprinkle of glucose.
  • BRAIN: Powered mostly by ketones, but still uses glucose.

Phase 5 is a when your body becomes the well-oiled machine it was designed to be. Each mitochondrion that can use ketones now efficiently handles this fuel type. Thanks to the steady, constant supply of ketones your cells efficiency to process them increased. They are produced and burned at almost equal rates. Because your production and usage are better matched,  your ketones no long circulate as long. Phase 5 is marked by a significant drop in your blood ketones. Subsequently, the amount spilling into your urine drops, too.

In a rare moment, your ketone production and usage match perfectly, leaving no extras in your urine. This can be tricky if you are only checking urine ketones. Did your ketones stop showing up in your urine because you ate a bunch of carbs? Drank booze? Maybe the bottle of strips was left open and went bad? Or did your urine ketones stop appearing because your system had a perfect match? Rest assured, the first three options are much more likely. In previous phases, the perfect matched situation was not an option.  In Phase 5, it is an option.

Phase 5 is the holy grail. Once your brain reaches this state, you will better appreciate all the hype surrounding a ketosis lifestyle. It borders on euphoric. When patients enter Phase 5, their depression symptoms lift, their focus improves, their attention lasts longer, their sleep is more restful, and their energy is contagious.

How do you get to Phase 5?

There is a fast way and a slower way. The fast way is a strict fast. That is not a play on words. I am referring to an absence of foods. A strict fast is a time of no calories. Only water, tea, or coffee. That’s all. Strictly limit yourself to only those items, and you will be at Phase 5 in about 30 or 40 days. That’s a tough sell.

I DO NOT recommend this option; especially if you are eating a high-carbohydrate diet right now. High carbohydrate means eating over 60 carb grams per day. There are just too many chemistry shifts that have to happen in your system. It’s too unsettling, too uncomfortable, and in many of my chronically ill patients, it’s dangerous.

Instead, transition to Phase 5 using a high-fat diet. Patients transition to a high-fat diet and pee ketones for several weeks. This allows time to adjust. It also provides time to see how much social pressure is placed on eating carbohydrates and low-fat foods.

Screw-ups often happen when first eating high-fat low-carb. They drink alcohol. They eat too much protein. They get stingy on their fat consumption. They mindlessly binge on ice cream after a stressful day. [or maybe that is just me!]

Or someone near them celebrates an occasion with sugary treats, and the temptation becomes too great at the moment. The bottom line?

Changing habits is hard.

The idea that a smoker wakes up one day and stops smoking for the rest of his life is a fantasy. That person who ‘suddenly’ quits smoking had months, maybe even years, of thoughts and false starts about quitting before they stopped for good. Their environment played a significant role in their success. If their world tempted them with cigarettes at every turn, their chances of achieving a smoke-free life one year later are unlikely. People in keto transition need support. Without it, temptations win out.

MY GOAL: a healthy life.

Not a sprint to ketone positive urine tests. The key to sustainability is the LONG GAME.

Ultimately, it doesn’t matter whether you get to Phase 5 in 6 weeks or 6 months. Boost your chances of lifelong success by keeping your priorities straight. Remember why you decided to go keto in the first place. Write it down. Say it out loud. Share it with a friend. My personal reason for going keto: Brain fuel, brain fuel, brain fuel.

If you want to learn more about the ketogenic diet, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

keto ebook cta

Keto Facts


2 months agoon

August 10, 2018

ketosis phase

Adapting your body to burn fat instead of carbs involves five specific phases. Each ketosis phase happens in a predictable order that have been researched and studied. Scientists documented the body’s transitions by entering patients into a study where they fasted for forty days. Each phase marks changes in your blood chemistry and occurs at specific, scientifically predictable times. With hopes of not overwhelming you, I will take three blogs to cover all five phases. Each phase I review where you are in the time since your last carbohydrate, and what fuel source your body is using: ketones versus glucose. I also take note of your brain-fuel in each phase.  This post focuses on phase three. In part one we discussed the first two ketosis phases. Check out part one here!

This is the second article covering these phases. Check out the previous post for the first two phases. You completed phase two by emptying your liver of all of the stored sugar.  Now you’re ready for phase 3 of the transition into keto-adaption.


  • THIS STARTS: 24 HOURS after you ate your last carbohydrate.
  • STATUS OF THE BODY: Your fuel is still mostly glucose, but your liver begins making ketones. Only a couple of areas in your body use ketones as fuel in phase 3.
  • YOUR BRAIN: Still powered only by glucose.

You will know the exact point when you complete phase 2 and enter phase 3. How? You start peeing ketones! Transitioning from phase 2 to 3 happens at different times for different people because of the liver’s variables described previously.

Here are some common statements from patients that tip me off to the possibility that they may have an overstuffed liver:

  • ‘Doctor, I have tried every diet. None of them worked.’
  • ‘Doctor, I am a dude, and I look pregnant. Can you fix this?’
  • ‘Doc, I had a gastric bypass and lost a bunch of weight… but I gained most of it back.’

These patients have a biochemistry crisis hidden inside their livers. They have had gastric bypass, gastric banding or their jaws stapled shut and still were not able to achieve lasting weight loss. They are patients who have used speed pills and antidepressants, participated in group therapy, undergone hypnosis, and injected hormones to lose weight. All share the same result: zero to minimal lasting weight loss. Alternatively, those that lost some weight gained it all back sooner or later.

They were all fighting the hidden monster of the chemistry that blocks against weight loss. The name of that enemy: insulin. The medical term for these patients is insulin resistance, but I tell them that they have stubborn livers.

If you pee ketones by the end of the second day of cutting out carbs, do a little dance. You are not likely to be the owner of a stubborn liver. Keep track of how long it takes you to get to ketosis phase 3. This time-to-first-urine-ketone predicts the size of your liver. Much like your fasting blood glucose results, this information tells you and your medical team what has been happening under the surface.

What is the key? Reduce your daily carbs to 20 grams or less. This shocks your sugar-dependent system. In ketosis phase 1, every cell in your body fueled their furnaces with glucose; specifically, your brain is 100% dependent on sugar.

In phase 3, certain parts of your body switch to using ketones for fuel. The first tissues to adapt is your liver. Yep. That stubborn liver makes the first ketones. In fact, your liver supplies the majority of your ketones. The rest of your body will slowly learn to BURN ketones. Only the liver and a few other types of cells make ketones.

Once ketones are circulating in your blood, the first cells to use them are your fat cells and your muscle cells.

Other sections of your body are more protective of which fuel they use. Those tissues wait to see if this ketone fuel will be available only temporarily or long term.

Here’s a cell ranking from most to least adaptable to use ketones: fat cells, muscles, skin, internal organs (heart, lungs, and kidneys) and brain.

The brain is the most resistant to fuel transition. That makes sense.  We don’t want our most vital organ flip-flopping between fuel sources. The brain waits the longest to convert to fat-based energy. When the brain finally switches over though–it feels good. SO GOOD!

Here is the play-by-play transition that I recommend for you. Just follow these steps.

Eat your final carb-based-meal and a couple of hours later go to bed.

When you awake, you are nearly 10 hours into your transition.

Within the next 12 hours, your liver will empty your stored sugar.

Throughout the day, use MCT C8:C10 oil or heavy whipping cream in your coffee. Drink water. Eat all the eggs you want. Cook them in butter.

Eat a couple of sausage patties or bacon for lunch. For work, take along some high-fat cheese and slices of pepperoni in case you feel like eating in between meals.

That evening, go out to eat and order buffalo wings dipped in blue cheese dressing. Be sure to order the wings in buffalo sauce and not honey mustard or barbecue sauce. Those have carbs in them. You want the buffalo sauce. Eat wings until you are full. No beer. No soft drinks. No breading on your buffalo wings. Keep the skin on. Double dip them in blue cheese dressing. Add only water for a drink.

By 8 o’clock that night, your liver should be cleared entirely of glycogen. It should be completely clear of stored sugar. Your early-adapting organs will gradually begin to switch their fuel source to ketones.

Go straight to bed. Forget about getting a carb-rich snack like you’re used to. If you followed instructions, your cupboards should be emptied of all those temptations anyway.

You’ve made it 24 hours since your last helping of carbohydrates. These next 12 hours are best dealt with by sleeping and staying SOBER: Don’t drink booze. Touch any alcohol, and you can kiss ketosis goodbye.


I have had some patients report their bedtime as 8 PM that first night. They did not know how else to get off their normal routine. I don’t care how you do it, just get to the next morning.

Wake up the next morning. It’s been 36 hours since your last high dose of carbohydrates. This puts you almost always into ketosis phase 3. Check your ketone strips. Even a slightly pink color on the strip is a win.

Stubborn livers beware! If your liver is overworked, stretched out or engorged with stored sugar, you might not be there yet. If you’ve been a huge carb junkie, overweight for many years, or a full-blown diabetic, you might have another day ahead before your ketone test turns positive.

Make this your morning ritual: Check your ketone urine strip.

Put four more strips in your pocket. These little urine-strips break down when exposed to air for too long. You have only that day to use the strips in your pocket. Otherwise, throw them away. Each time you pee, check your urine for ketones.

Use those ketone strips to see exactly which ketosis phase you are in. Are you in ketosis phase 2 or have you arrived at ketosis phase 3? The answer is hidden unless you look.

ketosis phase

Before I insisted that patients check their ketones, several patients who needed this lifestyle the most gave up. I lost them in frustration. This sets in when you don’t know what is going on inside your system. Changing eating patterns shocks the daily routine of most patients. They are delighted when the results hit them – mentally and physically. But if the results never come, frustration leads to failure. They ask for my help, and I need reliable information to help them. Keep track of how long it takes your liver to empty. Check your urine ketones.

My experience with peeing my first ketone involved a full month of frustration. I was insulin resistant and then I ate too much protein. I realized I had one of those stubborn livers. I was also unaware of the carbohydrates hidden in gum, toothpaste, cough drops and sauces. I didn’t know the mayonnaise I was using had carbs in it. I also ate soups made with flour. I would be doing well and then BAM-no more ketones.

Had I not been looking at that urine ketone strip the first month, I would have certainly given up. The mistakes I was making would have been unknown without that feedback.


If you want to learn more about the ketogenic diet, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

Click Here for Part 3!

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Keto Facts


3 months agoon

August 6, 2018

Adapting your body to burn fat instead of carbs involves five specific phases. Each Ketosis phase happens in a predictable order that has been researched and studied. Scientists documented the body’s transitions by entering patients into a fasting study. They fasted for forty days. Each phase marks changes in your blood chemistry and occurs at specific, scientifically predictable times. With hopes of not overwhelming you, I will take three blogs to cover all five phases. Each phase teaches how much of your body is using ketones versus glucose. Take note specifically of what fuels the brain in each phase. This post gets us through phases one and two.

Ketosis Phase 1: Use Up The Sugar In Blood


  • STATUS: Your fuel is 100% glucose during phase one. The glucose you burn comes from the carbs you just ate or drank. NOT ONE section of your body runs off ketones.
  • BRAIN: Powered only by glucose.
  • Entering Phase 1 is the easiest part of getting into ketosis. You do this every night when you go to sleep. You simply use up the sugar that’s currently in your bloodstream. Every time you eat more than a spoonful of sugar or a handful of carbs you reset your system back to the beginning of Phase 1.

Phase 1 begins by processing the glucose that’s already in your blood. This glucose came from the food you ate over the last 4 hours. Phase 1 is short. It ends after 4 hours unless you reset things by eating more carbs. Then it starts over. Don’t do that.

Go to bed two hours after your last carbohydrate. Before you wake up, you are through Phase 1.


Ketosis Phase 2  Burn Sugar Stored In Liver

  • TIME: 12+ HOURS
  • STATUS: Your fuel is still 100% glucose, but now your carb fuel is coming from your stored sugar called glycogen.
  • BRAIN: Powered only by glucose.
  • You burned up those circulating sugars in your bloodstream. With no more food coming into the body through your mouth, your system will use your stored sugar. This stored sugar is called glycogen, and you keep it in your liver cells. Phase 2 fuels your body using this stored energy.

How Long Will Your Storage of Glycogen Last?  Good Question.

The answer depends on a couple of things: the size of your liver and the level of energy usage in Phase 2. Sleeping during this phase takes less fuel than running for 45 minutes. Fighting cancer or infection requires more fuel than living without those issues. Mending a broken bone or repairing from surgery requires more energy than sitting at your desk writing a blog.

In addition, how large is your storage tank? Asked another way: How big is your liver? I bet you’ve never thought about that. Its size depends on how much stress you’ve put on your life in recent years. Your liver constantly grows new cells to meet your body’s needs.

If you drink excessive alcohol for twenty years, you will make additional liver cells to keep up with your drinking. Similarly, if you eat lots of extra carbohydrates for two decades, your liver will expand to store your extra sugar.

From my experience, patients with the largest livers are not alcoholics. Instead, the biggest livers belong to my patients addicted to carbs. If they are not already diabetics, they will be. They have overstuffed their livers with the age-old habit of constantly eating carbohydrates. They don’t allow enough time to empty stored sugars before eating more.

Long before diabetics are diagnosed as such, their livers strain from the pressure of the carbs they eat. They make more and more liver cells to keep up with the carbohydrate onslaught. If they cannot make extra liver cells as fast as they overeat, sugar remains in their bloodstream longer than normal. Insulin works overtime whipping the glucose into the mitochondria’s furnaces or into storage. The danger signal of insulin rings constantly. They keep eating and therefore more sugars enter the bloodstream before the abundant pine needle-like fuel gets burned or stored. The screaming alarm signal of insulin becomes a constant noise. This hormone’s danger signal becomes less and less effective as blood sugars steadily rise.

Diabetes is defined as a state of constantly elevated blood sugars. Diabetics never empty their storage. I do mean NEVER. Their liver cells are stuffed with glycogen. Their cells have no more room. In an attempt to store their extra sugar, they grow additional liver cells.

Did you empty your liver last night? Let’s check. After 12 hours with only water, prick your finger and check your fasting blood sugar.

Don’t roll your eyes. You must know someone who has diabetes and checks their blood sugar. Borrow their glucose monitor for one day. No, they won’t die if they don’t check their sugars for a day.

If you burned through all your glycogen and emptied your storage [emptied your liver] your fasting sugars will fall between 55-80 mg/dL. That’s a surefire sign you have a normal sized liver. If your liver has been stretched and stuffed with too many extra carbs in recent years, you won’t burn through all the storage in 12 hours. It might take you 20 hours to burn all those pine needles. Some severely overweight patients take a week. If your blood sugar is greater than 120 mg/dL at 12 hours of fasting, you have DIABETES. No joke! That’s the rule of how to diagnose a diabetic.

Ideally, your liver should deplete all stored sugar before you eat another bite of food, especially foods filled with carbs. By the end of Phase 2, your body has burned all of your fast-burning fuel.

If you want to learn more about the ketogenic diet, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

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