In and Out of Ketosis: How Harmful Is It?

In January, lots of people are extra motivated to get back into their healthy (keto) lifestyle and workout routine. Of course this is a great thing! However, it can also be a month wherein we are more harsh on ourselves. Sayings like: ‘I have to become fit again’ or ‘I have to get back into ketosis again’ are not uncommon. Especially after treating yourself some high-carb foods during the December month, which come on; we all do at some point!

In the beginning of this first month of the New Year, it might also happen that you experience feelings of guilt: ‘why have I indulged and what have I done to my body to get myself in and out of ketosis?’ ‘Help, I totally ruined my progress and I have to start all over again!’ Maybe you even feel like you have cheated on keto and are not a real keto-er.

Let’s all be a bit kinder towards ourselves, shall we? Cheat moments and getting in and out of ketosis are not the end of your keto progress! We are all human and we all fall of the wagon sometimes. So let’s dive into the science and tips and tricks to make sure these indulgent moments will not ruin your keto progress and positive feelings.

First things first: nutritional ketosis versus fat-adaptation

Did you know that it is possible to be in ketosis but not fat-adapted? Or to be fat-adapted while not being in ketosis? Probably not! Let me explain.

In the situation when your body uses fat (the ketones) as primary fuel instead of carbohydrates, you can enter nutritional ketosis in a matter of days. This basically happens when you have depleted all your stored glucose in the form of glycogen or when you fast.  The amount of days depend on individual circumstances like your activity level, and your metabolism. When your body is in nutritional ketosis for a prolonged duration (one month or longer), it becomes “fat adapted”. This is a fancy way of saying that your body now runs on (stored body) fats instead of on carbs for energy. Once your body is fat-adapted, you conserve carbohydrates.

Fat-adaptation is a long-term thing since you have been used to burning glucose almost all your life. Your whole body changed the way your cells react to carbs and fats. It therefore requires a return to eating carbs for at least a couple of days, before spoiling all the health benefits of fat adaptation.

Signs of fat-adaptation are: weight- and fat loss, increased energy levels, better sleep and less sleep needed, feelings of fullness in between meals, less or no (sugar) cravings, improved sports performances.

So why do we all want to be in ketosis?

That’s a good question! Measuring is knowing right? Yes, that is correct and especially if you are new to keto you just want to know if you are on the right track. That being said, measuring ketone levels is a very precise thing to do and depends on many different factors.

The trigger of being in nutritional ketosis is that your body has run out of stored glucose (glycogen) for energy. Your liver starts to produce ketones caused by looking for a different type of fuel. You can already be in ketosis after a couple of days, when your body enters starvation mode after a prolonged fast for example. Or after a workout marathon. Or even right after waking up. Your body is constantly producing ketones, and your levels of ketones can vary throughout the day. Factors such as movement, stress levels, and carbohydrate sensitivity determine your ketone levels. You can even be in nutritional ketosis when you normally follow a high-carb lifestyle and decide to do a fast for 18 hours.

The sweet spot of blood ketone levels? Studies and research shows that ketone levels of 1.0 - 3.0 mmol / L are an optimal range of nutritional ketosis. That being said, the higher is not per se the better. For one individual, levels of 2.5 result in experiencing all the keto benefits while for the other this is already at a level of 0.5.

Short-term versus long-term goal

At the beginning of your keto journey, you produce lots of ketones. You are able to measure them with urine strips. As soon as you become fat-adapted, these levels drop. Your urine strips probably don’t colour anymore and you might think you are doing something wrong. Do not stress yourself about this: it is how it naturally works! Your body and especially your muscles have programmed themselves to run on broken down stored body fat (in the form of free fatty acids), and ketones are therefore less needed. All the ketones are now being used by your brain.

After being on keto for a while and almost no cheat days, your body is in optimal fat-burning mode. Your body is now using the ketones more efficient and as a result it shows lower levels of ketones on your blood ketone meter or other type of device. Yes, it may sound confusing and contradictive…

Remember that nutritional ketosis is a short-term goal but not the long-term goal. It is easy to get in and out of ketosis. Drink a glass of coffee with MCT and you are basically in! Just try it yourself by using a blood ketone meter and see what happens. Falling out of ketosis is easy as well. Experience a lot of stress, lack of sleep or skip your workouts and your insulin and blood sugar levels will spike. Resulting in lower levels of ketones. So, nutritional ketosis is a variable status!

For me personally, my blood ketone levels were 0.7 two hours after dinner and the next morning my meter showed levels of 1.9! And I have to admit, I felt way better after seeing the high number. It even felt like a placebo effect, cause I was not even hungry anymore that day ;) We humans like validation, that is a fact: knowing that we are on the right track and making progress.

Oops, I cheated (again): what now?

You decided to have a cheat day or meal and you can just feel you kicked yourself out of ketosis. ‘Help, I ruined it all!’ Is going through your mind. Calm down, take a deep breath and read what actually happened.

As soon as those carbohydrates and sugars enter your body, your blood glucose levels starts to rise. As a respond, your pancreas starts to secrete insulin. This fat storage hormone stimulates your body to store the blood glucose in the liver as a form of glycogen up till 100 grams. This state is also known as the fed state. In this state, your body is not producing ketones anymore. Until your body has used all the stored glucose for energy or stored it in your muscles. So when these stored carbs are gone again, your blood sugar levels starts to fall and your liver sends out a signal to release the glycogen. This process takes up about 16 hours and depends on your activity level and the amounts of carbs you ate.

Bottom line: once all your glycogen is depleted, the production of ketones starts again. This return is exactly the same as when you initially started your keto lifestyle. Getting back into ketosis happens faster the longer you have been on keto before you decided to cheat. And the good news? You can help your body a bit to get into the fat-burning mode a little faster. Deplete your glycogen levels by implementing a day fast and a solid workout! The higher the intensity, the more glycogen your body uses and the faster you will hop on the keto-train again. Those side-effects of being out of ketosis like guilt, feeling tired, brain fog, and cravings will disappear rapidly.

Negative effects on the body when you cheat

Some studies indicate that cheating when you are just started keto can cause blood vessel damage when you suddenly fuel your body with glucose-rich foods again. Your body is not fully fat-adapted yet and is therefore in this in between stage which makes it more harmful to cheat compared to when you are already fat-adapted. This suggests that cheating should be less damaging when picking food products that are lower in glucose, have a lower glycemic index, and are higher in ‘healthy’ high-fiber carbs such as sweet potato, legumes, oatmeal, butternut squash, quinoa, and brown rice.

Regular cheating will have a worse impact on your body compared to a cheat once in a while. Your body is in the first case constantly switching from burning fat for energy and burning carbs for energy. This causes a lot of stress in your body and can lead to negative health outcomes such as weight gain, increased blood pressure, increased cholesterol levels, and increased blood sugar levels. So do not use this article as an excuse to be cheating regularly!

Another possible negative effect is that you turn back to binges when you fall “off your keto wagon,” and cheating may reinforce this behaviour. I am talking about yo-yo dieting health risks here.

Planned healthy carb-ups

Another interesting fact: planning carb-ups with low-glycemic carb products so now and then (also known as cyclical keto) might even improve your keto results and progress. Especially women (considering differences in their hormonal balances throughout their cycles), and fanatic sporters could really benefit from this. Check this article to find out if this is the right approach for you.

The bottom line

The ultimate advice is to listen to your body and understand where your carb tolerance lies and where your cravings are coming from. Just notice how you are feeling and decide for yourself whether your cheat meal or day will be worth it or not!

Measuring ketone levels can be very helpful in this case, but make sure not to obsess about the numbers. Your levels can show you how your body respons to different food products, exercise, sleep, and stress levels. These are great measurements to keep track off, yet know that the longer you are on keto the lower your blood ketone levels probably are.

Instead, focus on the long-term positive metabolic change which is fat-adaptation. Yes, one carb meal so now and then (once a month) will kick you out of ketosis but when you are on keto for a while it will not kick you out of fat-adaptation. The longer you are fat-adapted, the less worries you should have about not being in ketosis. Cheating is not the healthiest thing you can do, but we also totally understand that some days it is difficult to stay 100% keto. That being said: if you are a newbie, save those cheat days for later! Otherwise you have to start all over again and maybe experience the keto flu one more time. Your body will thank you :)

It is also good to know that there are enough keto snacks and sweets to make or buy that will not kick you out of ketosis. And what if it happens that you are finding yourself munching on that high-carb treat or piece of bread? Enjoy it to the fullest and just pick it back up the following day! Keto is a lifestyle and not a restricted short-term diet as some people suggest. You might feel a bit off afterwards, but being angry at yourself is even more stressful than having a brain fog.

In other words: be mindful throughout your keto journey, that is really the most important part.

Measure your ketones the right way!

So how can you (besides noticing how your body responds and how you feel) properly measure if you are in or out of ketosis? Invest in a high-quality blood ketone meter; make sure that you buy a good brand to get the most accurate results. The glucose- and ketone blood meter we use from our partner Swiss Point of Care will meet your needs and standards. Buy it here!

DISCLAIMER

Keep in mind that going in and out of ketosis can be more harmful to individuals who follow keto for therapeutical reasons compared to individuals who use keto for more energy and weight loss. Information and other content provided on Myndfuel, or in any linked materials, are not intended and should not be construed as medical advice or as a substitute for a substitute for your current medical treatment. Always talk to your doctor or healthcare professional before starting to implement a significant diet change. On Myndfuel you can get advice from a Certified Dietitian who creates a personalised program for you, meeting your individual needs and wishes.