Chapter 5: Ketogenic Diets


Why You’re Fat and Sick

When we burn fat, we can’t do it directly.  Your cells don’t run on bacon grease.  To burn fat, the body must send it to the liver to be processed into a burnable fuel called ketones.  These are the modified form of fat that your body can use for energy.  So a “ketogenic diet” is a diet designed to help the body shift from burning glucose to burning fat.  Recall from previous chapters that the human body is either in fat storage mode when burning glucose or fat-burning mode (when glucose isn’t present).   Your body uses the hormone insulin to signal which fuel it is using.  When you are insulin resistant, your body has too much insulin and isn’t signaling correctly.

The human body is designed to be adaptive; it is supposed to run on glucose and ketones at different times.  All human beings should enter a state where the body produces ketones regularly.  This can be accomplished by eating a very low carbohydrate diet for a period, or it can be achieved by simply not eating.

The idea that excessive carbs make you fat is nothing new. When I was a kid, I remember my elders talking about how certain foods make you fat.  They always mentioned baked goods.  It wasn’t until much later that fat was demonized, and massive doses of sugar were given the green light. Historical medical texts dating back hundreds of years control weight with carb restrictions.  Not all were labeled “ketogenic,” but the term is a good description.

Ketogenic diets are all the rage these days.  There is a lot of hype, and the internet (as usual) has factionalized with keto prophets espousing the virtues of the lifestyle and others claiming it is a public health crisis that must be eradicated.  If we look at it objectively, a ketogenic diet requires adherents to eat very low levels of carbs such that the body switches from burning sugar to burning fat.  There are several million permutations of this theme.  Contrary to what some detractors have suggested, you are not required to live on bacon exclusively.  Vegan keto is possible if you don’t want to eat anything with a face (it is just a lot more challenging).

When the body is being fueled by fat (ketones specifically), you are said to be in a state of ketosis.  This can be accomplished by any strict low-carb diet, including but certainly not limited to a gluten-free diet, the Paleo diet, and the old Atkins diet.   Keto is just a supercharged version of these old ideas.  I say supercharged because the amount of carbs allowed is very, very low.   To accomplish the goal, you just avoid foods with a lot of carbs:  Soda, fruit juices, pasta, bread, rice, potatoes, corn, and processed junk food like candy and chips.

Instead, you eat meat, fish, fresh vegetables, and natural fats (avocado, butter, etc.).  Vegetables can be tricky, and you have to learn which ones are high in carbs and which are low in carbs (never fear, a list is provided in Chapter 7).  These sorts of diets keep popping up in a slightly different form decade after decade for one compelling reason: They work.

A word of warning is warranted here.  In the body, glucose locks up a lot of water.  When you go on a keto diet, you start shedding glucose, eliminating a lot of water.  Water is heavy, weighing in at around 8 pounds per gallon.  Any weight you lose on a keto diet above a half-pound per day (roughly) is water weight, and you will put it back on as soon as your glucose levels go back up.  Only a tiny fraction of the initial weight loss is fat.   Many people see this and give up on keto because “the weight comes right back.”  You are losing fat (unless you eat crazy amounts of low-carb foods), but it is a small fraction of the total weight loss when you step on the scale.  Fat is incredibly calorie-dense, and it takes a lot of time to burn up all that stored energy.  Be patient and realistic in your expectations.

After a few months on a keto diet, you will feel better and be leaner.  Metabolic conditions will likely improve, and cravings for junk food will diminish.  Your energy levels will even out, and you won’t want to snack all the time.  That is, you will have constant energy throughout the day.   Once you burn fat for fuel, you have a nearly limitless supply that never runs low.  You can be happy with fewer meals, and avoiding snacks is easy for the first time.

In our everyday language, abnormal is terrible.  When it comes to diet, abnormal is now standard.  The world eats high-carb foods that are processed and concentrated and designed to be addictive.

Do Calories Matter?

As you suspect, the internet is full of misinformation. This book argues that you can’t lose weight until you get insulin under control.  The basic logic is that when you eat the standard American diet and eat the wrong things too frequently, you can’t burn fat because your body is stuck in fat storage mode. While fasting and ketogenic diets will help you flip the metabolic switch and start burning fat, the amount you eat matters.  It isn’t a calorie in calorie out model, but the model does have some merit when you are in fat-burning mode.

Before we look at what works, let’s take a few minutes to review what doesn’t work.  By that, I mean the classic “healthy diet” method advocated by the establishment.   Let’s say you go to your doctor for something, and she doesn’t like some number.  There are most likely several numbers that she doesn’t like because metabolic syndrome is the cause of lots of problems, and those problems are what doctors tend to measure.  Your cholesterol is high, your blood sugar is high, your blood pressure is high, and so forth.  She’s likely to tell you that all these problems are related to obesity and that you need to lose weight.  This isn’t false information.  All this stuff has a common cause, so they are related (correlated is the word scientists use).

You’re a fat ass, so you ask the obvious question: How do I go about losing weight?  Ah, easy stuff.  Just limit your calories and burn more of what you have.  If you want to empty your gas tank, (1) don’t stop at the gas station and (2) drive a lot.   So the standard advice is to reduce what you eat by about 500 calories daily.  If a pound of fat takes 3,500 calories to build, you should lose a pound per week on such a diet.

This advice has been the status quo for around the last 40 years, and it doesn’t work for anybody (except for that guy in Albuquerque with a popular YouTube channel).  It doesn’t work for several reasons.  Most of those reasons have to do with how the body operates, not a moral failing on the part of the patient.  When I say it doesn’t work, I mean that it is only successful in a sustainable way for about one-half of one percent of people who try it (Fung).

Any treatment with a 99.5% failure rate sucks and should be abandoned.   People who should know better but still give this advice are cowards or idiots.  They don’t want to be sued or questioned by the old guys in the long white coats, or else they don’t want to bother with the hard work of helping fat asses get their shit together.  The “a calorie is a calorie” idea is just plain stupid when we examine the “empirical research evidence” that medical best practice is supposed to be based on.   In this garbage model of human nutrition, 100 calories in a candy bar are identical to 1oo calories from salmon.

Yet we know that from the moment those foods touch your mouth, the body’s response is entirely different.   Food contains nutrients, but it is critical to understand that food contains instructions.  In other words, the makeup of the foods we eat tells our bodies what to do with them.  If you eat that candy bar, the hormone insulin spikes way up, preparing the body to deal with the sugar that’s coming.  Part of that message is, “please store body fat.”

Calories can be used, or they can be stored. If you eat the candy bar, it goes straight into fat storage.  Suppose you eat the salmon, on the other hand. In that case, insulin will not spike very much. Your body can use those 100 calories for energy and other things, like building and repairing tissues.   The bottom line is that calories matter, but so do the instructions we give our bodies about what to do with them.

If you are a chemist, “a calorie is a calorie” is so apparent the statement is silly.  It’s like saying, “a cat is a cat.”  Of course, a cat is a cat, and a calorie is a calorie.  Logically, it can’t be any other way.  But the question we care about isn’t really that.  The better question is, “are all calories equally fattening?”  The answer to that question is decidedly no.  If your doctor persists in telling you that cookies and cauliflower are equally fattening, get a new doctor.  Your grandmother understands this, and so should your doctor.   Nobody ever got fat eating cauliflower.

At this point, you’re probably thinking, “well, genius, if the standard diet doesn’t work, what am I supposed to do about being a fat ass?”  The answer is that we need to adopt an eating strategy that encourages our bodies to use all that energy we’ve stored in the form of body fat.  There are two essential things you can change to pull this off.  My suggestion is to do both.  The first thing you can modify is what you eat.  If insulin is the fat storage signal to the body, then we need to lower it.  That means we cut out sugar and limit other forms of carbohydrates.  The most powerful way of doing this is the ketogenic diet, which we will discuss in greater detail below.

You can also manipulate when (how often) you eat.  Both issues are massive rabbit warrens on the internet and in the book selection on Amazon.  Ketogenic diets do work.  They do so because they control the body’s production of insulin and encourage the burning of body fat in doing so.  Intermittent fasting also works because it calls for us to limit how often we eat.  The presence of carbohydrates (carbs) in the body signals insulin, which signals the body to store fat.  When we don’t eat for a time, insulin levels fall, and the switch flips from fat storing to fat burning.  So there are two basic strategies to fix a fat ass.  I believe that both, working together, is the most potent strategy.

In an age of perpetual plenty, it is unfortunate that the human body is a highly efficient machine.  The body makes a concerted effort not to waste energy; it doesn’t burn calories if it can help it.  It is metabolically easier (i.e., “cheaper”) to use blood ketones than to take the fat out of storage and burn it.  So if you eat more calories worth of fat and protein than you need, you will not lose body fat because you are burning what you just ate instead.  This is why Dr. Fung and similar thinking people suggest that fasting is better than ketogenic diets.  You take in zero calories when you fast, so you gain zero new calories.  No new fat can be generated, so your body must burn body fat.  Ketogenic and other low-carb diets can flip the metabolic switch and allow the body to burn fat. Still, the number of calories you take in must be less than your body requires for energy needs.

A significant benefit of eating healthy whole foods is that most real natural food contains a ton of fiber.  The body doesn’t break down dietary fiber; it just passes through the gut and feeds some healthy bacteria.  It will keep you regular, but it can’t make you fat.  You can eat an entire bag of broccoli from the freezer and still not have the same calories as a candy bar.  The broccoli won’t spike your insulin (much), so your metabolic health will improve.

If you have ever been at a Chinese buffet and eaten like a pig, you probably started feeling nauseated by the food’s sight and smells. So, you can’t just ignore calories at the end of the day.  But most people don’t need to count if you are fasting or eating a healthy ketogenic diet.    Suppose you are eating a lot of high fiber, nutrient-dense, low-calorie foods. In that case, you will automatically be in a caloric deficit. Nutritionists use the word “satiety” to describe feeling full after a meal.  If you feel full, you stop eating. That is maximal satiety.  A key factor in feeling full is the stretch receptors in your stomach—volume matters.  In addition to retraining your body to know it doesn’t need massive volumes of calorically dense foods, you can feel full faster by eating nutrient-dense foods that are not calorically dense.

Is It Unhealthy?

The biggest downside to ketogenic diets is that you must learn much about the macronutrients in foods to keep your carbs below the target.  Not an easy task! This is usually a meager target, like 20 grams per day of carbs.    You can also spend a lot of money on keto products, but often these are highly processed and aren’t very low carb like the phrase “keto-friendly” suggests.

If you worry that you need carbs for something, put your mind at ease. Your body needs only a tiny fraction of the sugar and carbs we eat.  That’s the reason we are so fat and sick.  We pack the body full of glucose and have no idea how sick that makes us.  Your body, especially the brain, does require a little glucose, but your body can make that out of stored fat.  You don’t die every night while you are asleep because you are fasting.

You will go into ketosis if you choose a ketogenic diet with nothing but steak, bacon, and cheese.  You will, however, not likely lose much weight.  All that super-calorie-dense food provides all the energy your body needs, so while you can burn body fat, you don’t need to do so.  Your body will take the easy path and burn the food you just ate rather than pulling fat out of storage.  Interestingly, you can have some initial success eating a lot of meat.  If you have steak and eggs for breakfast, you will feel full for a long time because these dense, high-protein foods are very satisfying and take a long time to digest.  If you are satisfied while being in a caloric deficit, you will lose weight.


Most people that diligently attempt a keto diet have excellent results.  They cut a lot of weight and do it very quickly.  At some point, however, the weight loss stalls.  You’ve reached a “plateau.”  This means that the weight loss stops, and the weight remains constant.  Often, this is caused by people getting sloppy and moving from keto to “sort of keto.”  Ketosis is nearly a binary proposition.  Either you are burning ketones, or you are burning carbs.  You have to keep your carbs below the threshold.

A big problem with this is that there is no single threshold, so what you see on the internet is just a rule of thumb.  Some people say to stay below 50 grams of carbs per day; some say below 20 per day.  I suggest buying ketone strips and keeping a food diary until you figure out your level.  Failing that, err on the side of caution and go with 20 grams per day.  Then it’s a matter of digging into what you’re eating and identifying the always-present hidden carbs.

If any category of keto-friendly foods holds people back from achieving their weight loss goals, it must be dairy.  Many people begin eating ketogenic, using cream, sour cream, cream cheese, and cheese as a consolation prize for missing out on fried potatoes and sweets.   Dairy may taste great, but it is very energy-dense.  I suggest establishing a reasonable limit for dairy, say 4 ounces of dairy per day total.  Also, note that fresh milk is relatively high in carbs from the keto perspective.

The High Fat Problem

It may be hard to wrap your head around this, given the war on fat that’s been waged in the Western world for the past several decades. Still, there is some convincing clinical evidence that fat may be beneficial.  Saturated fat is still demonized, but the medical and nutritional establishments seem to be warming up to other types of fat.  For example, Gadgil et al. (2013) observed that

…the results suggest that reducing carbohydrate while increasing unsaturated fat in a healthy diet improves insulin sensitivity in the setting of stable weight. Interestingly, there was no corresponding improvement when participants consumed the reduced-carbohydrate, increased-protein diet. Hence, the improvement in insulin sensitivity on UNSAT [the high-fat diet] appears to result from an increase in unsaturated fat rather than a decrease in carbohydrates.

My takeaway from these findings?  A high-fat diet can help reduce insulin sensitivity.

Why No Fruit?

Conventional wisdom says to eat lots of fruits and vegetables if you want to be healthy.  This may be true if you are metabolically healthy and want to stay that way. Still, once you become insulin resistant and metabolically ill, you can’t reverse the process if you put any sugar into your body.  Fruit juice is liquid fructose, and nobody should ever drink that stuff.  It can have more sugar than soda.  Metabolically fit people perhaps should follow the old dictum of eating an apple a day to keep the doctor away.  The fiber in whole, fresh fruit forms a barrier to rapid fructose absorption, so there isn’t the massive insulin spike that comes with drinking juice.  A single cup of apple juice contains 28 grams of carbs and very little nutrition.


To be successful in any healthy eating strategy, you have to learn not to consider “drinking” as something separate from “eating.”    Whether your nutrients come in a solid or liquid form doesn’t matter.

If you are fasting, your list of beverages is minimal because you want to avoid any macronutrients.  This means that water is your “go-to” beverage.  If tap water is terrible, try to find an alternative you enjoy.  Still or sparkling as fine.  It just can’t be sweet.  Many people prefer mineral water to distilled water because the minerals add flavor.  Coffee and teas are acceptable if you don’t add cream or sugar.


Perhaps the most controversial diet to come out in recent years has been a limited subset of the keto diet universe, commonly called the carnivore diet.  Advocates of this style of eating admit that it is challenging. They suggest that you make at least a 30-day commitment to see the full spectrum of results.  Obviously, as the name suggests, you will eat a lot of meat.  Suppose you have been eating the Standard American Diet. In that case, you may need to work into carnivore, perhaps via a keto diet.    Meat is hard for the body to digest. So difficult, in fact, that about 25% of the energy in meat is consumed to digest it. It can be difficult for the digestive system to ramp up to deal with all that meat.

When you eat a carnivore meal, the goal is to eat what Dr. Ken Berry calls “comfortably stuffed.”  In other words, eat until you are full, then stop.  Many people love the diet because of this.  You don’t count calories or worry about portion sizes.

You can eat up to three meals today without snacking in between.  Since the heavy meat-based meals on the carnivore diet are so filling, you will likely not want snacks anyway.   Eat the highest quality meat that you can afford on an ongoing basis.  Hotdogs and bologna are not optimal.  Don’t forget: Any food that comes from an animal is carnivore.  Don’t forget about eggs, organ meats, and seafood.   Dr. Anthony Chaffee suggests that you take care with organ meats.  They are so rich in vitamins and minerals that you can get too much.  The bulk of your diet should be fatty muscle meats.

It’s hard to accept in our culture, but fat is good if you are on the carnivore diet. Deliberately look for fatty cuts.  Dr. Ken Berry suggests a 50/50 ratio of fat to lean meat.   Get rid of all of the seed oils and learn to cook in animal fats.  This improves the fat-to-protein ratio.    Don’t be afraid of salt.  Salt is an essential electrolyte, and going ketogenic, or carnivore, causes tons of water to leave the body. That fluid takes a lot of electrolytes with it.

Dr. Chaffee suggests that you don’t need to worry about what time you eat, how often you eat, and how much you eat on a carnivore diet.  He argues that you should eat as much as you enjoy.  When it ceases to be enjoyable, you should stop.  It really is that simple.  It seems like this is the most crucial facet of the carnivore diet.  It is straightforward.  You eat a minimal spectrum of animal foods, but you eat them when you want and as much as you want.

A big concern with ketogenic and carnivore diets is the threat of elevated cholesterol.  Eating saturated fats has long been associated with cholesterol, which has long been associated with heart disease.  The counter-argument to the cholesterol hypothesis is convincingly made by Dr. Sophia Le in a lengthy blog.  (This blog is also a great introduction to your “cholesterol numbers” and what they mean.  You should read it).

The basic argument is that LDL is not a good marker for heart disease risk, so we shouldn’t worry if we see it increase.  The markers that matter tend to go down, so the carnivore diet is protective rather than risky.  She concludes, “While LDL particle sizes increased on low-carb high-fat diets (which is probably the reason for the increase in total LDL cholesterol), the numbers of total LDL particles and small LDL particles actually decreased. Research has shown that both changes, in fact, indicate a decrease in the risk of cardiovascular diseases.”

I must admit that the medical science of cholesterol is very murky.  Some brilliant people make persuasive arguments on both sides of the debate.  I am convinced that if you are metabolically ill, you must control insulin resistance. If you have to suffer from high cholesterol while doing that, then so be it.  Either way, some markers are likely to get better, and others are more likely to worsen.  Getting lean and healthy will undoubtedly improve most of them, no matter how you do it. Cardiovascular disease is a long-term process, and a year doesn’t seem likely to kill you.

I can’t stop thinking that hyperlipidemia is a defining characteristic of metabolic syndrome. I withhold judgment when it comes to being on a carnivore diet forever. I encourage you to dive down the cholesterol rabbit hole, consult your trusted physician, and make your own informed decision about what strategy is best for you.

The real question in my mind is what you want to do for the long term to maintain your status as a metabolically healthy human being when you get there.  I am sure that it involves whole foods and an absence of sugar and refined garbage. Suppose you get your shit together and reverse the metabolic syndrome. In that case, you will most likely do yourself more good than you would worrying about some fat in your diet.

References and Further Reading

I’ve added a complete reference page to my book on this site.  I’ve also included “further reading” articles in books on this site, organized by the book chapter headings.  Book links to Amazon are affiliate links, and if you happen to buy something via one of those links, I get a small kickback from Amazon to help keep this site up and running.  Thank you for your support!

Thomas DeLauer, a recovered fat ass, is one of the most popular health and nutrition influencers on YouTube.  He tends to get off into the weeds a bit with the science sometimes, but that should make you feel good.  He believes in giving advice based on scientific evidence.  The video below is a bit long (around 45 minutes), but it does a great job of explaining how to do a keto diet in a healthy, sustainable way.

Is Keto Safe?

There is a lot of press surrounding ketogenic diets.  Shock and awe stories of Indian actresses dying of keto drive clicks, but are far from the truth.  Dr. Ken Berry weighs in on keto safety with his usual style in the brief video below:

Carnivore Diets

If regular keto was controversial, the “Zero Carb” or “Carnivore Diet” has caused a clickbait explosion on the internet.  Dr. Berry explains the diet below:

The Fat Problem

Worried that fat and cholesterol will destroy your heart if you try any of this stuff?  Think again.  Dr. Prandip Jamnadas explains the true causes of heart disease in this illuminating video:



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Last Modified: 07/11/2022


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