Now that I’m back in Manila, one of the most requested topics people ask about is the Ketogenic Diet.

Before diving in, it is very important to understand that nutrition is highly personalized and there is no one single diet that fits all. To know how best to optimize this particular diet to YOUR genetic make-up or simply know more about it, I’d like to dive into the science from a Functional Medicine perspective and provide easy tips at the end to know if this is the right eating program for you.

What is Ketosis?

Back in the ages of antiquity, our hunter-gatherer ancestors had a food supply issue. They would undergo prolonged periods of starvation during times of changing climates and scarcity of animals to hunt. As a response, the human body developed the process of ketosis to withstand these long weeks of hunger. Ketogenesis is the process of utilizing fat molecules in the absence of carbohydrates to create ketone bodies called aceto-acetate and beta-hydroxybutyrate (BHB). These compounds are able (in lieu of carbohydrates) to enter the brain and muscle providing fuel. When this increase of ketones in the blood stream is >0.5 mmol/L, the body is then categorized to be in a state of ketosis (1).

What does the diet look like?

Anatomy of the Kitogenic Diet:

  • 1) Low carbohydrate <50g/day
  • 2) High fat 70% of daily energy
  • 3) Adequate protein 20% of daily energy


  • We now know that Beta-Hydrxybutyrate (BHB) induces a wide variety of cell signals able to regulate mechanisms to induce cellular protection and reduce oxidative stress causing cell damage. It reaches up to the genomic level turning sequences on/off that control an individual’s metabolism and the diseases that originate from it (2).
  • Ketosis allows access to fat stores with more energy (40,000-150,000 calories) vs. muscle and liver glycogen stores (2,000 calories) with limited energy.
  • The shift in energy source and reduction in simple carbohydrates allows individuals to have changes in weight, cardiovascular risk, insulin sensitivity allowing for an avenue for the reversal of Type 2 Diabetes.
  • Ketogenic diets allow individuals with seizure disorders an alternative fuel source toward the brain providing a sustainable intervention for intractable seizures non-responsive to medications.
  • Athletic endurance and fat mobilization has been shown to improve by increasing aerobic and anaerobic exercise capacity while maintaining glycogen stores in the liver and muscle (3,4). Being mindful of oxidative stress and cellular damage from exercise should also be considered – see tips below.

How to know if you are in ketosis?

  • Urine test: measure urine excretion of aceto-acetate
  • Blood: finger stick measure of BHB (most accurate)
  • Breath test: measures acetone

Optimal levels:

  • Overnight fast: 0.2-0.5 mM
  • Nutritional ketosis: 0.5 – 3.0 mM
  • KD with extra ketones from medical foods: 0.5 – 8.0 mM
  • Ketoacidosis: >10mM

Now that we have an overview what ketosis is all about and some of its benefits, next week, we’ll dive into how best to optimize these diets and how to make them fit YOUR genetic requirements! See you next week!

Your partner in Health,

Dr. Rayms