Step 1 – Lower Insulin to Baseline

To achieve nutritional ketosis the first step is limiting all starch & sugars (carbohydrates) intake.  For most people this requires lowering carbohydrates to less than 20 grams per day.  

Lowering insulin can’t be achieved by just drinking exogenous ketones.  Many people preach this and some have misunderstood this concept. To achieve nutritional ketosis, you have to restrict any food type that stimulates large surges in insulin. 

Step 2 – Balance Protein & Fat

Second, during during the first three months of this process, there really isn’t a limit to fat intake, however, I recommend a 1:1 ratio of protein to fat (in grams – NOT CALORIES) .  This puts one around 70% fat.  After the third month of a ketogenic diet, people become very fat adapted and it may be necessary to decrease the fat intake slightly further. 

I am not a fan of “macros” because the actual need of fuel differs for every body.  I have hundreds of people that see me in the office because their “keto-expert” told them to follow a set macro count that didn’t work. 

Improving health and losing weight is not caloric, it is hormonal.  

How much protein and fat do you need?  It differs for everyone and is based on your body composition and activity levels.  Simple calculations can be found in my book, The Keto Cure.

Yes, I understand that many of the amino acids that make up protein have an insulin response, but compared to starches and sugars, this response is very minimal. 

Step 3 – Fat is a Lever

Once you become fat adapted (keto-adapted), you will raise or lower fat based on energy needs and weight loss goals. 

When you are in nutritional ketosis, craving disappear and hunger is well controlled.  Most people see plateaus with weight loss because they aren’t listening to the hormonal signals of actual hunger.  This may take some time to understand and is often overcome by keeping a food journal.  Working with your doctor, or someone who understands the hormonal signals and the subtle causes of obesity can help.  That’s where I come in.

Fat comes in many forms.  We delve into this concept in detail as part of my membership program.  However, the biggest question I get about added forms of fat is using fat is exogenous ketones.  I have been a fan of exogenous ketones for many years.  I often get asked the question, “Why use exogenous ketones when ketosis can be achieved naturally through nutrition?”

I often respond with my own question… “Why do body builders use protein shakes when they could do it with real food?”  “Why do people use ‘green drinks’ instead of actually eating leafy greens?”

I am amazed that people (especially the low-carb world purists) get all worked up over using an exogenous ketone, yet they won’t bat an eye about a protein powder, a keto-bar, or using alcohol.

I use  and recommend exogenous ketones because I am a human being and I like to make my life easy. I use them as a meal replacement, as my “sports drink with electrolytes” and as an adjunct to providing adequate fat for energy when I’m traveling or can’t find a good meal. I also use them because they are an easy way to provide both ketones and butyrate for gut health during a fast. (I know, I’m probably going to hear from the fasting purists out there – but I personally don’t drink coffee and I’ve found that this is what works for me and many of my patients).

I like & personally use two different brands: 

Pruvit

Ketologie

Step 4 – Use A Good Multi-Vitamin Supplement

I found that there are a number of key components that the insulin resistant, pre-diabetic or diabetic patient just doesn’t quite get in the day to day fast-paced activities of life.  A good multi-vitamin helps cover the holes your diet may not be filling. 

Second, when roughly 85% of the people who enter my clinic have some degree of insulin resistance, I’ve become a big fan of berberine to control blood sugar and help the liver handle insulin more effectively. 

Because it was so expensive to purchase all the different supplement I felt were necessary to make up a good vitamin, I designed a multi-vitamin for myself that contains everything the insulin resistant, pre-diabetic, or diabetic patient needs.  It’s called KetoEssentials. 

I also found that a good berberine supplement was essential.  You can find my brand called Berberine Plus at the KetoLiving.com site. 

You can find all the supplements I personally developed, use and recommend here on my supplements page.

Step 5 – Balance the Thyroid

I find that much of the thyroid illness I see in my office is driven by insulin resistance, once this is corrected, the thyroid often returns to normal.  However, if it does not, work with your doctor you balance your thyroid. 

Step 6 – The Sex Hormones

Balancing the Steroidogenic Pathway is essential for many people. Estrogen, Progesterone & Testosterone are often overlooked. In many of my patients, this is the last piece of the health and weight loss puzzle that needs to be addressed. 

I’ve found that the most effective way to balance the steroidogenic pathway is through the use of bio-identical hormones.  My patients seem to function at their very best when these are correctly balanced along with the correct supplements and a ketogenic lifestyle.