Rule #1: Ketosis Can’t Begin if you Have Extra Sugar in Your Blood
No fat-burning until the extra sugar is gone. Your body will not allow you to use ketones as fuel until your sugars are burned through. Your mitochondria are the “furnaces” inside each cell that fuels your system. Burning sugars as your fuel spike your energy up and then it crashes down. Pop a sugar into the furnace and your produce a spark of energy that only lasts for a flash of a moment.
Linked up a string of sugars to burn through your furnace and your energy rushes up, only to be followed by a crash when the fuel is gone. Each sugar molecule gives 2 units of energy. Compare that to the 32 units of energy each ketone provides.
If you want a steady, constant source of energy, use fat as your fuel. You CANNOT use this fat-burning option if you have a bunch of sugars in your system. Let me say that again: Glucose or carbohydrate fuel is always used before fat fuel. There is no getting around this. This rule always applies.
At first glance, you might want to call the human body lazy. Using those carbohydrates as energy first seems like the easy way out, but there is more to the story. Our body must use those carbohydrates first. You see, too much sugar in your blood damages your body. As your sugars rise, along with the extra sugars you will collect more and more inflammation within your blood vessels, joints, and even your brain. Your body will protect you from toxic, inflammatory sugar levels at all costs. How is sugar toxic?
Each sugar molecules attracts nearly 100 water molecules as it floats around your system. This creates a toxic inflammatory state. As your blood sugars rise and rise, so does the level of inflammation. If your system does not reduce sugars, soon every part of your body will swell with inflammation. The end results are a coma and death due to the swollen inflamed brain led by the toxic amounts of sugar.
You defend against this toxic death as you churn those sugars through your furnaces, your mitochondria. Your blood glucose lowers along with the extra inflammation. That toxic level of sugar disappears as does the inflammation.
Rule #2: Ketosis Can’t Begin with High Insulin in your Blood
When your blood sugar spikes, an alarm signal rings throughout your body warning against uncontrolled sugar levels. This chemical alarm signal is called insulin.
Insulin is the hormone your body uses to protect from toxic sugar levels and the associated swelling.
Insulin is your body’s most important hormone. Nothing speaks louder and rules over more parts of the human body than insulin. When insulin circulates in the blood, sugars disappear into your cells. Insulin signals the alarm until sugar levels return to ‘normal.’
How long does it take before your mitochondria switch from using carbs to burning fat for energy? Put another way, how long does it take for insulin to sink back down allowing fat to become available for your furnaces? ANSWER: Days
Yes. It takes most American days before their extra stored sugar gets low enough for their insulin levels to sink to normal. High-carb diets have intoxicated your body with sugar followed by insulin. The insulin chases those sugars out of the bloodstream keeping your body safe from toxic sugar levels. Before you can be rescued by ketone power, your sugars and insulin must drop back to normal.
Your Standard American Diet ensures that your blood pools with extra insulin. Before your mitochondria flip the switch from carb-burning to fat-burning, you have to first lower the amount of insulin in your blood. This means reduce sugar intake. Again: cut the carbohydrates.
What? Do I have to go days without my carbohydrates in order to lose fat? Doc, this sounds like a starvation nightmare!!
Rule #3: Eat fat to burn fat
When you stop eating the carbs, your system must empty out the stored sugar you’ve stuffed into your liver. As the storage empties your blood sugar level creeps back up. By emptying that storage, your blood sugar stays up and that keeps triggering insulin.
It can take a couple of days before your liver storage bin is empty. No matter if those sugars come from the carbs you’re eating or from storage, insulin enters the equation and always stops ketosis. The enemy of ketones is insulin. When insulin is whipping those carbohydrates around, not one stinkin’ ketone circulates in your system. Insulin blocks that process until the sugars are low enough. No ketones allowed until both your carbs and insulin have settled down.
To exit this whole messy cycle of insulin and sugars, eat fat without consuming carbs. We call this a “fat fast.” The one food you can eat that signals NO insulin is fat. Stop the carbs, and eat fat.
You stop releasing insulin once your sugar level drops low enough. If you have struggled with your weight for fifteen years, your system is very used to producing a large amount of insulin to manage the abundant carbohydrate you eat. The reversal of that insulin is not instant. If you lower your carbohydrate intake to 20 carbs per day, your insulin can take several days to adapt to the reduced carb intake. In some of my patients with years of weight troubles, we have struggled for several weeks before we lowered their insulin levels.
After both your insulin and sugars are lowered your mitochondria flip their furnaces from burning carbs to burning fat. That’s when you will find a trickle of ketones circulating in your system. Stay away from carbs day after day and you will turn that trickle of ketones into a bath of steady fuel from fat. Ketones deliver steady and stable energy.
Rule #4: Measure Ketones
How will you know when your furnaces switched fuels? MEASURE IT!!
This is my favorite part. Don’t guess which fuel you’re using-MEASURE IT. When your body is making ketones by fueling from fat, the urine and blood will show it. Prick your finger to check for ketones in your blood, or more simply pee on a urine ketone stick. You can pick these up at your local pharmacy. These sticks will quickly let you know if you’ve achieved ketosis.
Recapping the Rules for Ketosis:
Mitochondria produce energy throughout the human body. These little furnaces within your cells pump out the energy your body needs to survive. You can choose which energy your body runs on by your choice of food.
You can choose your energy source by what fuel you put in your furnaces.
If you eat carbs, you will flood your bloodstream with glucose. Insulin chases those sugars out of circulation and into your cells. Your mitochondria rapidly process those carbs to produce hot, fast energy. Much like the fire from dried pine needles, this sugar energy shoots up and crashes down within a short timeframe. That super hot fire feels like a rush at first, but over time that repeating frame does more damage than good.
Stop eating carbohydrates and fuel your body with fat. Within days, you will shift away from carb-chemistry and start burning fat.
Switching the body to ketone production will not begin until you significantly lower your sugar and insulin. While your system empties the stored sugar from years of carb-fueling, eat fat so as not to produce any extra insulin.
Learn more about what foods to eat through our FOOD GUIDE teaching you the good – better – and best options for ketosis eating.
- Westman, Eric C. ADAPT Program: a Low Carbohydrate, Ketogenic Diet Manual. Adapt Your Life, Inc., 2015.
- Klement, Rainer J., and Reinhart A. Sweeney. “Impact of a Ketogenic Diet Intervention during Radiotherapy on Body Composition: I. Initial Clinical Experience with Six Prospectively Studied Patients.” BMC Research Notes, vol. 9, no. 1, May 2016, doi:10.1186/s13104-016-1959-9.
Keto Diet 101: What Can Possibly Go Wrong? KETO FLU.
If you are peeing ketones and feeling fine, skip these next four parts of this articles reviewing what can go wrong when you start a keto diet.
However, if you tried to make ketones and you never turned your strip pink, read these posts. Or maybe you succeeded for a time, but then something went wrong.
If you are a worrier and you read on the internet all the ways this ‘crazy’ diet supposedly messes up your body, read this.
Keto-recap: A body fueled by sugar is chronically inflamed and in crisis. It is impossible to drip in the exact amount of carb fuel needed without going over or under your requirements. More than a teaspoon of carbs pushes your body into releasing insulin. When glucose is your fuel, eating too little leads to a steady decrease in your metabolism. Conversely, extra, unused glucose, rings your ‘insulin alarm’ triggering a spike of this hormone and continuing the cycle of inflammation.
Fueling your body with fat means no insulin. You rid yourself of the crisis. Your body produces ketones from fat when the glucose falls low enough. Ketones slip through your system and body putting out fires of inflammation the longer the ketones are around. A state of ketosis reverses inflammation caused by chronic high insulin levels.
As an internal medicine doctor, my job is helping with your health’s ‘long game.’ In other words, chronic disease management. When your body swells on the inside, that inflammation causes trouble. Chronic, slow-growing inflammation creeps into more and more areas of your body.
After years of too many carbohydrates, your system gets really messy on the inside. But it is stable. Your cell walls become stiff and inflexible. The ‘hoses’ that carry your blood are crusty and can’t be easily stretched or relaxed. Reversing this chronic problem is tricky. The day you flip your energy source from carbs to fat, your body chemistry changes. This sends your crusty, stiff-albeit stable-system into flux.
What can go wrong when a carb addict switches to ketones?
- THIS PROBLEM AFFECTS PATIENTS: On Day 2 of producing ketones
- THIS PROBLEM LASTS UNTIL: Lasts for up to a week.
If you Google any side effects of the Keto Diet, keto-flu tops the list of search results.
This condition got its name because chronically inflamed patients experience flu-like symptoms as they transition. Yep, give up those tasty, sweet carbs, and you will feel like you have the flu. When you get the flu, a ‘bug’ sets up a colony or home inside your body and messes with your system. Those critters invading your body cause lots of symptoms. The invading infection steals your water, drinks your salts, and eats up your sugar. Your tummy aches, in part, because the bugs selected your guts as their new home.
Flu symptoms include a headache, tiredness, dizziness when you stand up, racing heart, nausea, loss of appetite, and feeling rather irritable. When you get the flu, you get dehydrated. That dehydration causes all those symptoms. A body switching from sugar to fat also gets dehydrated. Dehydration causes the symptoms collectively called ‘keto flu.’
What’s so dehydrating about producing ketones? Ketones aren’t the cause. Instead, it’s the lack of all those glucose molecules circulating in your system. Glucose is a large, monster-sized molecule that flows through your veins.
Glucose acts like a sponge and holds onto water as it percolates throughout the body. Each glucose molecule holds onto hundreds of water molecules. Excess bloodstream glucose translates to thousands – even millions – of extra water molecules.
Do the math.
Check your blood sugar. Is it above 100? For every point above 100, you added thousands of extra monster-sized glucose molecules to the 7 liters of blood you hold. Now, multiply that by the hundreds of water particles clinging to each glucose.
Twenty carbs per day lead to way less glucose in your bloodstream. Less glucose holding onto that circulating water causes you to flush that extra fluid out. Over the course of the first week, I have had patients lose 20 pounds. That’s nearly three gallons of excess water.
Removing the extra water causes significant weight loss. KETO or the ATKINS diet gets picked on through statements like this: ‘The only way you lose weight on a high-fat diet or Atkins-like diet is because you lose water weight.’ That’s exactly what happens….at first.
Millions of water particles lost their chemical sponges and are gone. Without that sugar, the water flows right out the kidneys. Dehydration is defined by the rapid loss of water. All that extra water inflames or irritates your body. Removing it is the right answer.
Your ‘flu’ or dehydration symptoms appear when you are caught unprepared for ketosis’ water loss.
This water loss hits your kidneys like a tidal wave. Your kidneys remove water from your blood by adding it to your urine. They ‘steal’ salts from your bloodstream to make this happen.
Before long, you get a headache and feel really tired. You try to stand up only to suffer sudden dizziness and a pounding heart. Oftentimes, you get crabby. Welcome to the keto flu.
The antidote is simple: eat SALT, drink water and slow down.
Let’s start with salt. Yes, I mean salt. Like the white stuff in the shaker on your table. I prefer pink Himalayan salt or sea salt, but common table salt will do. Salt, like fat, is an overly demonized compound.
Fat and salt are essential to the Keto diet. You need to replace the fluid that belongs in your body. Knowing that keto transition sucks salt and water into your urine should motivate you to add salt to anything you eat or drink.
You get dizzy because there’s not enough fluid in circulation. Replace that fluid by eating and drinking with salt.
If you add plain water back to your system, you will not fix the flu-like symptoms. The water will go in and flush right back out. The salt holds the proper amount of water in your circulation and corrects the dehydration. Drink salty broth to keep the keto flu away!
The next step is to slow down.
If you are reading this and considering fueling your body with fat, GREAT. Let me help you succeed. If you are a carb addict with a daily intake of more than 300 carb gram, start slowly.
Begin with zero calories in your drinks for the first week. Once you are successful with that for seven consecutive days, then remove all white foods: No bread, no rice, not pasta, no pastries. Follow that rule in addition to the no-calories in your drink for seven straight days as you prepare for ‘transition day.’ This plan gives you the space to allow a gentle shift in your body chemistry to prevent the keto flu. This schedule also gives you enough time to clean out your cupboards.
WARNING: BE CAREFUL IF YOU TAKE HIGH BLOOD PRESSURE MEDICATIONS
- THIS PROBLEM AFFECTS PATIENTS: On Day 2-3 of producing ketones
- THIS PROBLEM LASTS: up to a week.
If you are on blood pressure medication and you want to get off them, the keto lifestyle is the answer. However, the transition can be dangerous. Prepare yourself.
My patients taking high blood pressure meds must check their own blood pressure at home. Without all those large glucose molecules loaded with hundreds of additional water particles, your body’s circulation volume drops. Not because of blood loss; because of water lost. Lower volume means less pressure! It takes far less medication to control blood pressure when all that water is gone.
Thanks to the Keto diet, helping patients get off blood pressure medication has never been easier. You must use a home blood pressure monitor though. Check your blood pressure 2-3 times a day when transitioning. As you reduce and remove carbohydrates from your diet, your blood pressure will drop quickly. Be careful. Let your doctor help you remove those blood pressure medicines as quickly as you remove the carbohydrates.
In a matter of five days, I got one patient off of five of his blood pressure meds! This, of course, all depends on how strict you are at following the less-than-20-carbs-a-day rule and how long you have been a carb addict.
When your heart races inside your chest, a feeling of terror takes over your mind – even if you are a doctor. Your fear is justified. A pounding heart can be a warning of impending death. It signals us to pay attention. If your heart begins to thump inside your chest during ketosis transition, pay attention. Your body is warning you of something.
The most common reason for this symptom is the dehydration mentioned above. Dehydration forces your heart to pump fast and strong. Fix this problem quickly by drinking salted water! Keep doing this until the heart-pounding goes away.
If you have a history of heart arrhythmia or heart failure, you must consult your doctor before you go on a keto diet. If your heart is pounding because of an abnormal rhythm, you can drown yourself in salted water only to make things worse for your heart.
- Seyfried, Thomas N. Cancer as a Metabolic Disease: on the Origin, Management, and Prevention of Cancer. Wiley-Blackwell, 2012
- Siri-Tarino, P. W, et al. “Meta-Analysis of Prospective Cohort Studies Evaluating the Association of Saturated Fat with Cardiovascular Disease.” American Journal of Clinical Nutrition, vol. 91, no. 3, 2010, pp. 535–546., doi:10.3945/ajcn.2009.27725.
- Effect of exercise intensity and starvation on activation of branched-chain keto acid dehydrogenase by exercise; G. J. Kasperek, and R. D. Snider; 01 JAN 1987. https://doi.org/10.1152/ajpendo.1987.252.1.E33
- Scott AR1; Joint British Diabetes Societies (JBDS) for Inpatient Care; JBDS;Management of hyperosmolar hyperglycemic state in adults with diabetes; Diabet Med. 2015 Jun;32(6):714-24. DOI:10.1111/dme.12757
Keto Diet and Kidney Stones: Keto 101.
Keto Diet and Kidney Stones
Kidney stones should be called kidney crystals. That’s what they are: crystals. and the keto diet and kidney stones do sometimes cross paths. Hold on. Don’t run away. Finish reading about the keto diet and kidney stones.
- THIS PROBLEM AFFECTS PATIENTS: 2-4 after their first ketone is made
- THIS PROBLEM LASTS UNTIL: the rapid weight loss stops. [The blood ketones along with the blood sugars are stable.]
The formation of these crystals deep inside the kidney starts with a tiny chemical attraction between two elements. Your kidney handles a huge volume of these elements every second.
If you want to begin making a kidney stone, the first step is to get dehydrated. Run low on water (dehydration) and the concentration of urine in your kidneys shoots way up. This concentrated waste flowing through your kidneys puts these crystallizing elements really close together. Voila! Your first crystal is made.
Next, you add one tiny element to that crystal every time your urine becomes concentrated. As you add one element after another, the crystal grows in size as does its power to attract even more elements. Maybe it takes you five years to build that crystal up to a speck. Maybe it takes you ten years. Unless you ‘melt’ your kidney stones away, you keep adding one tiny element after another. You can even grow multiple kidney stones at the same time.
Change Over Time
Over time, that crystallized spec turned into a tiny pebble. Then a stone. One awful day, that big crystal breaks away from the place where it grew. The crystal tumbles through your waterworks like a boulder. Each tumbler’s sharp edges cut and scrape through tissue causing one of life’s most excruciatingly painful experiences.
Making kidney stones is painless. No one can feel those tiny changes inside your kidney as the stone grows. Painlessly your stone collects more and more particles. If you want to grow those stones faster, add insulin to the system. A lot of insulin. A high insulin state leads to several changes that are GREAT for growing kidney stones.
If we use a super advanced imaging system to look into the kidneys of adults, almost every person has tiny little kidney stones. They are growing and shrinking all the time. The stones are either adding crystals or slowly melting away. This is constantly happening.
If your kidney bathes in crystal-growing chemicals, your stones will continue to grow. High sugar levels favor crystal growth. Ketones favor crystal melting. Ketosis shifts the body’s chemistry in the opposite direction of the high sugar state.
Does this mean ketosis will melt all the stones lurking in your kidneys? Not quite.
The good news: ketosis’ chemistry shift ensures your kidneys’ existing crystals stop growing. Indeed, some of those crystals can disappear over time.
The bad news: Your stone may dislodge before it dissolves.
When your body produces ketones, kidney stones’ crystals get removed one element at a time. We don’t get to choose which order the elements peel off of that crystal.
If you have a stone that has been there for years, your new keto-centered blood chemistry may whittle away at the base of the stone. This could set the big stone free to roll down the tubes of the kidney and bladder system. When that stone is securely fixed to the wall of the kidney system, you have no symptoms. If the stone breaks free, boy, oh, boy will you feel it! That crystallized boulder rolls downstream sending shockwaves of pain through your back and groin.
Question: Can ketosis CAUSE you to pass kidney stones?
That’s a trick question. It certainly disrupts your body’s chemical balance which can lead to your existing stones melting and, in some unlucky situations, passing. Ideally, your body’s chemical shift would melt stones one element at a time without dislodging them from their current position. But this is not guaranteed.
ANTIDOTE: Don’t cheat! The best way to shake loose a bunch of kidney stones is to go in and out of ketosis a lot. The shift from making the stones to melting the stones unsettles your system.
If you have no stones in your kidney, then you are fine. You won’t make new stones while on ketosis. If you have a crop of growing kidney stones and don’t know it, beware. If you know you have kidney stones because you have had troubles in the past, you need to commit to this shift in chemistry and stay in ketosis. Pray that the stone melts in an orderly and smooth way. Finally, stay hydrated. A dry kidney is a painful kidney. Never is this truer than when dealing with kidney stones.
- THIS PROBLEM AFFECTS PATIENTS: 2-4 after their first ketone is made
- THIS PROBLEM LASTS UNTIL: the rapid weight loss stops
If you’ve ever had a gout attack, pay attention to this section. Gout happens when waste products crystallize within the body’s joints and produce pain when those crystals start to move.
Ketosis significantly reduces your body’s inflammation. It causes your body to adjust. One of those adjustments can involve gout crystals getting dislodged from inside your joints-a gout attack.
Don’t let a history of gout stop you from a keto diet. Gout crystals formed because of the food you ate years ago. Diets high in carbohydrates combined with fatty meat sparked the problem in your joints. When you switch to a high-fat-low-carb diet, the inflammation drops and the process begins to reverse. As the crystals dissolve, the burden on your joints lessens. But the moment too many crystals move at once, you may spark a gout attack.
Not everybody with a history of gout suffers a flare on this keto diet. If you’ve had attacks in your past, you need this lifestyle change more than others. Those crystals hiding in your joints are just a barometer, an indicator, of all the things that have slowly gone wrong deep inside your system. Your high-carb, high-insulin lifestyle has led to gout. Believe it or not, gout crystals are produced by the body as a quick fix. The body stuffs joints full of these extra crystals for storage to prevent your blood from becoming toxic with excess uric acid.
Your body will store these crystals into every joint possible unless somehow you tip the scales back the other direction. Bathing your system in ketones will reduce insulin and inflammation. This process also dissolves gout crystals. The process of melting such buildup can result in a painful gout flare.
Antidote: Keep your probenecid or your colchicine around. And of course, stay hydrated.
- Mehmood A. Khan MD John V. St. Peter Gail A. Breen Guilford G. Hartley John T. Vessey; Diabetes Disease Stage Predicts Weight Loss Outcomes with Long‐Term Appetite Suppressants; 06 September 2012
- Stubbs, James, et al. “Macronutrients, Feeding Behavior, and Weight Control in Humans.” Appetite and Food Intake, 2008, pp. 295–322., doi:10.1201/9781420047844.
- E. Cersosimo, M. Ajmal, R. J. Naukam, P. E. Molina, and N. N. Abumrad; Role of the kidney in plasma glucose regulation during hyperglycemia; American Journal of Physiology-Endocrinology and Metabolism, Volume 272, Issue 5; 1997 May 01; https://doi.org/10.1152/ajpendo.1997.272.5.E756
- I. Alexandru Bobulescu, Naim M. Maalouf, Giovanna Capolongo, Beverley Adams-Huet, Tara R. Rosenthal, Orson W. Moe, and Khashayar Sakhaee; Renal ammonium excretion after an acute acid load: blunted response in uric acid stone formers but not in patients with type 2 diabetes; American Journal of Physiology-Renal PhysiologyVolume 305, Issue 10; 2013 Nov 15; https://doi.org/10.1152/ajprenal.00374.2013
- Goldberg, Emily L., et al. “Î²-Hydroxybutyrate Deactivates Neutrophil NLRP3 Inflammasome to Relieve Gout Flares.” Cell Reports, vol. 18, no. 9, 2017, pp. 2077–2087., doi:10.1016/j.celrep.2017.02.004
Keto Diet 101: Ketosis and Bad Breath.
THIS PROBLEM AFFECTS PATIENTS: When you begin making ketones.
The problem of ketosis and bad breath lasts until the patient is Keto-Adapted (up to 6 weeks). When your body uses ketones, it releases extra units of ketone compounds. Unused ketones flush out of the body as acetoacetate in the urine or acetone through your breath.
Acetone breath is a dead giveaway you’re burning fat for fuel. Acetone smells weird causing metallic- or fruity-scented breath. Surprisingly, many don’t experience this problem at all. Others only have acetone breath for a few days while others can smell the ketones coming out of their sweat and their breath for months on end.
For most people, bad breath lasts for about a month as they adapt to ketosis. The odor usually improves over time as blood ketone levels stabilize in the second or third week.
Remember: acetone ends up in your breath when lots of extra ketones circulate in your blood. When first transitioning to ketosis, your blood can fill with a whole bunch of ketones waiting their turn to be used as fuel. As your cells ‘remember’ how to use this kind of fuel, more and more cells turn on their ketone-burning parts. At first, only a few cells burned ketones, but by the end of the third or fourth week, many cells throughout the body can burn either ketones or glucose.
With that improved army of ketone-furnaces inside your mitochondria, less excess compounds float around and in turn fewer acetone fumes out of your mouth. Gradually, your body burns ketones as fast as you make them. With less excess ketones, your breath won’t stink of acetone.
To Deal With Acetone Breath, Try The Following:
#1: GET YOUR TEETH CHECKED. I found it helpful to remind patients that we evolved using ketones. The human race did not evolve eating starches and sugars. Today’s diet fills your mouth with a sugar-bath. It leaves your teeth with tiny pockets where sugar feeds bacteria and other microbes. These hidden cavities allow smelly bacteria to flourish. Cavities and their bacteria are the sources of the long-standing bad breath associated with ketosis.
Please note that the longer you bathe your teeth in ketones, the stronger and healthier your teeth get. Your ancestors kept their teeth for a lifetime by constantly circulating ketones in their blood and spit. Thanks to their high-fat diet, this continued exposure to ketones strengthened their teeth while fighting the bacteria living in their mouths.
#2: DRINK ENOUGH WATER: Dehydration leaves your mouth dry. Mouth dryness concentrates the power of the bacteria living in your oral cavity. Proper hydration flushes and continually washes your mouth while also diluting the places where bacteria live.
Also, when you drink enough water, you flush ketones from your blood into your urine. You only breathe out acetone when your blood is overflowing with extra ketones. Staying properly hydrated allows your body to get rid of excess ketones through your kidneys. It takes the pressure off your lungs to process ketones and breathes them off as acetone.
#3: STAY THE COURSE. The best way to keep that acetone fuming out of your mouth is to go in and out of ketosis. Steady ketone production allows the system to adapt and stabilize fully. Stabilize in this context means that the production of ketones matches the burning of ketones. There will never be a perfect match between these two parts of the equation, but they should get rather close once you have hit your keto-rhythm. The way to mess up this equation is to go in and out of ketosis. That leaves the extra acetone molecules stinking up your breath.
- Anderson JC, Measuring breath acetone for monitoring fat loss: Review. Obesity (Silver Spring). 2015 Dec;23(12):2327-34. doi: 10.1002/oby.21242.PMID: 26524104
- Toth, Csaba, and Maria Schimmer Zsofia Clemens. “Complete Cessation of Recurrent Cervical Intraepithelial Neoplasia (CIN) by the Paleolithic Ketogenic Diet: A Case Report.” Journal of Cancer Research and Treatment, vol. 6, no. 1, Apr. 2018, pp. 1–5., doi:10.12691/jcrt-6-1-1
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