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What Are Ketones Used For & How They Assist With Inflammation.



what are ketones

What are ketones used for? I begin with asking have you ever met a toothless dentist? Have you met a veterinarian who’s never owned a pet? How about a preacher who always seems worried?

It’s the same problem when you meet an unhealthy doctor and her family. They’re overweight, stressed, on high blood pressure meds, wearing a CPAP machine… they’re just unhealthy. I can draw a sharp line sorting the colleagues who figured this out and those who haven’t. The same process goes for patients. I can draw a line down my list of patients who have adapted to a high-fat life versus those still loading up on carbs.


When I began this adventure into the keto lifestyle, I thought almost exclusively about my mother and her battle with cancer. It was not long into my education that I lost track of all the additional benefits this high-fat low carb lifestyle would have for patients.

I’m a physician that studies chronic disease.  The unfounded claims from other diets left me somewhat skeptical that food alone could make this much change from the inside out.

My list of benefits from a life of ketones continues to grow. Central to all these benefits is ketosis’ impact on INFLAMMATION. Inflammation: Think of a collection of flames when you hear this word linked to your health.  If the heart is inflamed, the tissue making up your heart is swollen or bathing in extra liquids.

What Happens If Your Have Swollen Joints?

If you have swollen joints, they also sponge up extra water in the wrong places. Sadly, when one section of your body suffers from inflammation, the trouble spread to neighboring tissues. Much like fire, the flames from inflammation spread.

Each new part of the system that adds to the fire makes the whole system more accessible to be inflamed. Consequently, it is harder to shut down the forest fire of inflammation once it starts burning.

In recent months, biomarkers of inflammation have been shown to shut off using the ketone found in our blood: Beta-hydroxybutyrate.  Also called BHB. You form this ketone when you drain your supply of extra sugars and carbs and starts using fat for fuel. Within as little as a week of being in nutritional ketosis, my patients have reported remarkable improvements in their symptoms related to inflammation.

Even in the folks reluctant to make the switch to a ketogenic diet, the improvements from supplements of BHB were striking.

Here are a few of the symptoms that people felt after switching their fuel from glucose (or carb) to ketones:


When burning fat for fuel, your body bathes in ketones. Your joints soak up this slick, lubricating substance reducing inflammation and friction. Ketones sneak into the tiniest spaces in your body. Our joints go through quite a bit of wear and tear. While they do have the ability to self-repair, they can only do so if they are not inflamed.

I’ve had arthritis patients on ibuprofen for the better part of a decade who ditched it once they switched to a keto lifestyle. I didn’t ask them to stop the ibuprofen. Instead, they became relatively pain-free about 6 weeks after they made the keto switch.

In one specific case, the woman didn’t recognize how much better her arthritic hands felt until she had a carbohydrate binge while at her granddaughter’s birthday.  “The next day I woke up with a pounding headache — almost like a hangover feeling.

Then I went to brush my teeth and I could not squeeze my fingers around the toothbrush. My hand had swollen up that much with the binge of carbs I had eaten the day before.”


Tinnitus is the fancy term for ringing in the ears. Tinnitus is almost always linked to a chronic inflammation within the ear. I have spent hundreds of hours helping patients with this condition.  Patients suffer from a constant buzzing in their ears-without escape.

The buzzing is caused by the presence of extra water molecules inside the delicate inner parts of their ear. The water does not belong there, yet it is trapped in a cycle of inflammation.  

I recommended the ketosis diet to a patient of mine who was suffering from Parkinson’s disease. She was about eighty pounds overweight and also suffered from chronic tinnitus. She asked for support from her granddaughter who was also trying to lose weight.

To my surprise, it was not the twenty-five pounds of weight that she lost that excited her the most. Instead, she remarked repeatedly how the ringing in her ears disappeared nearly two months after going keto.

Because this medical problem is such a lonely and trying ordeal-much like a personal prison, I reached out to two other patients and suggested a ketone-producing diet.

Both of these chronic sufferers agreed to transition into ketosis for a minimum of three months. At their 90-day follow up, one had complete resolution of her tinnitus and the other said he had several days in a row without the noise-something he had not experienced in over five years.

Although this is not a formal study looking into a connection between ketosis and tinnitus, the difference this advice made in the lives of these patients is priceless. I contend tinnitus is one of many chronic nagging symptoms of long-term inflammation.

The Longer The Better

When you use fat for your body’s energy source and stop consuming carbs, swelling disappears because there is no longer an abundance of glucose molecules holding onto extra water. At first, the easiest swelling goes away, like that in your blood vessels and your muscles. The longer you stay in ketosis, the better your body drains chronic inflammation resolving tinnitus.  


Gingivitis occurs when the gums lining each of your teeth swell. Halitosis means bad breath. I talk about these together because they are closely linked. Patients with chronic sensitive teeth or gum disease tell me that producing ketones helped improve their oral health.

At first, keto patients report bad breath. Part of this is due to the acetone-a byproduct of ketosis -they are breathing out. The change in your breath also reflects the dramatic shift in your mouth’s bacteria. Prior to ketones, the bacteria inside the mouth and in the saliva use glucose and other sugars as their main energy source.

After the switch, these bugs die off because they no longer have the fuel they need to live. The death of sugar-hungry bacteria reduces swelling in your gums and the smell in your breath.

The cells in a keto-adapted mouth compared to someone with swollen gums are much like the improved skin cells I mentioned earlier. The keto-adapted cells are plumper, more flexible, and fit together tighter. This is protective against the roots of your teeth.


Plan on a burst of flavor from your food when you go keto. Maybe this comes from the improved dopamine produced by a well-nourished brain. Or maybe from the well-needed reset after years of constantly flooding your taste buds with sweeteners.

Strangely, patients report this even as they eat less and less food!  The natural tendency to eat less when fueling the body with fat happens in every patient. Once their hunger fades, it only takes a minor coaxing to help them recognize the difference between eating because the clock says so versus eating due to actual hunger.

Once they let go of the eat-according-to-the-clock tradition, many of my ketosis patients eat only one meal a day.  Despite their lower eating frequency, patient after patient shared their intensely rewarding eating experiences.

Other inflammation-based problems improved with a switch to ketosis include the following:   

  • IBS [Irritable Bowel Syndrome]
  • PCOS [Polycystic Ovarian Syndrome]

Want to learn more about the benefits of a ketogenic diet? Check out the audiobook ANYWAY YOU CAN!


  1. Tiukinhoy, Susan, and Carolyn L. Rochester. “Low-Fat Dietary Pattern And Risk Of Cardiovascular Disease-The Women’s Health Initiative Randomized Controlled Dietary Modification Trial.” Journal of Cardiopulmonary Rehabilitation, vol. 26, no. 3, 2006, pp. 191–192., doi:10.1097/00008483-200605000-00015. 
  2. Forsythe, Cassandra E., et al. “Limited Effect of Dietary Saturated Fat on Plasma Saturated Fat in the Context of a Low Carbohydrate Diet.” Lipids, vol. 45, no. 10, July 2010, pp. 947–962., doi:10.1007/s11745-010-3467-3
  3. Goldberg, Emily L., et al. “β-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

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The Unspoken Cons of Gastric Bypass.



Gastric bypass is probably one of the greatest crimes committed against Baby Boomers in medical history. I feel it is an atrocious option for weight loss due to the cons of gastric bypass that get swept under the rug. Clinicians who recommend it ignore the body’s weight loss chemistry.

Even worse, once the surgery was over patients were abandoned. The typical surgical package includes a year of follow-up. Once those 365 days are over, the surgical team disappears. Patients are left with their new rerouted anatomy and severe nutrient malabsorption problems. Patients are entirely on their own as they attempt to manage the medical consequences of bypass surgery. On. Their. Own.

These obese patients entered surgery with ‘inflamed brains’ from years of high insulin and no ketones. Insurances will not pay for this surgery until the patient spends years carrying over 100 extra pounds.  It guarantees their inflamed brain combined with malnutrition.

They underwent major surgery. No matter what label the surgery team used, mini-bariatric or sleeve bypass or gastric banding, there’s no denying this type of surgery is major. This procedure added more inflammation and trauma to already burdened and unhealthy patients.

Next, they undergo a year of post-surgery starvation. It injures the patient’s body and brain anew. With starvation-based weight loss in full swing, the year following surgery is often remembered by the patient as a cloudy, dark, and depressed time.

These patient are expected to attend classes to master the advanced science behind their surgically induced, lifelong malabsorption problems. Years after this crime-of-a-surgery, patients suffer from extreme depression, wilted immune systems, tingling or dead nerves and diarrhea with most meals.

They had no idea their gastric bypass was destroying them one day at a time. The majority of them continue to struggle with significant obesity after having spent upwards of $50,000 for this procedure.

Problems Found After These Surgeries

The following nutrients are no longer absorbed correctly after surgery:

  • Thiamin, Pyridoxal Phosphate, Folate
  • Vitamin A, Vitamin K, Vitamin D, Vitamin B12
  • Omega 3 and Omega 6
  • Magnesium, Phosphorus, Potassium
  • Selenium, iodine
  • Zinc, Copper, Iron,  

Copper and zinc levels do not return to normal causing hair loss, poor immunity, anemia and poorly functioning nerves and muscles. Surgery removed the section of their gut that’s responsible for absorbing iron and many of the listed compounds above.

After surgery, these nutrients slowly decrease. Years later, gastric bypass patients live with brain fog, low energy, thinning hair, and slower disease recovery. This malnourishment is PREDICTABLE and PREVENTABLE.

If you’ve had gastric bypass, PLEASE follow up annually with your doctor to measure these nutrients. It is VERY IMPORTANT.

Thanks to the high-density nutrients found in keto-compliant foods, bariatric bypass patients can overcome the nutrient deficiency caused by their surgery. I insist my weight loss patients add two nutrient-dense foods to their menu: liver and sardines. For real!

I show them these charts on the following page. Look carefully at the rows for sardines and liverwurst. These two food items solve a lot of deficits.

Let me expand on the reason I encourage patients to develop a taste for liver. Iron builds healthy brains.  When patients present in a brain fog, I first check to see how much iron circulates within their system. Iron provides one of the primary starting points to make our brain hormones.  To make serotonin, norepinephrine, dopamine, and GABA the patient needs iron to begin.

Iron studies of thousands of patients over the last 20 years have taught me to look at their iron first. Specifically, ferritin level less than 20 guarantees the patient will not get better until I fix that problem.

We Replace Iron in Two Ways. Elemental Iron or Hemoglobin Iron.

Elemental iron refers to iron that comes from the soil. If you are eating vegetables that are toted as a source of high iron, the type of iron those foods deliver to your system is elemental iron. The plants obtained iron through their roots grabbing the iron found in our soil.

Elemental iron, commonly used in vitamins or supplements, follows an absorption rule that catches 1 out of 10 iron particles that pass by the intestinal area that absorbs iron.

When using a tag to observe how much iron is absorbed, elemental iron has one particle out of 10 that is absorbed into our circulation. It is consistent with the side effect that iron causes constipation.  You know this to be true if you’ve ever started taking iron supplements. Start taking 1-2 iron replacement tablets per day. Within 2 to 3 days you will find your stools are much darker. Along with those dark stools, you will see that unfortunate side effect of constipation.

Hemoglobin-Based Iron

Conversely hemoglobin-based iron is iron found with several hemoglobin proteins surrounding the iron element.

Hemoglobin is added to the iron mineral allowing it to enter the creatures circulation.  Who ’s circulation? It doesn’t’ matter if the iron came from a cow, or a pig, or a duck, or a moose, or a fish. All of them added hemoglobin to that element of iron.  When we eat these foods, we have the chance of absorbing iron as part of our nourishment.

The absorption rate for hemoglobin-based iron is far superior when compared to elemental iron. Hemoglobin-based-iron adds 9 out of every ten swallowed. Almost the exact opposite of what happened with elemental iron. Replace someone’s iron with a supplement, and you will cause many weeks of constipated side effects trying to boost their numbers.  Use hemoglobin-based iron, and the task becomes more attainable.

Most patients with iron deficiency present to the clinic with failing health.  They are tired, weakened immune systems and a brain that seems sluggish. Also, their gut was unable to keep up with the ideal absorption rates.  These ideal absorptions rates of 1 out of 10 elemental iron or 9 out of 10 hemoglobin iron apply to those patients with normal absorption.

Using the ideal absorption numbers, I calculated out how many tablets of iron supplements is found in a tablespoon of a liver.  It took more than 20 tablets of iron supplements to equal 1 tablespoon of iron found in liver.

A tablespoon of liver improves the deficit of iron far greater than a handful of iron supplements. When asking someone with a gastric bypass to absorb iron, it is nearly impossible to meet the demands of their body through supplements. Copper and zinc are also absorbed in the same section as iron. All three of these must be adequately replaced for their body and brain to flourish again.

If you want your system to operate at peak performance, you need to nourish it properly.

Use These Charts To Inspire Your Shopping List:

If you want to learn more about the ketogenic diet, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.


  1. Kratz, Mario, et al. “The Relationship between High-Fat Dairy Consumption and Obesity, Cardiovascular, and Metabolic Disease.” European Journal of Nutrition, vol. 52, no. 1, 2012, pp. 1–24., doi:10.1007/s00394-012-0418-1
  2. Ness, A. “Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916. Report of a Joint WHO/FSA Expert Consultation.” International Journal of Epidemiology, vol. 33, no. 4, 2004, pp. 914–915., doi:10.1093/ije/dyh209
  3. Nestle, M. “Mediterranean Diets: Historical and Research Overview.” The American Journal of Clinical Nutrition, vol. 61, no. 6, Jan. 1995,  doi:10.1093/ajcn/61.6.1313s
  4. Mechanistic and regulatory aspects of intestinal iron absorption; Sukru Gulec, Gregory J. Anderson, James F. Collins; Am J Physiol Gastrointest Liver Physiol. 2014 Aug 15; 307(4): G397–G409. Published online 2014 Jul 3. doi:10.1152/ajpgi.00348.2013  PMCID: PMC4137115

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Ketogenic Diet and Migraines: Assessing and Treating Them.



ketogenic diet and migraines

Migraines suck. Not only do they ruin the day that they happen, but they can also kill brain cells. That is not an exaggeration. When a severe, throbbing pain lasts for several hours, listen.

 Stop. Pay attention. Why is this migraine happening? This intense pain is a deep, primal signal from your brain screaming for help.

The advantage of brain scans allows us to look at what happens to the brain during a migraine. We can see the area “under attack” swells the longer the pain continues.  

Originally thought to be from disrupted blood flow, there‘s way more to the story of what happens during a migraine.

Experts summarize the mechanisms causing migraines as “neurobiological changes that occur in the brain.” That fancy talk does little to help my patients and their families understand the cause, the scope, or the cure for the problem.

When explaining what happens at a cellular level, I teach patients that migraines are a chemistry shift causing swelling in that area of the brain.

It contributes to the early onset of death in those brain cells. Yes. You read that correctly.  The cells affected by a migraine die sooner and more often.

Ketogenic Diet and Migraines

The death of our brain cells usually takes time and happens with age. Scan an, and you are sure to find imperfections in their brain scan.  Scan an 80-year-old who has untreated high blood pressure for years and see many, many more defects.

Want to kill off brain cells the fastest? Put them under high pressure with lots of inflammation. Maybe your brain teeters on the edge of diabetes with “only slightly elevated” blood sugars.

Maybe you deny your brain the proper healing time by chronically living on 6 or 7 hours of sleep. Now add the chemical mystery of a migraine: BAM!  The perfect storm for coaxing brain cells to die sooner than they should. The longer that brain cell stays swollen, the more cells die.


Ask yourself these questions:

  • Has a headache limited your activities for a day or more in the last three months?
  • Are you nauseated or sick to your stomach when you have a headache?
  • Does light bother you when you have a headache?

If 2 of the three are true, chances are quite high that you damage your brain with every headache.  When teaching students or patients how to pick out a migraine from a minor headache I use the word POUND.

Ketogenic Diet and Migraines

 Although, brain experts argue over the exact mechanism for why the brain glitches into this searing pain, none say with the scans showing lost white matter. Indeed, the frequency and severity of your migraines unequivocally contribute to just how many brain cells die.

Don’t rush to the MRI machine the next time you get a headache. Instead, focus on stopping the underlying cause of those migraines.

The good news: brain swelling is reversible with treatment.


In past years, this would be when I would chirp at patients to do the following:

  • get 8 hours of sleep,
  • stop drinking alcohol,
  • fix your anxiety,
  • reverse your depression,
  • stop smoking cigarettes,
  • and lose weight.  


Also, they should take up meditation practices to lower stress along with turning off all electronics 2 hours before bed.  

Those recommendations still stand strong. But that list is impractical. It leaves patients hopeless and overwhelmed.

I have yet to see a patient walk into my clinic and say, “I want to be on the ketosis diet because I heard it helps with migraines.” I hope to hear that someday.

Teaching patients to produce ketones has become the most effective way to get my patients off of migraine medication and on to a healthy, pain-free life. After years of coaxing them to tackle that list written above, my approach now is to PEE A KETONE FOR 6 WEEKS.*  

I Find That This ONE Change is The Best First Step.

The root reason is the anti-inflammatory effects of ketosis. The authentic antidote to migraines is to remove the inflammation in that area of the brain.  Ibuprofen or acetaminophen certainly help a little bit. But bathe your brain with ketones for several weeks and watch the headaches evaporate from your life.

Ketogenic Diet and MigrainesAs patients continue to practice the keto-lifestyle, other improvements get checked off the list. Their sleep is better and more profound.  It doesn’t mean they can go with less than 8 hours. However, many of my migraine patients struggling with sleep problems. The magic elixir to sleep lurks in that third week of ketosis. That also seems to be when their mood improves.  

Each week into ketosis, more patients report a complete end to their migraines – usually within six months of peeing on that first ketone stick.

Just like other chronic problems, migraines don’t cause brain damage overnight. Similarly, recovering from years of swollen and damaged tissue takes time.

The longer patients stay in ketosis, the more thoroughly they remove the amount of extra brain swelling. At first, the water gets shed from their legs and bloating in the gut.

Over the next few months, patients also experience water removal in your skin, joints, eyes, and brain.  Those who stay in ketosis can’t help but observe the following: glowing skin, better joint movements, improved eyesight and overall less pain. These positive improvements show up around the 3-6 month mark, precisely the time most patients’ migraines disappear entirely.

For more information about ketosis, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.


  1. Achanta, Lavanya B., and Caroline D. Rae. “β-Hydroxybutyrate in the Brain: One Molecule, Multiple Mechanisms.” Neurochemical Research, vol. 42, no. 1, Aug. 2016, pp. 35–49., doi:10.1007/s11064-016-2099-2
  2. Bergin, Ann M. “Ketogenic Diet in Established Epilepsy Indications.” Oxford Medicine Online, 2016, doi:10.1093/med/9780190497996.003.0006
  3. Craig, Courtney. “Mitoprotective Dietary Approaches for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Caloric Restriction, Fasting, and Ketogenic Diets.” Medical Hypotheses, vol. 85, no. 5, 2015, pp. 690–693., doi:10.1016/j.mehy.2015.08.013
  4. Lorenzo, C. Di, et al. “Migraine Improvement during Short Lasting Ketogenesis: a Proof-of-Concept Study.” European Journal of Neurology, vol. 22, no. 1, 2014, pp. 170–177., doi:10.1111/ene.12550.

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Keto Diet and Brain Health: What Ketosis Does to Depression Symptoms.



keto diet and brain health

Mental Effects on Brain Function from the Keto Diet 

I’ll be honest. This is what kept me keto. It wasn’t the weight loss. It was the benefits of the keto diet and brain health. Certainly, I started ketosis because of my mother’s cancer, but its anti-cancer benefits aren’t the reasons I kept going.  

It’s hard to believe switching to a keto diet is going to improve your mental processes-especially during the initial transition from carbs to fat. As your brain adapts to using ketones for fuel instead of glucose, you get a woozy feeling. Often, this comes with a noticeable slump in your thinking. Your mood dips while your irritability goes up.

This can be rough. I have lost several patients to this slump when I failed to properly warn them that this gets better. As those first days lead you into your second week of ketone production, things change dramatically. The brain is one of the last organs in the body to adapt to using ketones. The cells in the brain tend to hang on to the quick and easy carbohydrate fuel.

When I first became a doctor, it was very hard for me to guess how medications I prescribed would affect patients. For example, when I would write out a prescription for an antidepressant, patients would ask how long before they feel better.

The Right Answer Was, “I Don’t Know.”

 Different people respond to medication differently. Also, the depths of one person’s depression looks quite similar on the outside but is indeed very different on the inside as compared to another.

keto diet and brain health

Some get better in two months while others take much longer. At first, I over promised the way patients would feel. I told them they would notice improvement without properly understanding how poorly their brain was working and how little the medication would do. Years of experience have taught me to carefully answer that question based on many factors unique to each patient.  

When I first transitioned into producing ketones, I did not really expect it would improve my mental functions or emotional well-being. I didn’t suffer from depression or anxiety. Slept well. I, essentially, felt normal. Indeed, any claim I had heard regarding ketosis and mental improvement reminded me of those over promised expectations I spouted to patients two decades ago.

By the end of the second week, I wrestled with giving credit for my improved energy, focus, and mood to the ketones coursing through my veins. Since then, I have continued to see nothing but improvement in my brain function. I feel like I am 25 years old again. I can concentrate on complex tasks for hours straight.

Keto Diet and Brain Health on Reversing Depression Symptoms

keto diet and brain health

Patients report their dreams became more vivid after successful keto-adaptation. Personally, I think many of these patients had a form of depression. Even if they resisted that depression ‘label’-and I don’t blame them for pushing back against the term-the improvement in their cognitive state mirrors that of recovering depression patients.

Watching a patient come out of the depths of depression teaches the observer how far the brain can sink and yet quickly recover and self-repair. If I could bottle the secret formula for that awakening, I would use it hundreds of times a month in the patients I see.

My severely, chronically depressed patients waddle in the sludge of darkness and brain fog for months-even years. They struggle to make decisions. When I insist they switch their diet, even their dog groans with disbelief. A successful behavior change appears too heavy of a burden. When they fall that far into the depths of brain-fog, they want a quick fix.  A pill. A jolt of “fix-me-doc.”

For these patients, I look to their caregiver. Their spouse, or parent, or even their child must lead the way to this new way of eating. Just like when I lead the way for my mom at 71 years old and suffering from a decade of cancer, the diet was just as helpful for me as it was for my mom.       

Whatever reason they started eating 80% fat, I don’t care. I am awestruck at how fast their brains become re-energized.

Prozac or no Prozac, I switch all of my depression patients to a keto diet. The results have been nothing short of impressive.

We know that remission of clinical depression is associated with normalization of inflammatory markers.  Although this does not link a cause and effect, the link matches what I see clinically.

Relationship Between Depression and Inflammation

keto diet and brain health

Many disorders with root causes of inflammation include emphysema (COPD), heart attacks and strokes, multiple sclerosis, Parkinson’s disorder, as well as autoimmune disorders such as Rheumatoid Arthritis, Crohn’s disease, or some thyroid disorders. These inflamed situations all are linked to increased populations with depression.

Another example of inflammation and depression is the recent advances in Hepatitis C treatment. The miraculous interferon drug used to kill this nasty virus is infused into patients and sparks quite a spike in inflammatory markers.  One-quarter of those people develop major depression.

Just like other chronic problems, these problems don’t cause damage overnight. Similarly, recovering from years of swollen and damaged tissue takes time.

When you become fully keto-adapted, about 4-6 weeks into the production of ketones the evidence of improved brain function is clearly present. The journey over those several weeks has shown that this awakening occurs at different times for people. As you continue to practice the keto lifestyle, the list of symptoms related to chronic inflammation slowly fade away.  Sometimes reversal is so slow they don’t identify the fact that the symptoms have gone down until I question the specific symptoms.

Within 6 months of peeing on that first ketone stick, I have seen many of my chronic depression patients get off all of their medications. I did not think this was possible. This all started with a ketone.  keto diet and brain health

The longer you stay in ketosis, the more completely you remove the amount of extra fluid lurking between those brain cells. Some swelling is found WITHIN the brain cells. That takes even longer.  

At First Sign of Ketone Production

At the first production of a ketone, the easy water gets shed. This is the water weight often found in your legs or feet. The next time you take off your socks, take notice if there is a ring left by your socks. That is not caused by extra fat. That is caused by water hanging out where it shouldn’t. That the swelling that disappears first when you start peeing ketones. Next, I notice the reversal of the bloat in the gut. By the second week of ketones, they look at their tummy and clearly it is not as extended. Stop peeing ketones and BOOM, it comes back.

Over the next few months, you’ll experience water removal from places that are harder to reach:  your skin, joints, eyes, and even your brain.

What do I see in my three months follow up patients that tell me they have peed ketones for the better part of those 100 days? Glowing skin, better joint movements, reduced neck pain, improved eyesight, and a brain that seems much more resilient than it was then.

These positive improvements show up around the 3-6 month mark, precisely the time most patients’ migraines disappear.

The first transition into ketosis does have reports of depression, lethargy, and tiredness.  Especially if they are going from a heavy carb diet to a low carb diet. Some patients struggle with a rise in anger and anxiety when they transition.

Switching Fuel Sources

Switching fuel sources from carbs to fat affects all areas of the body especially the brain. That striking change is FOR THE BETTER. The transition is tough. I’m not going to lie. The good news? There are tools to help you get through the switch as quickly and successfully as possible.  

Learn more about which foods are good – better – and best options through our FOOD GUIDE or check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.


  1. Lowe, Aileen, et al. “Neurogenesis and Precursor Cell Differences in the Dorsal and Ventral Adult Canine Hippocampus.” Neuroscience Letters, vol. 593, 2015, pp. 107–113., doi:10.1016/j.neulet.2015.03.017
  2. Maalouf, M, et al. “The Neuroprotective Properties of Calorie Restriction, the Ketogenic Diet, and Ketone Bodies.” Brain Research Reviews., U.S. National Library of Medicine, Mar. 2009,
  3. Masino, Susan A., et al. “A Ketogenic Diet Suppresses Seizures in Mice through Adenosine A1 Receptors.” Journal of Clinical Investigation, vol. 121, no. 7, Jan. 2011, pp. 2679–2683., doi:10.1172/jci57813
  4. Seyfried, Thomas N., et al. “Metabolic Therapy: A New Paradigm for Managing Malignant Brain Cancer.” Cancer Letters, vol. 356, no. 2, 2015, pp. 289–300., doi:10.1016/j.canlet.2014.07.015

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