How to Transition Through Every Ketosis Phase: Part 2

Adapting your body to burn fat instead of carbs involves five specific phases. Each ketosis phase happens in a predictable order that have been researched and studied. Scientists documented the body’s transitions by entering patients into a study where they fasted for forty days. Each phase marks changes in your blood chemistry and occurs at specific, scientifically predictable times. With hopes of not overwhelming you, I will take three blogs to cover all five phases. Each phase I review where you are in the time since your last carbohydrate, and what fuel source your body is using: ketones versus glucose. I also take note of your brain-fuel in each phase. This post focuses on phase three. In part one we discussed the first two ketosis phases. Check out part one here!

This is the second article covering these phases. Check out the previous post for the first two phases. You completed phase two by emptying your liver of all of the stored sugar. Now you’re ready for phase 3 of the transition into keto-adaption.


  • THIS STARTS: 24 HOURS after you ate your last carbohydrate.
  • STATUS OF THE BODY: Your fuel is still mostly glucose, but your liver begins making ketones. Only a couple of areas in your body use ketones as fuel in phase 3.
  • YOUR BRAIN: Still powered only by glucose.

You will know the exact point when you complete phase 2 and enter phase 3. How? You start peeing ketones! Transitioning from phase 2 to 3 happens at different times for different people because of the liver’s variables described previously.

Here are some common statements from patients that tip me off to the possibility that they may have an overstuffed liver:

  • ‘Doctor, I have tried every diet. None of them worked.’
  • ‘Doctor, I am a dude, and I look pregnant. Can you fix this?’
  • ‘Doc, I had a gastric bypass and lost a bunch of weight… but I gained most of it back.’

These patients have a biochemistry crisis hidden inside their livers. They have had gastric bypass, gastric banding or their jaws stapled shut and still were not able to achieve lasting weight loss. They are patients who have used speed pills and antidepressants, participated in group therapy, undergone hypnosis, and injected hormones to lose weight. All share the same result: zero to minimal lasting weight loss. Alternatively, those that lost some weight gained it all back sooner or later.

They were all fighting the hidden monster of the chemistry that blocks against weight loss. The name of that enemy: insulin. The medical term for these patients is insulin resistance, but I tell them that they have stubborn livers.

If you pee ketones by the end of the second day of cutting out carbs, do a little dance. You are not likely to be the owner of a stubborn liver. Keep track of how long it takes you to get to ketosis phase 3. This time-to-first-urine-ketone predicts the size of your liver. Much like your fasting blood glucose results, this information tells you and your medical team what has been happening under the surface.

What is the key? Reduce your daily carbs to 20 grams or less. This shocks your sugar-dependent system. In ketosis phase 1, every cell in your body fueled their furnaces with glucose; specifically, your brain is 100% dependent on sugar.

In phase 3, certain parts of your body switch to using ketones for fuel. The first tissues to adapt is your liver. Yep. That stubborn liver makes the first ketones. In fact, your liver supplies the majority of your ketones. The rest of your body will slowly learn to BURN ketones. Only the liver and a few other types of cells make ketones.

Once ketones are circulating in your blood, the first cells to use them are your fat cells and your muscle cells.

Other sections of your body are more protective of which fuel they use. Those tissues wait to see if this ketone fuel will be available only temporarily or long term.

Here’s a cell ranking from most to least adaptable to use ketones: fat cells, muscles, skin, internal organs (heart, lungs, and kidneys) and brain.

The brain is the most resistant to fuel transition. That makes sense. We don’t want our most vital organ flip-flopping between fuel sources. The brain waits the longest to convert to fat-based energy. When the brain finally switches over though–it feels good. SO GOOD!

Here is the play-by-play transition that I recommend for you. Just follow these steps.

Eat your final carb-based-meal and a couple of hours later go to bed.

When you awake, you are nearly 10 hours into your transition.

Within the next 12 hours, your liver will empty your stored sugar.

Throughout the day, use MCT C8:C10 oil or heavy whipping cream in your coffee. Drink water. Eat all the eggs you want. Cook them in butter.

Eat a couple of sausage patties or bacon for lunch. For work, take along some high-fat cheese and slices of pepperoni in case you feel like eating in between meals.

That evening, go out to eat and order buffalo wings dipped in blue cheese dressing. Be sure to order the wings in buffalo sauce and not honey mustard or barbecue sauce. Those have carbs in them. You want the buffalo sauce. Eat wings until you are full. No beer. No soft drinks. No breading on your buffalo wings. Keep the skin on. Double dip them in blue cheese dressing. Add only water for a drink.

By 8 o’clock that night, your liver should be cleared entirely of glycogen. It should be completely clear of stored sugar. Your early-adapting organs will gradually begin to switch their fuel source to ketones.

Go straight to bed. Forget about getting a carb-rich snack like you’re used to. If you followed instructions, your cupboards should be emptied of all those temptations anyway.

You’ve made it 24 hours since your last helping of carbohydrates. These next 12 hours are best dealt with by sleeping and staying SOBER: Don’t drink booze. Touch any alcohol, and you can kiss ketosis goodbye.

I have had some patients report their bedtime as 8 PM that first night. They did not know how else to get off their normal routine. I don’t care how you do it, just get to the next morning.

Wake up the next morning. It’s been 36 hours since your last high dose of carbohydrates. This puts you almost always into ketosis phase 3. Check your ketone strips. Even a slightly pink color on the strip is a win.

Stubborn livers beware! If your liver is overworked, stretched out or engorged with stored sugar, you might not be there yet. If you’ve been a huge carb junkie, overweight for many years, or a full-blown diabetic, you might have another day ahead before your ketone test turns positive.

Make this your morning ritual: Check your ketone urine strip.
Put four more strips in your pocket. These little urine-strips break down when exposed to air for too long. You have only that day to use the strips in your pocket. Otherwise, throw them away. Each time you pee, check your urine for ketones.

Use those ketone strips to see exactly which ketosis phase you are in. Are you in ketosis phase 2 or have you arrived at ketosis phase 3? The answer is hidden unless you look.

Before I insisted that patients check their ketones, several patients who needed this lifestyle the most gave up. I lost them in frustration. This sets in when you don’t know what is going on inside your system. Changing eating patterns shocks the daily routine of most patients. They are delighted when the results hit them – mentally and physically. But if the results never come, frustration leads to failure. They ask for my help, and I need reliable information to help them. Keep track of how long it takes your liver to empty. Check your urine ketones.

My experience with peeing my first ketone involved a full month of frustration. I was insulin resistant and then I ate too much protein. I realized I had one of those stubborn livers. I was also unaware of the carbohydrates hidden in gum, toothpaste, cough drops and sauces. I didn’t know the mayonnaise I was using had carbs in it. I also ate soups made with flour. I would be doing well and then BAM-no more ketones.

Had I not been looking at that urine ketone strip the first month, I would have certainly given up. The mistakes I was making would have been unknown without that feedback.


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.

Click Here for Part 3!

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