#208: Keto Adaptation and the Gut Liver Axis

by Mike Mutzel


Want Early Access to Interviews and Additional Bonus Content? Become a High Intensity Health Insider and Access Bonus Content


Listen to the recording


Sound Cloud


In this video, we discuss some of the science about:

– The relationship between low blood glucose and ketosis
– The liver’s role in making ketones
– How we can improve liver health

Sponsored Content: Learn How to Successfully Incorporate the Ketogenic Diet and Low-Carb Living Into Your Lifestyle for Fat Loss and Better Blood Sugar Balance

Read the Show Notes

00:25 A ketone body is fat repackaged by your liver for energy. The two main metabolites created are beta hydroxybutyrate (BHB) and acetoacetate. When you are eating low carb, insulin levels are low. Your brain and muscle need fuel. When there is no sugar, messages are sent to the liver to make ketone metabolites.

01:47 When you are exercising or fasting, your adipose tissue releases triglycerides and free fatty acids to be repackaged as ketones. Muscle tissue likes to use acetoacetate. BHB fuels muscle contraction. Your brain requires BHB when blood sugar is low.

02:30 BHB has secondary signaling properties. BHB downregulates the NLRP3 inflammasone network, which turns on a number of pro-inflammatory pathways. BHB upregulates Nrf2 (nuclear regulator factor 2), a huge anti-inflammatory phase 2 detox and anti-oxidant signaling hub. Nrf2 turns down NFkB. Glucose does not have secondary beneficial properties.

04:25 Ketones affect histone deacetylase inhibitors (HDACs). Our DNA is sensitive and easily damaged. It is tightly wound around these histone-like proteins. Histone deacetylase inhibitors affect DNA structure and gene signaling.

05:23 Low Ketones: Get back to the basics. It is about more than eating low carb/high fat. There are other considerations: fat tissue health, muscle health and sleep hygiene. Everything is connected. Your fat tissue communicates with your liver. Your gut communicates with your liver. Your liver and intestinal tract have cross talk.

06:17 Good Liver Health/Constipation: Increase your salt intake. Constipation is common with ketosis and can kick you out of ketosis. Constipation can also cause the recirculation of nasty chemicals, negatively impacting your liver. Do a detox before going onto a ketogenic style diet. Clean house.

07:11 Liver Function Testing: ALT, AST, and GGT are enzymes created by your liver. They are elevated when your liver is undergoing damage and there are low glutathione levels.

07:52 Keto adaptation is challenging with elevated liver enzymes. Try low carb paleo before going keto. For the liver to make ketones, blood insulin and blood glucose must be low. Lethargy and even fainting may result if blood sugar is low and the liver is damaged, hindering the making of ketones for your brain.

09:11 Do calories matter if you alternate day fast? It depends. If you are trying to build muscle and gain strength, compress your feeding window. Alternate day fasting is more for weight management/loss, anti-ageing, resting your GI tract, cancer prevention or improving blood sugar regulation. Muscle tissue is one of the best organs to help you lose fat, slow ageing, and decrease inflammation. You need stimulus from exercise and nutrition. Listen to your body. Fasting the day after overeating is a good strategy.

11:21 Can eating too many non-starchy vegetables prevent you from ketosis? Review the PURE study. We need about 5 to 7 servings of vegetables per day. Do what works for you. Test your blood glucose. Check your heartrate variability. How was your sleep? How is your muscle tissue? Are you burning fat for fuel? Do your pants feel loose?

13:14 Can you recommend how much salt is needed for electrolytes? You need about 4 to 4.5 grams per day.

14:42 Can keto cause hair loss? Probably not. Hair loss can be from nutrition, anemia, iodine/thyroid health, and dihydrotestosterone. Look on your maternal side and check the hair balding pattern. The Dutch Test (Dried Urinary Total Comprehensive Hormone panel) will reflect hormone imbalances. If it is thyroid, you may lose part of your eyebrow as well. You may want comprehensive thyroid testing. Test ferritin, iron and total iron binding capacity to see if you have a functional anemia.

17:21 How would biotoxin/mold exposure impede keto adaptation? Inflammation of any kind affects insulin signaling and fat burning. Weight gain is a common side effect of mold and biotoxin exposure.

19:43 What is a target blood sugar when in ketosis? Around 4 to 4.5 millimolars or about 80 mg/dl blood glucose is a good target. Post meal you do don’t want to be over 5.5 millimolars or 100 to 110 mg/dl blood glucose.  Spikes in glucose affects insulin release. Insulin suppresses ketogenesis.

20:58 Hormones impact the synthesis and production of ketones in the body. Men keto-adapt a little easier than women because they have higher levels of androgens. Androgens are ketogenic. Fat tissue makes estrogen and contains the enzyme aromatase that converts testosterone to estrogen. Estrogen dominance negatively impacts fat burning.

21:52 Is there a test we can take to find what deficiencies we have so we can address these on keto or general? In January we will do a course on this. Check out our insider area and make sure that you are on our email list. Find a doctor that practices functional integrative medicine and request a comprehensive panel that covers gut, liver, kidney, thyroid, hormones and serum markers. Nutra eval organic acid testing can look at micronutrients.

23:21 What is the differences between salt and sodium? Sodium and salt are words used interchangeably. Use an unrefined table salt.

24:51 Will increasing salt intake effect blood pressure and water retention? Please watch the podcast with Dr. James DiNicolantonio or read his book, The Salt Fix.

25:48 I have been keto for 7 months, but gas out early when mountain biking, any advice for fueling energy? Mountain biking can be glycolytic. Be mostly keto, but carb cycle. Adding a few carbs while exercising is like adding rocket fuel to your muscle tissue.

27:29 How many grams of fat should you consume in a day to stay in ketosis? It depends upon the person. There is no magic number. You don’t know until you start testing. Measure blood glucose levels. When that is under control, measure blood ketone levels. Keep a 4 or 5 day record what you are eating that is not keto. Track your calorie intake, body weight, free fat mass and free muscle mass and start tweaking from there. Consumption should also be adjusted to activity levels.

29:38 What would you recommend to the person who reduces carbs to 20 grams per day or less and still can’t get into ketosis? A multitude of variables impact your liver’s ability to make ketones. Look at your lifestyle. Sign up for our master class and our private FaceBook group.

31:51 Does your requirement for sodium decrease as you become fat adapted?  No. You may need more. Look for signs that you are being depleted of electrolytes.

33:11 What are your thoughts on low carb/high fiber cereals? Cereal is processed food, even if it’s grain-free. The carbs they contain are going to be fast acting, affecting insulin. You can get good sources of fiber from real unprocessed microbiome rich foods.

Testing Your Blood Ketones: Learn Tips and Best Practices

Related Video: Turmeric Infused Ghee Butter + Tiger Nut Butter Ideas

    • Great question, Helen.

      Many of the bitter herbs and botanicals can be helpful, omega-3 FA and exercise.

      But It’s always best to work with a health professional to see “why” one’s liver is not functioning as it should.



Leave a Reply