Point-Counterpoint, TC's "Lifters Shouldn't Go Keto" Article

Diet and Nutrition
1

The Ketogenic Diet

The Ketogenic Diet appears to address some health issues in a positive way. That is the reason that I have been on it for the last two years.

Now let’s examine TC’s article…

“Nothing to Mop Up the Damage”

  1. As per TC: “…Avoiding so many foods and food groups…missing out on hundreds, possibly thousands of plant chemicals that are instrumental to human health in a number of ways.”

I agree.

  1. "As per TC: “…Most research suggests that keto diets are detrimental to weight lifting.”

Yes and No

  1. Most of the research on the keto diet being detrimental is primarily due to the fact that the majority of studies did not allow individual to become “Keto Adapted”.

It amount for a right handed batter in baseball given a couple of week to learn to hit the left handed. More time is required to become proficient at batting left handed, as well as becoming Keto Adapted.

That point was acknowledged by TC in the article, “…The subjects were only on the diet for four days and it takes several months for someone to truly adapt to a keto diet.”

  1. Energy System

a) The Phosphagen System: It runs off ATP (Adenosine Triphosphate), NOT glucose.

Limit Strength (1 Repetition Max) and Power Training employs The Phosphagen Energy System. That meaning the time to complete a set is between 15 to 30 seconds, which falls into the ATP Energy System.

New research has has demonstrated that Keto Adapted individuals performing high intensity training who fall within the parameters of the Phosphagen Energy System, 15 - 30 seconds, perform just as well as those on a Traditional High Carbohydrate Western Diet.

Muscle Glycogen Storage In Keto Adapted

Research has demonstrated that once Keto Adapted, muscle glycogen is approximately the same with individual on the Ketogenic Diet as with the Traditional Western Diet.

Now…

The Caveat In Question

  1. High Carbohydrate Diets make individuals glucose dependent. Their system is set up to utilized glucose more effectively and is less effective at burning ketones/body fat.

  2. High Fat Diets, like Keto, makes individual more dependent on ketones. Their system is set up to utilize ketone and is less effective at accessing glucose.

Thus, for Keto Adapted Athletes, they may not be able to effective access muscle glucose, if it is needed. Again, new research on the Ketogenic Diet is questioning it.

With That Said,…

I question (the research) regarding individual (like myself) being able to utilize ketones as effectively as glucose when in the “Glycolytic Energy System Training Zone”, like Hypertrophy Training.

If so, Ketogenic Diet Athlete may elicit a similar Hypertrophy Training Program effect by writing and follow program that employs the Phosphagen System (by passing the Glycolytic Energy System) that is specifically geared toward Hypertrophy. Another topic for another time.

“Should Bodybuilders Follow a Keto Diet?”

As per TC, “They’ll also likely lose some muscle, and they certainly won’t gain any.”

New Research Contradiction

Some of the latest research has demonstrated that a greater percentage of muscle mass is retained on a Ketogenic Diet than Traditional Western Diet.

The research goes on to identify gains in muscle mass with a well written Ketogenic Diet.

Now let’s take a look at…

Intermittent Fasting

This provides “The Goldilocks” effect.

High Carbohydrate Diets create glucose dependence and Kegogenic Diets a ketone dependence.

Research shows that Intermittent Fasting enable individual to utilize glucose and/or ketones, dependent on the activity. As per Goldilocks, “It just right” from my perspective.

Kenny Croxdale

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I don’t follow your logic. A ketogenic diet or a high carbohydrate diet refer to the types of foods (or, more specifically, macros) one consumes. Intermittent Fasting refers to a restricted window of time in which calories are consumed.

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I don’t know of one successful bodybuilder who has been so by following a ketogenic diet long term. When @The_Mighty_Stu prepped me, and when we prep other people, we only use a ketogenic diet at the tail-end of a prep for one week, coupled with depletion workouts to make a carbup effective and with the resulting saran-wrap-like skin and roadmap vascularity.

I reviewed many studies for my nutrition degrees dealing with ketogenic dieting for endurance athlete. Even when keto-adapted, the diet provided no benefit and in some cases no detriment for endurance performance. With that said, I don’t know why an endurance or other athlete would use it long term if it offers no physical advantage considering the complete omission of food groups.

Most bodybuilders don’t perform or feel well on the diet either. And carbs aid in muscle building.

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My take on the critique is that this was a poorly-argued case against ketogenic dieting.

Now maybe it was a quiet day at TNation Towers. The cynic in me might think low carb dieting has taken a bit of a hammering since Biotest launched certain products.

That aside, trying to make a case against ketogenic performance by cherry-picking studies where the participants went 4 days keto is just fundamentally flawed.

Then jumping to the conclusion that you lose muscle on keto is just plain wrong. There is good evidence to the contrary, e.g. Paoli’s gymnasts, but none of that was cited.

More recently, it is something of an open secret that some Tour de France riders were going low carb, and supplementing with exogenous ketones, and these are among the fittest guys on earth. This is hardly a surprise given the work of Volek and Phinney over the last several years.

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Glycogen Energy System

I touched on that issue in my initial post.

Bodybuilding fall more into the Glycogen Energy System. Thus, a Ketogenic Diet may nor work as well for them.

Nutrition Degree

What type of Nutrition Degree do you have?

Endurance Athletes

Yes, some cases have demonstrated that a Ketogenic Diet provided no benefit. benefits.

However, some studies by Drs Phinney and Volek have demonstrated there is a definite benefit advantage for endurance athletes who employ the Kegogenic Diet.

That because Endurance Athletes utilize more more ketones for long distance events; unless due to their high carbohydrate diet they are more glucogen dependent.

There are several Endurance Athletes who excel on a Ketogenic Diet.

You read “Some case” studies that found no benefits; you should examine the research studies demonstrating the benefits of the Ketogenic Diet for Endurance Athletes.

Bodybuilders Performing/Feeling Well On Keto

There are variety of reason…

  1. Many are not following a Ketogenic Diet. The majority of individual that I confer with usually are on a high protein, low carbohydrate, moderate fat diet.

That means they are never in and never will be in Ketosis; never are Keto Adapted.

  1. Bodybuilder fall more into the Glycogen Energy System. Thus, it appear their training is more glucose dependent.

  2. It appears that Volume Training may be more compromised on a Ketogenic Diet than on Traditional High Carb Western Diet.

“Carbs Aid In Muscle Building”

It appears they may be more effective in promoting muscle gains..

However, increasing muscle mass can be produce on a Ketogenic Diet; research has demonstrated that.

Kenny Croxdale

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Pros and Cons

There are pros and con to all diets.

I’d have preferred a review of that examined the upside and downsize of it.

Also, another interesting perspective would have been…

How Keto Strength Athletes Need To Training

In other word, working backward. Writing a Phosphagen Energy System Training Program geared to the Ketogenic Athlete.

Custer Set for Hypertrophy

As research shows, Hypertrophy TraIning produces a drop in Limit Strength (1 Repetition Max) and Power. Oliver’s research was to find a Hypertrophy Training Program that maintained Strength and Power.

Oliver looked at Cluster Sets. What Oliver found was that Cluster Sets increasing muscle mass while maintaining and increasing Limit Strength and Power.

The Traditional Bodybuilding Method is more effective for Hypertrophy. However, Oliver research found that Cluster Sets closely approximated similar results.

Oliver’s research determined that Cluster Sets of around 6 repetition with short rest periods Clusters were able to restore most of the ATP needed for force production.

Dr Greg Haff’s research on Cluster Set found that up to 79 of ATP was restored to muscle in approximately 45 seconds.

It appears that Keto Adapted Athletes interested in Hypertrophy Training could trigger the anabolic muscle building effect with Cluster Sets, that employed the Phosphagen System.

Kenny Croxdale

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This sounds interesting, how would you structure such a program?

Exercise selection, bodypart division, volume etc.
Just curious, because I made a point in trying the anabolic diet at least once in my life and I train for hypertrophy, so I might bookmark this for future usage.

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I see several benefits of a ketogenic diet, but it is important to compare a ketogenic diet both to a traditional western high carb diet (45-65% carbs) and to a diet which includes glucose only to meet the needs of glucose (and ketone) dependent tissues (about 100-150 grams of carbs or 20-30% of maintenence needs) per day. A 20-30% carb 50%+ fat diet also promotes a dramatic increase in fat utilization by muscle cells.

A problem is that there is a “bad zone” between about 20-30% carbs, and a keto-adapted state. In the keto-adapted state, gluconeogenesis should be downregulated since the body starts using ketones instead of glucose for “glucose dependent” tissue like the brain. This would occur maybe at 10% carbs (maximum) plus maybe a maximum of 20% protein, say 60 grams of carbs and 120 grams of protein on a 2400 calorie maintenance level. I know that I have been able to get to keep ketone levels between 0.4 and 1.2 at that level.

Anyway, between that 100-150 carb gram level, with 150-220 grams of protein, and the 60/120 level, there appears to be a zone of increase gluconeogenesis (basal insulin needs rise, and fasting blood sugar also tends to rise in the 10-20% carb range).

This “zone” creates a kind of barrier, but it also may have benefits that get lost in total extended ketosis. So I have 3 primary issues with constant ketosis which I will list briefly, but first I would like to say that I don’t see a health related issue with a virtual elimination of starches and sugars.

Problems?

  1. Autophagy (the immune system scavenging damaged cells for sources of gluconeogenesis) occurs in the zone between 20/30% (modified by degree of caloric restriction) and ketogenesis. In ketogenesis, atuophagy is blunted because there is no need for glucose sources. Also cancer cells generally don’t grow in a ketogenic state, so destruction of precancerous cells becomes less important to survival. I think that it is probably biologically important for those in ketosis to come out of ketosis and pass through the high autophagy zone occasionally to activate the immune response against precancerous and malformed cells. Likewise those who eat zone or 20-30% carbs, or even high can benefit from passing through that autophagous zone which is often accomplished with I.F. The autophagous benefits of I.F. seem to be lost for someone in perpetual ketosis.

  2. I believe that it is hard to spike leucine levels on a high fat protein source because the high fat protein source slows gastric emptying and protein absorption. Experiments have shown that amino acid levels in the blood can be mildly elevated for up to 12 hours after a protein source combined with high fat. This would make it difficult to undulate leucine levels and create spike. BCAAs ire nearly as insulinogenic as glucose on a gram per gram basis, and so the better your nutritional plan is at spiking leucine, the harder it will be to stay in ketosis. The leucine spike itself seems to affect protein synthesis most profoundly when there is also an increase in plasma insulin levels. The solutions seems to be to use very small amounts of pure leucine (3-5 grams) alone, shortly before a fat based meal, or to take in leucine peri-workout with carbs so that they may be cleared from the bloodstream by non-insulin mediated mechanisms. Protein synthesis has been shown to continue to rise as protein intake rises from 0.7 g/kg to about 1.0 g/kg BW, which would put most people out of ketosis, since gluconeogenesis also rises (and corresponding insulin levels) in this range. Protein becomes more insulinogenic as intake increases both by serving and over the course of a day. Small amounts of protein can enter muscle cells by non insulin mediated mechanisms fast enough to avoid triggering a large insulin response. They also won’t rob insulin from working on blood glucose from a meal, or from liver output, but higher levels of protein intake will hang around in the bloodstream long enough to steal insulin from working on glucose, basically resulting in a temporary degree of physiological insulin resistance. The same thing happens in gluconeogensis though which also raises basal insulin needs, largely because of increase in cortisol. So for a hypothetical example, a 200 pound man might consume 40 grams of protein a day with virtually no increase in insulin output for the day. The next 120 grams might require 65% as much insulin as an equivalent amount of carbs (this is actually an evidence based estimate) and almost all protein consumed above 160 grams is going to require or use up insulin at virtually the same level as an equivalent number of grams of carbs. (This cutoff of about 0.7 grams/kg is also evidence based, based on rising urea levels that occur at above about 0.7).

  3. While it is true that endurance athletes in ketogenesis store glycogen at high levels, it is also true that endurance athletes who eat high carb diets store higher levels of free fatty acids in muscle. All this tells us is that endurance athletes are unique in that they can store lots of glycogen and free fatty acids at the same time. Their muscles can store a lot of FFAs and still be very sensitive to insulin. Non endurance athletes will tend to lose glycogen in favor of FFA storage as the carb content of their diet drops. It seems to me though that the body simply loads muscle with the best combination of fat and glycogen to produce energy given the macros consumed and the activities engaged in. At high output levels, even a high carb endurance athlete will produce increased ketones. If endurance athletes eat more protein their body turns the protein into glucose much faster and in general, the more protein one consumes, the more protein the body turns into glucose.

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I’m not sure where you plucked those figures from but the basic fact is an absence of carbohydrate will result in ketosis regardless of how many grams of protein you are ingesting. This ‘120g’ figure seems to crop up frequently but the fact is even on high protein diets like PSMF (where intake can be double that) gluconeogenesis cannot be a significant factor given corresponding high blood ketone readings.

Otherwise, I believe you have provided a very thought-provoking piece here.

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A couple of points regarding protein.

  1. I have read articles from ketogenic proponents who claim that high cortisol levels alone can knock people out of ketosis even on virtually zero carbs, due to gluconeogenesis working on body proteins.

  2. I read a study of meat only dieters who ate large amounts of fat and protein but zero carbs for several years. They had high fasting blood sugars (110-125) which would be very unusual if they also had high ketone levels. It would represent a very high level of total energetic molecules in the blood. As carbs are replaced by fat in a diet, generally fasting blood sugar and fasting insulin levels rise until the subject reaches nutritional ketosis, at which point fasting blood sugar drops, though the sum of blood sugar and blood ketone energetics stays about the same. Total mmol/dL of glucose plus ketones in nutritional ketosis is usually the same as mmol/dL of blood glucose for that person on an isocaloric diet. For example, someone who typically has a fasting blood glucose of 5 mmol/dL on an isocaloric diet will have their blood glucose rise to around 6 mmol/dL when they drop below 20-30% carbs, and then will have blood glucose drop to about 4 mmol/dL when they first reach nutritional ketosis but their ketone levels will make up another 1.0. Total blood energetics doesn’t drop. Point is, meat only eaters DON’T report the low 4.0 (72 mg/dL) fasting blood sugar that those in nutritional ketosis do, rather they report levels above normal, and indicative of gluconeogenesis driven metabolism, around 6.0 (108 mg/dL).

  3. When protein intake rises above about 1 gram per kg of bodyweight, additional protein can be accounted for completely by increased loss of nitrogen in the form of urea and ammonia. There is a one to one correspondence between nitrogen from amino acids consumed above this level with nitrogenous molecules lost as urea and ammonia, HOWEVER, I am assuming that if an amino acid molecule loses a nitrogen atom to create a molecule or urea or ammonia, that there is a molecule of glucose yielded. I haven’t read up on those mechanisms much. Also, this might change in ketosis.

  4. I KNOW that insulin dependent diabetics on a ketogenic diet require injected insulin to manage protein even in the absence of consumed carbs, on almost a gram equivalent basis to carbs, or else experience a rise in blood sugar comparable to an equivalent amount of carbs. This suggests that the non insulin dependent individual in ketosis will also release insulin to match protein intake so as to maintain euglycemia. With the insulin dependent individual, we have a metabolically normal individual except for one fact-they secrete no insulin and we therefore have a complete account for all insulin that goes into the system without having to test insulin levels constantly. In addition, insulin dependent individuals who consume ketogenic diets require the same or slightly HIGHER basal insulin levels to maintain euglycemia as insulin dependent individuals who eat a mixed diet. From the data I have seen on at least a few dozen insulin dependents, some who eat ketogenic diets and some who eat mixed diets, the ketogenic dieters require about .3 units per kilogram per day to manage fasted needs (ie liver output of glucose), and the mixed dieters .2 units per kilogram per day to manage fasted needs/liver output. This is among those who are not considered to also be insulin resistant. They also both require as much insulin per gram of carbs, but the ketogenic dieters require about twice as much for a given amount of protein.

  5. Every time someone posts on this site saying that that they are trying a ketogenic diet with 40 something grams of carbs and 200 grams of protein, and they want to know why it’s not working, there seem to be several apparently keto knowledgeable posters claim that "keto is low carb and low protein and your not in ketosis on 200 grams of protein.”

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[quote=“mertdawg, post:8, topic:242191”]I believe that it is hard to spike leucine levels on a high fat protein source because the high fat protein source slows gastric emptying and protein absorption. Experiments have shown that amino acid levels in the blood can be mildly elevated for up to 12 hours after a protein source combined with high fat.
[/quote]

Research Data?

High fat slowing the Leucine spike makes sense.

As you noted, high fat mildly elevating amino acids for up to 12 hours.

Phinney and Volek have essentially stated something similar; Leucine levels being elevated on a Ketogenic Diet.

find this interesting. Do have references on this that you can provide?

Is this based any specific research or your extrapolating information from varies data. Either way, it’s is an interesting solution.

Kenny Croxdale

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It’s n = 1 again but I have blood ketone tested at 1.1mmol on a PSMF, which is higher than when I’ve measured after taking exogenous ketones on a SKD.

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I’m not aware of that but there is a theory that a downside of ketogenic dieting is a rise in cortisol. This, in fact, is one of the main reasons I adhere to a TKD in a bid to offset chronic cortisol production from high frequency training.

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A Work In Progress

I am a Powerlifter. My adherence to the Ketogenic Diet is drive by my trying to resolve a health issue.

Thus, my focus is on how to write a Strength and Power Training Program that avoids the weakness of a Ketogenic Diet and plays to it strengths.

Glycolytic Energy System

It appears that one of the downsides to the Ketogenic Diet is that it is counter productive for training or sports that are more glucose dependent.

With that said, some research indicates that Ketogenic Adapted individual may be able to perform well in the time periods of the “Glycolytic Time Zone”.

As someone on the Ketogenic Diet, I’d like to believe that but I don’t. When you break it down it doesn’t make sense.

Thus, it appears that a Keto Adapted individual’s training program needs are optimized by avoiding the “Glycolytic Time Zone”, where glucose is needed.

The Phospahgen Energy System

The Phosphagen Energy System for Keto Adapted individual appears to resolve the issue by keeping training in the “Phosphagen Time Zone”; under 30 seconds per set.

A good solution to this appears to be…

Cluster Sets

The majority of individual have at one time have employed Cluster Sets in their training without realizing it.

A Cluster Set involves short to moderate long pauses (10 to 45 seconds) between 1 Repetition to multiple repetition during a set.

Thus, any individual who let’s say is performing a heavy 10 Rep Max, who pauses on the 9th and 10th rep so they can complete the set, turns it into a Cluster Set.

Hypertrophy Training

The Traditional Bodybuilding Method is the optimal method for increasing muscle mass.

The downside for athletes is that Strength and Power drop.

Dr Jonathan Oliver’s Research

Most of Oliver’s research involves how to maintain or increase Strength and Power while increasing muscle mass (Hypertrophy).

Oliver’s research found…

  1. Cluster Sets that incorporated up to 6 Reps per cluster enabled athlete to increase Strength and Power while increasing muscle mass (Hypertrophy).

Bench Press Cluster Example: 6 Reps, rest 15 seconds, 6 reps, rest 15 seconds, 6 Reps, rest 15 seconds, 6 Reps, rest 15 seconds. Stop.

That is One Cluster Set with a Total Cluster of 24 Reps.

Perform Four more cluster of the above, with a 3 minute or longer between each. That amount to a total of 96 repetitions for your Bench Press.

The Cluster Set allows restoration of ATP, refueling the “Super Fast” and Fast Muscle Twitch Muscle Fiber; ensuring the “Super Fast”/Fast Muscle Fiber are engaged/trained and greater force is produced during each set.

As a side note, Cluster Sets Repetitions need be be performed via Compensatory Acceleration; each rep moved as hard and fast as possible.

Oliver found “Cluster Set Hypertrophy Training” produce an increase in muscle mass that was close to that of The Traditional Bodybuilding Protocol. However, The Traditional Bodybuilding Protocol optimized increases in muscle mass more so than Clusters.

Understanding The Concepts

The key to this/anything is understanding the concepts which elicit that optimal response in a training program.

That allows you have a multitude of options in writing a Cluster Set Training Program.

Volume Training

Another one of the downside of Keto Adapted individuals is it appears that they cannot tolerate high volume training; which is one of the fundamentals for Hypertrophy.

For me, performing fewer exercises on training days works better. I increase my volume by engaging in more training periods during the week.

Cyclical Ketogenic Diets

Research has demonstrated Cyclical Ketogenic Diets (like that Anabolic Diet) don’t work well.

A two day Carb Load doen’t allow you to get back into ketosis for around 3 1/2 day.

Thus, if you Carb Up on Saturday/Sunday, you don’t get back into ketosis until either late Thursday or on Friday. So, you during the week, you are only in ketosis for 1 - 1.5 days.

Secondly, research found that Cyclical Ketogenic Diets produce more body fat gains.

For More Cluster Set Hypertrophy Training Information…

Google Dr Jonathan Oliver. His PhD Dissertation is posted online, along with some additional of his research and his presentation of it (on youtube) at the Texas State National Strength and Conditioning Clinic, a few years ago.

Kenny Croxdale

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Acute Cortisol Production

Cortisol continue to be misunderstood and vilified the majority of gym rats.

As you know, acute cortisol plays a role in utilizing body fat.

I’ve never had an issue with Chronic Cortisol with my Ketogenic Diet or training or in some of my work with other.

Kenny Croxdale

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I think in the absence of daily testing, it is very difficult to accurately assess your cortisol levels. Of course, sleep disruption and chronic bloating may be evidence of raised cortisol but in absence of testing it is guesswork.

Certainly ketogenic diets are supposed to improve the testosterone to cortisol ratio so perhaps the need for carbs to mitigate the effect of the latter is misplaced?

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My “feeling” here is that when you get keto adapted, cortisol drops because the body stops needing glucose for the brain, and that high cortisol occurs more for those who are hanging in the autophagous zone between about 20% carbs and ketosis, or doing I.F. I don’t see any reason to use I.F. in a keto adapted state though.

Regarding your 1.1 ketones with high protein ketogenesis, what kind of fasting blood sugar do you get? I have seen high fat, high protein keto dieters get fasting blood sugars rise above 100 whereas those who limit protein drop to the 70s. This indicates to me that the first group is not keto adapted and still making glucose from protein. I also thought that I have read that when one initially enters ketosis, they should see ketones in the .7-1.2 range, but when they get adapted, the levels usually drop down to 0.2-0.6 because they are being burned efficiently.

Anyway, if fasting blood sugar is high, like 90+ AND ketones are high, it is not good for glycosylation damage, because ketones and glucose, (and blood fructose(and triglycerides and blood amino acid level) can all exert pressure toward glycosylation, even though A1C levels may be decreased. All energetic molecules in the plasma contribute to damage to sensitive tissues like kidneys, eyes, blood vessels. If ketosis doesn’t lower total blood energetics then its not helping.

Anyway, I will be offline for a couple of days by try to respond to everyone.

General questions for everyone: 1) Do you think that a ketogenic diet causes a faster or slower accumulation of lactic acid in the blood during exercise? 2) Are there studies on how a ketogenic diet affects testosterone levels? Thoughts on how it affects test?

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I haven’t done fasting blood glucose for a while, for some reason. By coincidence, I did one last night a couple of hours after eating and working out and it was 5.6mmol. I’ll do another tomorrow morning now as I’m curious.

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Ok, my test this morning was slightly flawed in design because my routine means I am finishing dinner (5 nights a week or so) at 11pm. So I tested today at 8am, which is only a 9-hour fast. The result was 5.9mmol which, according to the charts, is pre-diabetic! How can this be when I also tested blood ketones and was back in mild ketosis (0.4mmol) after last night’s very high protein feeding? Some research by Ted Naiman and others suggests there are perfectly rational explanations for this. One reason is ‘adaptive glucose sparing’ meaning while fasting levels are commonly higher in keto-adapted people, these drop throughout the day (which chimes in with my previous test several hours after working out then eating - at 5.6mmol). To paraphrase this phenomenon, prior to converting to the ketogenic diet, your muscles were the major sites to soak up and use glucose in the blood for energy. On the long-term keto diet, however, they now prefer fat as fuel. So the muscles are resisting the action of insulin to bring sugar into cells for energy, saying, in essence: “We don’t want or need your sugar anymore, so move it along.” Hence, the slightly elevated, but generally stable, glucose circulating in the blood.

Second, fasting glucose testing isn’t fasting insulin testing. The two are quite different, so the former does not inform me about the status of the latter (which I can assume is probably low).

Thirdly, morning cortisol impacts on test results (I think we discussed this before). Interesting stuff. I’m glad you brought it up.

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I have also heard this (although I would suggest at 0.2 you are not in ketosis; and at 0.3 to 0.5 you are in mild ketosis). One example, Luis Villasenor, of Ketogains. He took a reading following a 16-hour fast followed by a heavy chest workout, and tested at 0.3mmol (and BG at 7.8mmol).

I certainly believed this chimes with my own experience because, until very recently, I had never reached double digits on a test (albeit those damn strips are expensive so I have only done 20-30 tests). My highest reading has been 1.1mmol, and that is on a PSMF. In other words, a very low carbohydrate diet as well as general low energy diet (circa 50% deficit). However, I was listening to keto-bodybuilder Robert Sikes aka Keto Savage and he claims to get as high as 3.5mmol from being strict keto for 3-4 years.