Some people on a keto or low carb diet choose to count total carbs instead of net carbs. This makes it more difficult to fit in more leafy greens and low carb vegetables (which are filled with fiber), so you should only try that if you don’t get results with a net carb method. And, start with reducing sugar alcohols and low carb treats before deciding to do a “total carbs” method.
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The point of keto is to force your body to deplete its glucose (and the stored form, glycogen) so it will have to use body fat as a fuel source. It’s capable of making ketone bodies from your fat, which can replace glucose as an energy-storing molecule if necessary. To do that, you have to break apart fat molecules thus ‘burning’ the fat off. But here’s the thing: your body really really doesn’t want to run out of glucose. No glucose means starvation as far as it’s concerned—even if you're not feeling hungry, your body is still missing one of its key macronutrients. And when you’re (nutritionally) starving, your body will start to break down protein just to get those sweet, sweet carbs. Of course, you have a source of protein in your body already: your own muscles. “When in starvation mode, your body breaks down muscle in your body,” says Giancoli. “Ketosis is a way of trying to preserve that protein. It’s not ideal, but it’s your body’s way of saving you.”
Note that urine measurements may not reflect blood concentrations. Urine concentrations are lower with greater hydration, and after adaptation to a ketogenic diet the amount lost in the urine may drop while the metabolism remains ketotic. Most urine strips only measure acetoacetate, while when ketosis is more severe the predominant ketone body is β-hydroxybutyrate. Unlike glucose, ketones are excreted into urine at any blood level. Ketoacidosis is a metabolic derangement that cannot occur in a healthy individual who can produce insulin, and should not be confused with physiologic ketosis.
Nutrient-sensitive neurons reacting to glucose but also to fatty acids (FAs) concentrations are present at many sites throughout the brain and may play a key role in the neural control of energy and glucose homoeostasis. Central administration of oleate, for example, inhibits food intake and glucose production in rats. This suggests that daily variations in plasma FA concentrations could be detected by the CNS as a signal that contributes to the regulation of energy balance (Moulle et al., 2014).
One downside to a ketogenic diet for weight loss is the difficulty maintaining it. “Studies show that weight loss results from being on a low-carb diet for more than 12 months tend to be the same as being on a normal, healthy diet,” says Mattinson. While you may be eating more satiating fats (like peanut butter, regular butter, or avocado), you’re also way more limited in what’s allowed on the diet, which can make everyday situations, like eating dinner with family or going out with friends, far more difficult. Because people often find it tough to sustain, it’s easy to rely on it as a short-term diet rather than a long-term lifestyle.