Choosing the Right Type of Keto for You

Which path is best?

At Mason & Lanz, we work with people navigating complex health challenges. For some, a ketogenic approach can be a powerful tool for restoring metabolic balance and supporting healing. But not all “keto” is the same.

Ketosis: A Different Metabolic State

A metabolic state refers to the main type of fuel your body is using for energy.

💡 In a glucose-based state, your body primarily burns carbohydrates (sugar) for energy.

💡 In a ketogenic state, your body shifts to burning fat and producing ketones to use as fuel - usually when carbs are very limited.

This metabolic switch can happen either during fasting or by going on a keto diet, which means significantly reducing carbohydrate intake (typically to 20 - 50g net carbs per day) while increasing fats. This shift prompts the liver to produce ketones from fat, offering the body - and especially the brain -an alternative energy source.

Ketones play a critical role when glucose is low. While most of the body can use fat directly for fuel, the brain cannot. Instead, it relies on ketones, which can cross the blood-brain barrier and provide clean, efficient energy. This explains why many people report sharper mental clarity and improved focus while in nutritional ketosis.

How Fast Does Ketosis Start?

Here’s a breakdown of what getting into ketosis might look like when someone’s either fasting or starting out a ketogenic diet:

Fasting

Your body typically begins producing ketones within 12 to 24 hours.

0–12 hours: Glucose and glycogen (stored glucose) are the primary fuels; minimal ketones.

12–24 hours: Glycogen stores in the body deplete; fat-burning and ketone production increase.

24–72 hours: Ketones rise significantly (often 0.5–3.0 mmol/L); the brain shifts to using them.

Keto

On a ketogenic diet, most people can reach ketosis within 2 to 4 days. We can tell by measuring ketone levels using a blood ketone meter, a breathalyzer, or urine strips. To be considered “in ketosis” we look for ketone levels starting at 0.5 mmol/L.

How quickly a person gets into ketosis depends on several things. It might take a tad bit longer if:

➡ your usual diet is high carb

➡ you don’t move around very much (exercise depletes glycogen faster)

➡ you have more body fat

➡ you’re insulin resistant or you otherwise have poor metabolic health

If you’re starting out on keto and you want to get into ketosis quickly:

1️⃣ Tightly Restrict Carbs: Start out your keto diet at 20 total or net grams of carbs/day.

2️⃣ Fast: Start with a short fast to help jump start ketosis.

Nutritional vs. Therapeutic Ketosis: What's the Difference?

These two terms can get a bit confusing, especially because nutritional ketosis can mean two different things. We’ll break it down for you:

Nutritional ketosis:

1️⃣ (general definition) A state of ketosis achieved through dietary means, whether that's low-carb eating or fasting. On a keto diet, this typically means eating anywhere up to 50g of net carbs per day to reach ketone levels of 0.5 mmol/L or higher.

2️⃣ (common clinical definition): A milder, more sustainable form of ketosis used for general health, weight loss, blood sugar control, and metabolic support - not as deep as what’s typically needed for therapeutic purposes. According to this definition, nutritional ketosis achieves levels of ketones between 0.5 and 1.5 mmol/L.

Therapeutic Ketosis:

Therapeutic ketosis is a stricter form of ketosis, with ketone levels typically starting at 1.5 mmol/L and rising up to 3.0+ and above. These higher ketone levels are often needed for treating medical conditions like epilepsy or other severe neurological (brain) issues as well as cancer and some autoimmune disorders. The type of keto needed to reach these levels often requires a higher fat intake, protein restriction, and close tracking.

Throughout the rest of this article, we’ll be using the common clinical definition of nutritional ketosis (milder ketosis with lower ketone levels).

Protein & Fat: Nutritional vs. Therapeutic Needs

Protein

Another difference between nutritional and therapeutic ketosis is how much protein is consumed.

In nutritional ketosis, protein intake is usually moderate to high and based on individual needs - often around 1.2 - 2.0 grams of protein per kilogram of ideal body weight. This supports muscle maintenance, satiety, and metabolic function. Unless a person has certain health issues that require a lower protein intake, there’s no need to restrict protein aggressively, especially for people aiming for weight loss or long-term metabolic health.

In therapeutic ketosis, however, protein is more tightly controlled, with intake being kept anywhere between 0.6 and 1.0 grams. This is because excess protein - especially certain amino acids - can stimulate gluconeogenesis (glucose production) and reduce ketone production. For people who need a more potent intervention, a lower protein intake helps maintain higher and more stable ketone levels. Protein is typically calculated carefully based on body weight, lean mass, and clinical needs.

Good news! If you have to restrict protein, a ketogenic diet can help. Keto is protein-sparing - meaning your body is less likely to lose muscle. Here's why: Keto shifts the body’s energy use from glucose to fat and ketones, reducing the need to break down muscle for fuel. Stable insulin levels, reduced glucose demand, and supportive hormonal changes (like increased growth hormone) further help preserve lean body mass.

Added Fat

Keto is by definition a high fat diet, but that doesn’t mean you’ll be chugging from a bottle of olive oil every day.

In nutritional ketosis, fat is used to meet energy needs and support satiety, but intake from added fat like oils, butter, and animal fats is typically more moderate - especially for those aiming to burn body fat. The goal is to encourage the body to use its own fat stores.

In therapeutic ketosis, high fat intake is necessary to maintain deeper ketosis, particularly when protein needs to be limited. Added fats - including MCT oil - help raise ketone levels and stabilize energy and mood.

This makes sense. Remember, extra protein is turned into glucose in your body, which can get in the way of ketone production. At the same time, cutting out protein means you’re cutting out calories you need for energy. If you cut out calories from protein, then you need to add more calories from fat. Fat – as opposed to carbs and protein – is the only macronutrient that won’t get in the way of your body producing more ketones.

Benefits of added fat:

➡ Higher ketone production

➡ Improved satiety

➡ More stable energy and mood

➡ Potential anti-inflammatory and neuroprotective effects

Drawbacks to consider:

For those focused on weight loss, too much added fat can slow progress by providing more energy than needed.

There’s still conflicting evidence about the long-term effects of high saturated fat intake, especially in people with genetic or cardiovascular risks.

What About Exogenous Ketones?

Exogenous ketones are supplements (usually salts or esters) that raise blood ketone levels without necessarily having to make stricter dietary changes. While they don’t train your body to burn fat or produce ketones on its own, they can be useful:

➡ For short-term energy or focus

➡ To ease the transition into ketosis

➡ As a therapeutic tool, particularly when a keto diet designed to get therapeutic levels of ketones isn’t feasible (in other words, if someone cannot or does not want to go on a very low carb, strict keto diet)

Think of exogenous ketones as a supportive aid, not a substitute for nutritional change.

When to Use Nutritional vs. Therapeutic Ketosis

For example...

Weight loss & insulin resistance, CKD	Nutritional ketosis
Type 1 & 2 diabetes or prediabetes	Nutritional ketosis (with monitoring)
Chronic inflammation & fatigue	Start with nutritional; adjust as needed
Cancer, ADPKD, neurological or autoimmune conditions, complex, multi-system illness	Therapeutic ketosis (guided)

Can You Move Between the Two?

Absolutely. Nutrition should evolve with your needs. Someone may start in therapeutic ketosis to address specific symptoms or stabilize a condition, then shift to nutritional ketosis for maintenance. Later, they might even transition to a lower or more moderate carb plan that supports well-being without requiring ketosis.

Here’s what this progression might look like:

1️⃣ Therapeutic Ketosis (high ketones, strict)

2️⃣ Nutritional Ketosis (moderate ketones, flexible and more easily sustainable)

3️⃣ Low- or Moderate-Carb Diet (individualized, sustainable)

Moving between therapeutic ketosis, nutritional ketosis, and a lower or moderate carb diet doesn’t happen the same way for everyone. Nutrition isn’t one-size-fits-all - and it shouldn’t be. Whether you're managing a chronic illness, supporting kidney health, or aiming to improve metabolic function, your approach should reflect your goals and your body.

At Mason & Lanz, we specialize in therapeutic and functional nutrition for complex health needs. We guide clients from where they are now to where they want to be, whether that means beginning with therapeutic ketosis or simply learning how to eat in a way that feels clear, supportive, and sustainable.

Need support with keto, kidney health, or personalized nutrition? We offer one-on-one coaching - virtually and in-person, across Switzerland and internationally.

👉 Contact us today to schedule your first consultation or learn more about our coaching packages.