Linking To And Embedding Metabolic Mind’s “Q&A: Keto for AFib, Heart Risk, Ketone Levels & More”

Posted on June 28, 2026 by Tom Wade MD

For a post on Insulin Sensitivity, please see

This episode, “Q&A: Keto for AFib, Heart Risk, Ketone Levels & More”  is, like all of Metabolic Mind posts, outstanding. For me the most helpful part of the talk is from 9:57 to 14:12 where Dr. Scher discusses a lot of the nuances of ketogenic therapy. Here is the auto-generated transcript of that part.

Good.

Well, we will pick that back up once it’s been peer

reviewed and published

and we will talk more about it.

Okay.

Our next question comes from @matiaskoretzky1367

and it’s from YouTube.

And the question is, “I’ve been on a

strict keto diet for over 3 months.

I train 5x/week (resistance)-“

Woo. Good for you.

“And walk ~ 15k steps daily

daily and do 16-hour fasts.”

Wow.

“I keep carbs below 20g

and eat 160g of protein (181 cm, 80 kg).

Ketones rarely go above 0.9 mmol,

likely due to the protein.

Lowering it makes me too hungry given my activity level.

Over time I start feeling depleted-

low energy, brain fog, return of old symptoms.

Fasting insulin is 3.0 µU/mL, glucose 76 mg/dL”

I’m giving you all these numbers. So

insulin sensitivity looks fine.

How can I raise ketones without compromising energy,

satiety, or thyroid (T3)?

Can some carbs be added

without disrupting ketosis or metabolic balance?”

Yeah.

So good question.

I mean, there are a lot of details and

again, I can’t give

individual advice,

but the key for this, just like with

everything is to go back

to why are you in ketosis?

What are you using ketosis for and are

you seeing a benefit?

So that’s the first question because not

everybody needs to be in ketosis, right?

This person mentioned they’re rarely

above 0.9 millimoles per

liter on their ketones,

but does that matter?

If you’re treating a psychiatric diagnosis,

if you’re seeing benefits to symptoms at

higher ketone levels, then it matters.

If you’re trying to improve your

metabolic health or treat type II diabetes or lose weight,

then the ketones probably don’t matter as much.

So that’s the first part.

Now, the second part: How can I raise

ketones without compromising energy,

satiety, or thyroid?

So one is I want to make sure this

individual is getting

enough calories and enough fat.

They are very active.

So first is making sure they’re getting

enough fat calories

because that’s going to be their

energy source.

But second, they probably can also

increase their carbohydrates.

And that would be a good experiment

because someone who is

this active with very good

insulin sensitivity, they could probably

be in ketosis with 50 or

even 75 grams of carbohydrates.

Many people can.

Now, if they’re looking for higher ketone

levels, that may be an issue.

But if you’re happy in the 0.5 to 0.9

range, then you can

certainly increase your carbohydrates

if you were this active

and this insulin sensitive.

And so I think that’s

another important point.

We frequently say,

“Start with 20 or 30 grams of

carbs to get into ketosis,

but that is just a starting point and is

very individualized.

And the more active and insulin sensitive

you are, the more carbs

you can handle and still be in ketosis.

So one is making sure

you’re getting enough calories.

Two is you can increase

your carbs if you need to.

And the other thing is maybe the 16-hour fast

isn’t even necessary.

I mean, perhaps, that can be

helpful in a lot of

different ways, but not always.

So if someone is feeling a little

depleted and low energy,

then maybe not doing that fast,

or at least experimenting with that could

be an experiment to do.

So I guess the point is there are a few

different experiments

someone can do for this.

And you mentioned thyroid, so make sure

you’re checking your thyroid, right?

Make sure you’re checking your electrolytes.

Make sure you’re checking a regular blood

test to make sure

there’s nothing else going on.

But those are the things that

sort of pop into mind for me.

But I love that you’re exercising, that

you’re walking and

doing resistance training.

Yeah.

And then, of course, this is also the

time we’re working with

an experienced dietitian or

ketogenic coach or a clinician who’s

trained in ketogenic

therapy could also be helpful,

especially if you’re using ketosis to

treat a specific medical condition.

Yes, yes.

All great recommendations.

And so it sounds like to answer your

question, you may want to add some carbs

and it might be OK for you.

But again, it might be time to work with

a professional to try to

help dial those things in

and keep you going.

How can someone just last quick and dirty

question here to just add on to this

question that we just discussed, how can

someone raise their ketone

levels when all else fails?

The traditional answer is

lower your carbs, increase your fat,

lower your protein sort of in order.

Make sure your carbs are low enough.

Make sure you’re getting enough fat.

Make sure you’re not getting too much protein,

which is a tricky subject

because you still want to get

enough protein for metabolic health,

satiety, lean muscle, etc.

So still somewhere around

like the 1.2 grams per kilo or somewhere around there.

So those are the first steps.

And then also, there are non-food related

things. Make sure you’re sleeping.

Make sure your stress is well managed.

And then there are medications that can impact

ketone production. And then next is you

can add MCT oil or you can

even take exogenous ketones.

So there’s a number of stepwise approach

you can do to approach your

ketones and if you want them

to be higher and how you can do different

things to impact that.

All that follows is from The Metabolic Mind Post.

Q&A: Keto for AFib, Heart Risk, Ketone Levels & More

Jun 19, 2026 Metabolic Mind Podcast
Can ketogenic therapy help atrial fibrillation? What should you make of the KETO-CTA study? And do higher ketones always mean better results? In this Metabolic Mailbag episode, Dr. Bret Scher answers audience questions about cardiovascular health, ketosis, ketone levels, and how to personalize a ketogenic approach based on your goals and metabolic health. From AFib concerns to cholesterol controversies and troubleshooting low ketone readings, this episode tackles some of the most common questions in the keto community.
In this episode, we cover:
  • Ketogenic therapy and atrial fibrillation (AFib)
  • The latest update on the KETO-CTA study
  • LDL cholesterol, plaque, and cardiovascular risk
  • Why ketone levels don’t tell the whole story
  • Raising ketones without sacrificing energy or muscle
  • Carbohydrate intake and metabolic flexibility
  • Fasting, protein, and thyroid considerations
  • MCT oil, exogenous ketones, and other strategies to increase ketosis

One of the biggest takeaways: context matters. Whether you’re evaluating cholesterol, ketone levels, or cardiovascular risk, there is rarely a one-size-fits-all answer. Understanding your goals, metabolic health, and individual response is often more important than chasing a specific number. 🔎 Have questions about how to apply metabolic therapies effectively? Submit them at https://www.metabolicmind.org/questions/ to be featured in a future Metabolic Mailbag episode. #MetabolicMind #KetogenicTherapy #CardiovascularHealth Expert Featured:

Experts Mentioned:

Resources Mentioned:

Free CME Clinician Trainings: Are you a clinician who would like to learn more about the science behind these therapies and how to implement them in practice? Earn CME with our growing library of courses from some of the top experts in the field including Dr. Chris Palmer, Dr. Georgia Ede, Dr. Matthew Bernstein, Dr. Mariela Glandt, Dr. Deanna Kelly, Dr. Julie Milder, Dr. Zoltan Sarnyai, and Dr. Bret Scher with more coming soon. Our courses have been made FREE by grants from Baszucki Group, so we can spread these powerful therapies as widely as possible. Earn CME/CNE credits: https://www.metabolicmind.org/for-cli… Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry. Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/ About us: Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them. Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.

Timestamps:
0:00 – Introduction
0:45 – Keto & AFib: Can keto help or hurt heart rhythm?
3:45– What was the KETO-CTA Study?
5:20 – Why the original KETO-CTA paper was retracted?
7:25 – How to think about cardiac risk on keto?
9:47 – Ketosis, energy level, and adding carbs
14:10 – How to raise ketone levels when all else fails?
15:14 – Outro

 

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