Can You Eat Carbs and Still Be in Ketosis?

Are you trying to follow a low-carb diet but still struggling to get into ketosis? Or have you been enjoying a few too many carb-heavy meals and wondering if it’s still possible to maintain ketosis? Well, you’re in luck! In this article, we’ll explore the question of whether it’s possible to eat carbs and still be in ketosis.

The idea that carbs are strictly off-limits when trying to enter ketosis is a common misconception. In reality, it’s not the carbs themselves that kick you out of ketosis, but rather the type and amount of carbs you consume. So, if you’re looking to add some more variety to your diet without completely derailing your ketosis journey, then keep reading!

We’ll take a closer look at the science behind ketosis and how different types of carbs can affect your body’s ability to produce ketones. We’ll also discuss strategies for incorporating carbs into your diet while still maintaining ketosis. Whether you’re a seasoned keto-dieter or just starting out, this article has something for everyone!

Quick Answer:
It is possible to eat carbohydrates and still be in ketosis, but it depends on the individual’s carbohydrate intake and how their body responds to it. Ketosis is a metabolic state in which the body burns fat for fuel instead of carbohydrates. The amount of carbohydrates that can be consumed while remaining in ketosis varies from person to person, but generally, it is recommended to keep net carbohydrate intake below 50 grams per day to maintain ketosis. Some people may be able to tolerate more carbohydrates without leaving ketosis, while others may need to limit their intake more strictly. It is important to monitor blood ketone levels and adjust dietary intake accordingly to maintain ketosis.

What is Ketosis?

Understanding the Ketogenic Diet

The ketogenic diet is a high-fat, low-carbohydrate diet that is designed to force your body to burn fat instead of carbohydrates for energy. This metabolic state is called ketosis, which is characterized by the production of ketone bodies, molecules produced by the liver when it breaks down fat for energy.

The ketogenic diet is typically used to promote weight loss, improve blood sugar control, and increase energy levels. By drastically reducing carbohydrate intake and increasing fat intake, the diet aims to induce a state of ketosis in the body, in which it becomes more efficient at burning fat for energy.

The standard ketogenic diet (SKD) is the most common type of ketogenic diet, and it consists of a macronutrient ratio of 75% fat, 20% protein, and only 5% carbohydrates. This diet is typically followed for 4-12 weeks, and it requires strict adherence to the macronutrient ratio to maintain ketosis.

The cyclical ketogenic diet (CKD) is another type of ketogenic diet that involves periods of high-carbohydrate intake, followed by periods of low-carbohydrate intake. During the high-carbohydrate phase, the diet allows for more flexibility, while during the low-carbohydrate phase, the diet returns to the standard ketogenic diet ratio.

The targeted ketogenic diet (TKD) is a type of ketogenic diet that involves eating a normal, balanced diet most of the time, but restricting carbohydrate intake during specific periods, such as during exercise or when attempting to lose weight.

Overall, the ketogenic diet is a high-fat, low-carbohydrate diet that is designed to induce a state of ketosis in the body, in which it becomes more efficient at burning fat for energy. It is typically used for weight loss, blood sugar control, and increased energy levels. There are several different types of ketogenic diets, including the standard ketogenic diet, cyclical ketogenic diet, and targeted ketogenic diet.

The Science Behind Ketosis

Ketosis is a metabolic state in which the body begins to burn fat for energy instead of carbohydrates. This occurs when the body’s glycogen stores have been depleted, usually after a period of fasting or low-carbohydrate dieting. The liver converts fatty acids into molecules called ketones, which are then used as fuel by the body’s cells.

In order to understand the science behind ketosis, it is important to understand the role of glucose and fatty acids in the body’s energy production. Glucose is the primary source of energy for the body, and it is typically derived from carbohydrates. However, when glucose levels are low, the body begins to break down stored fat for energy. This process is regulated by a hormone called insulin, which helps to control the uptake of glucose into cells.

When the body is in a state of ketosis, it produces ketones, which are molecules produced by the liver during the breakdown of fatty acids. These ketones are then used as fuel by the body’s cells, including the brain. The brain can use either glucose or ketones for fuel, but it is thought that ketones may provide a more efficient source of energy for certain brain regions.

Overall, the science behind ketosis is complex and involves many interrelated physiological processes. However, at its core, ketosis is a metabolic state in which the body burns fat for energy instead of carbohydrates.

What are Carbohydrates?

Key takeaway: While following a ketogenic diet, it is possible to consume some carbohydrates and still maintain a state of ketosis, but the amount and type of carbohydrates that can be consumed will vary depending on the individual and their specific metabolic needs. The relationship between carbohydrates and ketone production is complex, and factors such as the glycemic index of foods, insulin sensitivity, total daily carbohydrate intake, and the timing of carbohydrate consumption can influence the ability to maintain ketosis while consuming carbohydrates.

Types of Carbohydrates

Carbohydrates are organic compounds that consist of carbon, hydrogen, and oxygen atoms. They are the primary source of energy for the human body and can be found in a variety of foods, including fruits, vegetables, grains, and legumes. There are three main types of carbohydrates:

Simple Carbohydrates

Simple carbohydrates, also known as simple sugars, are made up of one or two sugars. They include:

  • Monosaccharides: These are single sugars, such as glucose, fructose, and galactose. They are commonly found in fruits, vegetables, and dairy products.
  • Disaccharides: These are two-sugar molecules, such as sucrose (table sugar), lactose (milk sugar), and maltose (malt sugar). They are found in foods such as table sugar, honey, and candy.

Complex Carbohydrates

Complex carbohydrates are made up of longer chains of sugars. They include:

  • Polysaccharides: These are long chains of sugars, such as starches and fibers. They are found in foods such as grains, potatoes, and legumes.
  • Oligosaccharides: These are shorter chains of sugars, such as inulin and fructans. They are found in foods such as onions, garlic, and bananas.

Nutritive vs. Non-nutritive Carbohydrates

Carbohydrates can be further classified as nutritive or non-nutritive. Nutritive carbohydrates provide energy and are important for the body’s metabolic processes. They include monosaccharides, disaccharides, and polysaccharides. Non-nutritive carbohydrates do not provide energy and are not metabolized by the body. They include fibers and some types of oligosaccharides.

In summary, carbohydrates are an important part of a healthy diet and can be found in a variety of foods. They can be classified into simple and complex carbohydrates, as well as nutritive and non-nutritive carbohydrates, depending on their chemical structure and function in the body.

The Role of Carbohydrates in the Body

Carbohydrates are one of the three primary macronutrients, along with proteins and fats, that provide energy to the body. They are composed of carbon, hydrogen, and oxygen atoms, and can be found in a variety of foods such as grains, fruits, vegetables, dairy products, and legumes.

The human body can use carbohydrates in two different ways: it can either break them down into glucose (a simple sugar) and use it as an immediate source of energy, or it can store them in the form of glycogen in the liver and muscles for later use.

The brain, which is the body’s most energy-demanding organ, relies heavily on glucose as its primary source of fuel. Therefore, carbohydrates play a crucial role in maintaining brain function and overall energy levels.

Additionally, carbohydrates are necessary for the proper functioning of the central nervous system, the kidneys, and the muscles. They also help to regulate blood sugar levels and are involved in the production of hormones and neurotransmitters.

In summary, carbohydrates are an essential part of a balanced diet and play a vital role in maintaining overall health and well-being.

How Does the Body Produce Ketones?

The Process of Ketogenesis

Ketogenesis is the metabolic process by which the body produces ketones, which are molecules produced by the liver when it breaks down fat for energy. When the body is in a state of ketosis, it relies primarily on ketones as a source of energy, rather than glucose, which is the primary source of energy for the body when it is not in a state of ketosis.

There are two main types of ketones that the body produces: acetone, which is the most abundant ketone, and beta-hydroxybutyrate (BHB), which is the other primary ketone. These ketones are produced by the liver from the breakdown of fatty acids, which are molecules that are broken down from fats in the diet or from stored body fat.

The process of ketogenesis begins with the consumption of foods that are high in fat, which triggers the release of insulin, a hormone that regulates blood sugar levels. Insulin signals the body to store glucose, which is converted into glycogen and stored in the liver and muscles. When the body is in a state of ketosis, however, insulin levels are low, which allows the liver to break down stored fat and convert it into ketones.

The liver converts fatty acids into molecules called acetyl-CoA, which are then converted into ketones. Acetone, which is the most abundant ketone, is produced when acetyl-CoA is combined with acetate. BHB, on the other hand, is produced when acetyl-CoA is combined with butyrate. These ketones are then released into the bloodstream and transported to other organs in the body, where they can be used as a source of energy.

When the body is in a state of ketosis, it is able to use ketones as a primary source of energy, in addition to glucose. This is because the body is able to convert ketones into ATP, which is the primary source of energy for the body’s cells. The brain, however, is unable to use ketones as a source of energy, and must rely primarily on glucose. As a result, individuals in a state of ketosis may experience side effects such as fatigue, headaches, and brain fog, particularly during the initial stages of the diet.

In summary, the process of ketogenesis is the metabolic process by which the body produces ketones from the breakdown of fatty acids. When the body is in a state of ketosis, it relies primarily on ketones as a source of energy, in addition to glucose. This process is regulated by insulin levels and the availability of glucose in the body.

The Relationship Between Carbohydrates and Ketone Production

When the body is in a state of ketosis, it produces ketones, which are molecules produced by the liver when it breaks down fat for energy. This metabolic state is typically induced by a low-carbohydrate diet, which forces the body to rely on fat as its primary source of energy.

However, the relationship between carbohydrates and ketone production is not as simple as just reducing carbohydrate intake. The body can still produce ketones even if some carbohydrates are consumed. This is because the body is capable of switching between different metabolic pathways depending on the availability of energy sources.

The human body has two main sources of energy: glucose (derived from carbohydrates) and ketones (derived from fat). When glucose is available, the body prefers to use it as its primary source of energy. However, when glucose levels are low, the body will start to break down fat and produce ketones as an alternative source of energy.

The amount of carbohydrates that can be consumed while still maintaining ketosis varies from person to person. Some people may be able to consume a moderate amount of carbohydrates without affecting their ketosis, while others may need to strictly limit their carbohydrate intake to maintain the metabolic state.

There are several factors that can influence the relationship between carbohydrates and ketone production, including the type and amount of carbohydrates consumed, the individual’s metabolic rate, and the presence of other health conditions or medications.

Overall, while the relationship between carbohydrates and ketone production is complex, it is possible to consume some carbohydrates while still maintaining a state of ketosis. However, the amount and type of carbohydrates that can be consumed will vary depending on the individual and their specific metabolic needs.

How Many Carbs Can You Eat and Still Be in Ketosis?

The Recommended Daily Amount of Carbohydrates for Ketosis

When it comes to the recommended daily amount of carbohydrates for ketosis, there are varying opinions and approaches. Generally, the ketogenic diet recommends a very low carbohydrate intake, typically under 50 grams per day, to maintain a state of ketosis. However, some experts argue that a moderate carbohydrate intake, around 100-150 grams per day, can still promote ketosis and provide numerous health benefits.

It’s important to note that the recommended daily amount of carbohydrates for ketosis may vary depending on individual factors such as age, gender, weight, height, activity level, and current health status. For example, a sedentary individual may require fewer carbohydrates than an active individual.

Moreover, the type of carbohydrates consumed can also play a role in maintaining ketosis. It’s recommended to focus on consuming complex carbohydrates such as vegetables, fruits, whole grains, and legumes, which provide a range of essential nutrients and fiber. Simple carbohydrates such as sugar and refined grains should be limited or avoided altogether.

It’s recommended to consult with a healthcare professional or registered dietitian to determine the appropriate daily carbohydrate intake for your individual needs and goals. They can provide personalized guidance and support to help you achieve and maintain a state of ketosis while also meeting your nutritional needs.

Factors That Affect Carbohydrate Consumption and Ketosis

The Glycemic Index of Foods

One factor that affects carbohydrate consumption and ketosis is the glycemic index of the foods consumed. The glycemic index measures how quickly a particular food raises blood sugar levels. Foods with a high glycemic index, such as white bread and sugary drinks, can cause a rapid increase in blood sugar, leading to a decrease in ketone production. On the other hand, foods with a low glycemic index, such as vegetables and whole grains, are digested more slowly, leading to a more gradual increase in blood sugar and a higher likelihood of remaining in ketosis.

Insulin Sensitivity

Another factor that affects carbohydrate consumption and ketosis is insulin sensitivity. Individuals with insulin resistance or type 2 diabetes may find it more difficult to maintain ketosis, as their bodies have a reduced ability to respond to insulin. These individuals may need to limit their carbohydrate intake in order to maintain ketosis.

Total Daily Carbohydrate Intake

The total daily carbohydrate intake is also an important factor in determining whether one can maintain ketosis while consuming carbohydrates. A ketogenic diet typically restricts daily carbohydrate intake to less than 50 grams per day. However, some individuals may be able to maintain ketosis with a higher carbohydrate intake, depending on their individual metabolic needs and response to carbohydrates.

Timing of Carbohydrate Consumption

The timing of carbohydrate consumption can also affect ketosis. Consuming carbohydrates at the same time as protein or fat can reduce the body’s ability to produce ketones. On the other hand, consuming carbohydrates at different times throughout the day, rather than all at once, may make it easier to maintain ketosis.

In conclusion, the factors that affect carbohydrate consumption and ketosis include the glycemic index of foods, insulin sensitivity, total daily carbohydrate intake, and the timing of carbohydrate consumption. Understanding these factors can help individuals make informed decisions about their diet and maintain ketosis while consuming carbohydrates.

What are Keto-Friendly Carbohydrates?

When following a ketogenic diet, it is crucial to be mindful of the types of carbohydrates consumed. The majority of the diet should consist of fat and protein, with only a small amount of carbohydrates from sources that are considered “keto-friendly.” Among these are complex carbohydrates, which are typically considered to be a better choice than simple carbohydrates.

Types of Complex Carbohydrates

  1. Starchy Vegetables: Vegetables such as potatoes, sweet potatoes, and winter squash are high in complex carbohydrates and can be incorporated into a ketogenic diet in moderation.
  2. Legumes: Beans, lentils, and peas are all rich in complex carbohydrates and can be a valuable source of protein and fiber. However, they should be consumed in moderation as they are also high in net carbohydrates.
  3. Whole Grains: Grains such as brown rice, quinoa, and oats contain complex carbohydrates and can be a part of a ketogenic diet, but they should be consumed in moderation and in the proper portion sizes.

Benefits of Complex Carbohydrates

  1. Fiber: Complex carbohydrates are high in fiber, which can help regulate digestion and promote feelings of fullness.
  2. Micronutrients: Many complex carbohydrates are rich in essential vitamins and minerals, such as B vitamins and iron.
  3. Blood Sugar Control: Due to their slower digestion and absorption, complex carbohydrates can help regulate blood sugar levels and provide a sustained source of energy.

Moderation is Key

While complex carbohydrates can be a part of a ketogenic diet, it is important to consume them in moderation. Consuming too many complex carbohydrates can lead to an increase in net carbohydrates, which can kick you out of ketosis. It is essential to carefully monitor portion sizes and choose keto-friendly complex carbohydrates to maintain a state of ketosis.

Natural Sweeteners and Ketosis

While on a ketogenic diet, it is important to be mindful of the carbohydrates you consume. However, this does not mean that all carbohydrates should be avoided. Some natural sweeteners can be incorporated into a ketogenic diet without disrupting ketosis.

Natural Sweeteners:

  1. Stevia: Stevia is a natural sweetener derived from the leaves of the Stevia rebaudiana plant. It is a zero-calorie sweetener that is approximately 200-300 times sweeter than sugar. Stevia is a great alternative to sugar as it does not raise blood sugar levels and is keto-friendly.
  2. Erythritol: Erythritol is a natural sweetener that is derived from fermentation. It is a zero-calorie sweetener that does not raise blood sugar levels and is not metabolized by the body. Erythritol has a sweet taste similar to sugar but contains almost no calories.
  3. Xylitol: Xylitol is a natural sweetener that is derived from the birch tree. It is a zero-calorie sweetener that is about 40% sweeter than sugar. Xylitol is a great alternative to sugar as it does not raise blood sugar levels and is keto-friendly.
  4. Monk fruit extract: Monk fruit extract is a natural sweetener derived from the monk fruit. It is a zero-calorie sweetener that is approximately 150-200 times sweeter than sugar. Monk fruit extract is a great alternative to sugar as it does not raise blood sugar levels and is keto-friendly.

Incorporating Natural Sweeteners into a Ketogenic Diet:

When incorporating natural sweeteners into a ketogenic diet, it is important to keep in mind the amount of carbohydrates they contain. While natural sweeteners are keto-friendly, they should be consumed in moderation to maintain ketosis.

In conclusion, natural sweeteners can be incorporated into a ketogenic diet without disrupting ketosis. Stevia, erythritol, xylitol, and monk fruit extract are great alternatives to sugar and can be used to sweeten foods and beverages while maintaining a state of ketosis.

Tips for Incorporating Carbohydrates into a Ketogenic Diet

Planning Meals

When incorporating carbohydrates into a ketogenic diet, it is important to plan meals in advance to ensure that the daily carbohydrate intake stays within the recommended limit. Here are some tips for planning meals:

  • Keep track of daily carbohydrate intake: Use a food diary or app to track carbohydrate intake throughout the day. This will help to stay within the recommended limit of 20-50 grams of carbohydrates per day.
  • Choose low-carbohydrate ingredients: When planning meals, choose ingredients that are low in carbohydrates, such as leafy greens, non-starchy vegetables, and high-quality proteins.
  • Incorporate high-fiber, low-carbohydrate fruits and vegetables: Fruits and vegetables that are high in fiber and low in carbohydrates, such as berries, broccoli, and cauliflower, can be incorporated into meals to add nutrients and variety.
  • Use portion control: When consuming higher carbohydrate foods, such as whole grains and legumes, use portion control to ensure that the daily carbohydrate intake stays within the recommended limit.
  • Prepare meals in advance: Preparing meals in advance can help to ensure that the daily carbohydrate intake stays within the recommended limit. Consider preparing a large batch of a low-carbohydrate meal and portioning it out for multiple meals.
  • Consider the timing of carbohydrate intake: It may be helpful to incorporate carbohydrates at specific times of the day, such as at breakfast and lunch, to provide energy for physical activity and to help maintain ketosis.

By following these tips, it is possible to incorporate carbohydrates into a ketogenic diet while still maintaining ketosis. It is important to work with a healthcare professional or registered dietitian to determine the appropriate amount of carbohydrates for individual needs and goals.

Balancing Macronutrients

Maintaining a balance between carbohydrates, proteins, and fats is crucial when incorporating carbs into a ketogenic diet. A macronutrient is a nutrient that provides caloric energy to the body and is required in large amounts. Carbohydrates, proteins, and fats are the three primary macronutrients. Each has a unique role in the body and a specific number of calories per gram. Carbohydrates provide 4 calories per gram, proteins provide 4 calories per gram, and fats provide 9 calories per gram.

Balancing macronutrients is important for several reasons. Firstly, it ensures that the body receives all the necessary nutrients for optimal functioning. Secondly, it helps maintain a healthy weight and prevents overconsumption of calories. Lastly, it prevents nutrient deficiencies and promotes overall health.

To balance macronutrients, it is essential to track the daily intake of each macronutrient. This can be done by keeping a food diary or using a nutrition tracking app. It is also crucial to choose nutrient-dense foods that provide a balanced mix of carbohydrates, proteins, and fats. Examples of such foods include fruits, vegetables, whole grains, lean meats, nuts, and seeds.

Another effective way to balance macronutrients is by practicing portion control. Eating smaller, more frequent meals throughout the day can help regulate blood sugar levels and prevent overeating. It is also essential to avoid processed and high-calorie foods, as they are typically high in unhealthy fats and added sugars.

In conclusion, balancing macronutrients is critical when incorporating carbohydrates into a ketogenic diet. By tracking daily intake, choosing nutrient-dense foods, and practicing portion control, it is possible to maintain a healthy balance of carbohydrates, proteins, and fats while still being in ketosis.

List of Low-Carb, Keto-Friendly Recipes


For those following a ketogenic diet, incorporating carbohydrates can be a daunting task. However, with the right approach, it is possible to enjoy a few carbs while still maintaining ketosis. Here are some low-carb, keto-friendly recipes to consider:

  • Cauliflower rice: A low-carb alternative to traditional rice, cauliflower rice is easy to make and can be used in a variety of dishes. Simply pulse cauliflower florets in a food processor until they resemble rice, and then sauté with your favorite vegetables and protein.
  • Zucchini noodles: Another low-carb alternative to traditional pasta, zucchini noodles are a great option for those following a ketogenic diet. Simply spiralize zucchini into noodles and sauté with your favorite sauce and protein.
  • Keto-friendly bread: While traditional bread is high in carbohydrates, there are keto-friendly options available. Look for bread made with almond flour or coconut flour, which are lower in carbohydrates and can be used in sandwiches or toast.
  • Low-carb desserts: For those with a sweet tooth, there are plenty of low-carb dessert options available. Try making a keto-friendly cheesecake using almond flour and sweetener, or indulge in a low-carb chocolate mousse made with avocado and coconut cream.

Incorporating these low-carb, keto-friendly recipes into your diet can help you enjoy a few carbohydrates while still maintaining ketosis.

Maintaining Ketosis with a Balanced Diet

  • One of the main goals of a ketogenic diet is to induce a state of ketosis in the body, which is characterized by the production of ketone bodies from the breakdown of fatty acids.
  • Ketosis is a metabolic state in which the body uses ketone bodies as its primary source of energy, instead of glucose.
  • The ketogenic diet typically involves a high-fat, low-carbohydrate approach to eating, which is designed to induce and maintain ketosis.
  • However, some people may wonder if it is possible to incorporate carbohydrates into their ketogenic diet while still maintaining ketosis.
  • The answer is yes, it is possible to eat carbohydrates and still be in ketosis, but it requires careful attention to the types and amounts of carbohydrates consumed.
  • To maintain ketosis while incorporating carbohydrates into your diet, it is important to focus on consuming high-quality, nutrient-dense carbohydrates that do not interfere with ketone production.
  • This means choosing whole, unprocessed foods that are rich in fiber, vitamins, and minerals, such as vegetables, fruits, and legumes.
  • It is also important to be mindful of portion sizes, as consuming too many carbohydrates can disrupt ketosis and cause the body to switch to glucose as its primary source of energy.
  • To maintain ketosis while incorporating carbohydrates into your diet, it is recommended to aim for a net carbohydrate intake of around 50-100 grams per day, depending on individual needs and goals.
  • By following these guidelines and making mindful choices about the types and amounts of carbohydrates consumed, it is possible to maintain ketosis while still enjoying a balanced and varied diet.

FAQs

1. What is ketosis?

Ketosis is a metabolic state in which the body burns fat for energy instead of carbohydrates. This occurs when the body is in a state of fasting or has been on a very low-carbohydrate diet for an extended period of time. When the body is in ketosis, it produces ketones, which are molecules produced by the liver when it breaks down fat for energy.

2. How do you get into ketosis?

There are several ways to get into ketosis, including:
* Fasting: When you fast, your body will run out of glucose (the primary source of energy for the body) and will start to break down stored fat for energy. This will put your body into a state of ketosis.
* Very low-carbohydrate diet: If you drastically reduce your carbohydrate intake, your body will not have enough glucose to fuel its energy needs, and it will start to break down stored fat for energy. This will also put your body into a state of ketosis.
* Ketogenic diet: A ketogenic diet is a high-fat, low-carbohydrate diet that is designed to put your body into a state of ketosis. This diet is often used to help people lose weight and improve their health.

3. Can you eat carbs and still be in ketosis?

It is possible to eat carbohydrates and still be in ketosis, but it depends on how many carbohydrates you eat and how your body responds to them. If you eat a very low number of carbohydrates, your body may still be in a state of ketosis even if you do eat some carbs. However, if you eat a high number of carbohydrates, your body may not be in a state of ketosis anymore. It is important to note that the amount of carbohydrates that you can eat while still being in ketosis will vary from person to person.

4. What are the symptoms of being in ketosis?

The symptoms of being in ketosis can include:
* Increased energy levels: Many people report feeling more energized when they are in a state of ketosis.
* Improved mental clarity: Some people report feeling more focused and mentally clear when they are in a state of ketosis.
* Weight loss: Many people lose weight when they are in a state of ketosis.
* Decreased appetite: Some people report feeling less hungry when they are in a state of ketosis.
* Improved blood sugar control: Ketosis can help improve blood sugar control in people with diabetes.

5. How long can you stay in ketosis?

The length of time that you can stay in ketosis will depend on several factors, including your diet, lifestyle, and overall health. Some people can stay in ketosis for many months or even years, while others may only be able to maintain it for a short period of time. It is important to note that it is not healthy to stay in a state of ketosis for an extended period of time without taking breaks to eat carbohydrates.

How many carbs should you eat to stay in ketosis?

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