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Bila biasanaya tubuh menggunakan karbohidrat sebagai bahan bakar utama maka pada diet keto ini, tubuh akan menggunakan keton sebagai bahan bakar utama. Hampir semua sel tubuh manusia dapat menggunakan keton sebagai sumber energinya. Sel yang menggunakan keton adalah sel yang memiliki mitokondria yang berfungsi baik. Mitokondria adalah pabrik produksi energi dari sel. Sel darah merah yang matang adalah sel yang tidak memiliki mitokondria karena itu dia hanya bisa menggunakan glukosa untuk bahan bakarnya, tidak bisa menggunakan keton. Saat kadar gula darah sangat rendah dan sel darah merah membutuhkan gula maka tubuh akan memproduksi gula melalui proses glukoneogenesis. Bahan untuk membentuk gula dalam proses terdebut adalah protein, asam lemak, trigliserida, bahkan keton sendiri bisa diubah menjadi gula darah. Ini membuktikan bahwa karbohidrat bukan nutrisi esensial karena bisa diproduksi oleh tubuh sendiri tanpa mengandalakan asupan karbohidrat dari luar. 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