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This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »
While keto diets minimize sugar and other food sensitivities, they often allow full-fat dairy such as yogurt that, for some people, can stall fat loss. And some packaged keto-friendly foods (yes, there's a whole industry of keto-friendly cookies, candy, and other junk food!) can contain gluten, artificial sweeteners, and other reactive ingredients. These foods and additives cause dysbiosis (an imbalance between good and bad bugs), leaky gut syndrome, and increase insulin resistance, which raises blood sugar levels—stalling weight loss. Read your labels carefully: Food sensitivities can be sneaky and hide in foods that you would never suspect, like mustard.
As a gut health doctor, this is my biggest pet peeve about keto diets: They sometimes overemphasize foods high in dietary fat like meat and full-fat dairy at the expense of gut-supporting plant foods. Knock your gut flora out of balance and you're almost sure to hit a plateau since gut health affects weight loss. Even on the strictest keto diet, you can incorporate fermented and cultured foods including sauerkraut, kimchi, and kefir.
Touting their discovery as “a great step forward in weight loss history,” the panel were quick to offer up their hard earned cash to back the entrepreneurial pair. “We were shocked. The most we were hoping for was some advice…we weren’t even sure that we would manage to get any investors,” explained Samantha. After outstanding offers from each panel member, the sisters burst into tears.
Hi, I’m still a bit skeptical, I have seen some of my friends do the keto diet, and have had good results. Though I am still not sure about the idea of the fats being eaten. They say they eat meat with the fat and must do so, is this correct? Also isn’t this not good for the body especially for the kidneys? Second, can a diabetic do this diet? There are many questions running through my head.
Some previous studies have suggested that very-low-calorie ketogenic (VLCK) diets may be effective tools to manage overweight and obesity (10, 11, 13). VLCK diets are a nutritional intervention that emulate fasting by restricting carbohydrates and fat with a relative increase in protein intake (6). The increased protein content may be partially responsible for the muscle mass preservation (12–14). Importantly, the weight-reducing action of these diets is rapid, and despite the fact that the ketosis state lasts only 60 to 90 days at the start of treatment, the weight reduction remains for up to 2 years (13). Therefore, VLCK diets operate by potent mechanisms to induce weight loss, and various body compartments might be altered. To the best of our knowledge, no studies have exhaustively assessed the changes in body composition associated with this type of diet, and variations in muscle strength have been only assessed in athletes (15).
The data are presented as mean (standard deviation). All statistical analyses were carried out using Stata statistical software, version 12.0 (Stata, College Station, TX). A P < 0.05 was considered statistically significant. Changes in the different variables of interest from baseline and throughout the study visits were analyzed following a repeated measures design. A repeated measures analysis of variance test was used to evaluate differences between different measurement times, followed by post hoc analysis with Tukey’s adjustment for multiple comparisons. In addition, linear regression analyses were used to evaluate the accuracy of MF-BIA and ADP in comparison with DXA, because DXA is considered the reference technique in the estimation of body composition in clinical research (26). Finally, the Bland-Altman approach was also used to assess the accuracy of MF-BIA and ADP against DXA in the estimation of FM%.
A systematic review of 26 short-term intervention trials (varying from 4-12 weeks) evaluated the appetites of overweight and obese individuals on either a very low calorie (~800 calories daily) or ketogenic diet (no calorie restriction but ≤50 gm carbohydrate daily) using a standardized and validated appetite scale. None of the studies compared the two diets with each other; rather, the participants’ appetites were compared at baseline before starting the diet and at the end. Despite losing a significant amount of weight on both diets, participants reported less hunger and a reduced desire to eat compared with baseline measures. The authors noted the lack of increased hunger despite extreme restrictions of both diets, which they theorized were due to changes in appetite hormones such as ghrelin and leptin, ketone bodies, and increased fat and protein intakes. The authors suggested further studies exploring a threshold of ketone levels needed to suppress appetite; in other words, can a higher amount of carbohydrate be eaten with a milder level of ketosis that might still produce a satiating effect? This could allow inclusion of healthful higher carbohydrate foods like whole grains, legumes, and fruit. [9]
“The totality of evidence is very clear: A low-carbohydrate dietary approach is the most effective way to manage the insulin resistance syndrome which is that single biggest driver of obesity, type 2 diabetes and cardiovascular disease. Diet Doctor has been instrumental in providing extremely useful, clear and educational material to all who want to implement this dietary approach in to their lives. That’s why I recommend the website to all my at-risk patients.”

“I recommend low-carbohydrate, high-fat (ketogenic) diets to almost all my patients to improve their quality of life. The LCHF diet reduces inflammation, promotes weight loss, and improves blood biomarkers without prescription agents. The result is improved sleep, sharper mental clarity, more energy throughout the day, and healthier relationships to food. Most patients suffer “fat phobia” but fat does not make you fat! Sugar does! We teach patients to eat lots of healthy fats and cycle in and out of ketosis. We refer everyone to Diet Doctor as a great resource, especially for the carb contents of various food and drinks.”

In the 1990s, Atkins published an update from his 1972 book, Dr. Atkins New Diet Revolution, and other doctors began to publish books based on the same principles. This has been said to be the beginning of what the mass media call the "low carb craze" in the United States.[59] During the late 1990s and early 2000s, low-carbohydrate diets became some of the most popular diets in the US. By some accounts, up to 18% of the population was using one type of low-carbohydrate diet or another at the peak of their popularity.[60] Food manufacturers and restaurant chains like Krispy Kreme noted the trend, as it affected their businesses.[61] Parts of the mainstream medical community have denounced low-carbohydrate diets as being dangerous to health, such as the AHA in 2001[62] and the American Kidney Fund in 2002[63] Low-carbohydrate advocates did some adjustments of their own, increasingly advocating controlling fat and eliminating trans fat.[64]
In 1967, Irwin Stillman published The Doctor's Quick Weight Loss Diet. The "Stillman diet" is a high-protein, low-carbohydrate, and low-fat diet. It is regarded as one of the first low-carbohydrate diets to become popular in the United States.[52] Other low-carbohydrate diets in the 1960s included the Air Force diet[53] and the Drinking Man's Diet.[54] Austrian physician Wolfgang Lutz published his book Leben Ohne Brot (Life Without Bread) in 1967.[55] However, it was not well known in the English-speaking world.
But it has its share of critics as well. The keto diet is sometimes referred to as “the bacon and butter diet” because it calls for 75% of daily calories to come from fat. Keto followers are gobbling up bacon, steak, sausage, and chicken (skin and all). They’re adding butter to their morning coffee. They’re drowning their salads with ranch dressing.
Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.
As ingested CHO is broken down by the stomach and absorbed through the small intestine, rising blood sugar creates a feedback loop which results in secretion of insulin. The primary role of insulin is to “dispose” of excess blood sugar by signaling tissues to “uptake” more glucose from the circulating supply. In this manner insulin serves a prominent role in glucose regulation. This concept also provides the basis for the glycemic index, a concept which attempts to quantify the impact CHO foods have on blood sugar response. For example, foods rich in simple CHO (i.e., “sugars”), which are absorbed quickly, trigger a rapid rise in blood sugar (and subsequently insulin response), whereas foods rich in complex CHO, such as fiber-rich legumes, exert a relatively blunted response on blood glucose.
The keto diet works for such a high percentage of people because it targets several key, underlying causes of weight gain — including hormonal imbalances, especially insulin resistance coupled with high blood sugar levels, and the cycle of restricting and “binging” on empty calories due to hunger that so many dieters struggle with. In fact, these are some of the direct benefits of the keto diet.
No diet plan fits all and not everybody can follow a very low-carb diet. Even Dr Volek and Dr Phinney noted that there is not enough evidence that a very low-carb diet (such as less than 20 g net carbs) is beneficial for those with preexisting thyroid or adrenal conditions. Dr. Broda Barnes, who spent over 50 years on thyroid research, suggested in his book “Hypothyroidism: The Unsuspected Illness”, that the minimum amount of carbohydrate intake for patients with hypothyroidism should be at least 30 grams of net carbs.
If you do try the diet outside of medical supervision, Kizer says it’s important to test your urine with urinalysis ketone test strips to ensure your ketone levels don’t become dangerously high. Ketone urine test strips are also used by people with diabetes to determine if they’re at risk for ketoacidosis (DKA), a life-threatening complication that occurs when an individual doesn’t have enough insulin in their body. (Healthy ketosis is considered 0.5 to 3.0 mM blood ketones.)
“The totality of evidence is very clear: A low-carbohydrate dietary approach is the most effective way to manage the insulin resistance syndrome which is that single biggest driver of obesity, type 2 diabetes and cardiovascular disease. Diet Doctor has been instrumental in providing extremely useful, clear and educational material to all who want to implement this dietary approach in to their lives. That’s why I recommend the website to all my at-risk patients.”
“I am amazed at what a low-carbohydrate diet can do in real life and in my oncology practice. I see many cases of difficult to treat cancers, and know full-well the limitations of conventional chemotherapy. When patients ask about the ketogenic diet and cancer, I point out our recently concluded clinical trial that showed the ketogenic diet to be safe in advanced cancer patients and possibly beneficial in improving quality of life and survival. The diet, together with regular cancer treatment, could be a win-win combination. Diet Doctor is a fabulous website, chock full of information!”
If you want to try a ketogenic diet, be aware that you'll have to adjust it for your individual metabolism and experiment with the right balance of carbs and calories. While some low-carbohydrate dieters find they are able to break stalls in their weight loss, others find that it is more difficult for them to stay in this state. You may want to consult a registered dietitian to build keto-friendly menus for you that will meet your nutritional needs. Be sure to keep your health care provider informed when you start a new diet, especially if you have ongoing health conditions.
High-fat dairy also contains high-quality protein, vitamins, minerals, and conjugated linoleic acid (one of the few fatty acids that have been found to promote fat loss). The combination of these nutrients is essential for maintaining strength and function as we age. By adding just 7 ounces of ricotta cheese to their daily diet, for example, the older participants of a recent study were able to increase their muscle mass and muscle strength. In other words, ask for extra cheese, please.

Determining the diet that best suits you is a very individual choice, so it's hard to make a general recommendation for one type of diet. You can lose weight through a variety of eating styles, whether you choose a low-carb, low-fat, keto or Mediterranean diet, or another one. But in general, eating lots of fruits and vegetables, lean proteins and whole grains is going to help you lose weight and achieve a healthy lifestyle.
“The mission of Diet Doctor says it all: Make low carb and keto simple. For over a decade the website has been an invaluable resource for evidence-based nutritional advice and support for anyone seeking to lose weight and improve health with diet. And the results speak for themselves. By building a nutritional safe harbor, available to anyone, anywhere, anytime, Dr. Eenfeldt and the Diet Doctor team have revolutionized the delivery of nutritional information for the greater good of a world that needs it desperately.”
Keto diets, like most low carb diets, work through the elimination of glucose. Because most folks live on a high carb diet, our bodies normally run on glucose (or sugar) for energy. We cannot make glucose and only have about 24 hours’ worth stored in our muscle tissue and liver. Once glucose is no longer available from food sources, we begin to burn stored fat instead, or fat from our food.
Excessive ketone bodies can produce a dangerously toxic level of acid in the blood, called ketoacidosis. During ketoacidosis, the kidneys begin to excrete ketone bodies along with body water in the urine, causing some fluid-related weight loss. Ketoacidosis most often occurs in individuals with type 1 diabetes because they do not produce insulin, a hormone that prevents the overproduction of ketones. However in a few rare cases, ketoacidosis has been reported to occur in nondiabetic individuals following a prolonged very low carbohydrate diet. [4,5]
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
There is evidence that the quality, rather than the quantity, of carbohydrate in a diet is important for health, and that high-fiber slow-digesting carbohydrate-rich foods are healthful while highly-refined and sugary foods are less so.[4] People choosing diet for health conditions should have their diet tailored to their individual requirements.[19] For people with metabolic conditions, in general a diet with approximately 40-50% high-quality carbohydrate is compatible with what is scientifically established to be a healthy diet.[19]
10 pound weight loss , chicken broth works to relieve . But have to be careful of salt intake . I retain fluid, Dr gave script for dieuretic before I even started Keto . I have had the retention problem for a long time , when I took the dieuretic on a normal high carb diet ( I would drop 4 lbs ) but would make me really tired , afraid if I take it now on Keto I will pass out. Any idea what I should try other than the chicken broth

“As an interventional cardiologist for 30 years —and an avid runner and active person — I realized as I aged that eating less and moving more did not work for me or for my patients. The ketogenic diet resulted in a 30-pound weight loss and a dramatic increase in energy. As a past president of the Canadian Cardiovascular Society, I have been urged by medical colleagues to share my ketogenic knowledge widely. With my wife, a certified health coach, I have established a cardiometabolic clinic for obesity and insulin resistance syndromes. One of the resources we recommend is Diet Doctor.”
In most circles, ketosis refers to nutritional ketosis, an optimized state in which you burn fat instead of sugar. Nutritional ketosis has been used to treat epilepsy since the 1920’s and its popularity for mental acuity and weight loss has surged recently. More technically, ketosis refers to a metabolic state in which most of your body’s energy comes from ketones in the blood, as opposed to glycolysis, in which energy supply comes from blood glucose. Ketones are the energy source made by the body (in the liver) when there’s not enough carbohydrates to be burned for energy demand, so the body turns to fat for energy. The body enters ketosis when blood sugar levels are below a certain level, and liver glycogen is no longer available to produce glucose for energy.
Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.

But let’s look a little deeper at that. Though the subjects’ energy expenditure increased in the first two weeks of ketogenic diet, this increase eventually plateaued in the final two weeks and fell back down to the study’s baseline. What’s more, though participants lost weight rapidly in the first few days of going keto as a result of decreased water retention, body fat loss eventually also slowed. Further testing also returned that the participants on the keto diet even started to break down lean tissue for energy – not body fat.
A CKD on the other hand is a diet where you will eat a minimum amount of carbohydrates per day (that 30-50 gram number) and then on the weekend (or at a time that is appropriate for you) do a large 'carb-up' phase where you will eat a large amount of carbohydrates in an effort to refill your muscle glycogen stores so you can continue to workout the coming week.
I am just starting the Keto diet and I eat a banana or a little pineapple in cottage cheese once a day as part of my lunch or a snack will this be bad at the start of my diet or should I cut it out all together? I’m so disappointed that my favorite fruits are high in carbs,especially bananas, once I heard the help with anxiety I have been eating one almost every day and I think it lifts my mood.

In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week.


While CHO is almost universally regarded as necessary for both health and athletic performance, many studies have called into question the absolute necessity of dietary CHO. As early as 1930 there was evidence demonstrating the efficacy of long-term CHO restriction (14). In an audacious attempt to demonstrate proof-of-concept, arctic explorers Dr. Viljalmur Stefansson and K. Anderson, agreed to participate in a study that involved one year of eating a diet that consisted solely of “meat.” The diet, which consisted of beef, pork, lamb, and chicken, also included significant portions of animal fat, as well as organ meat. This dietary regimen yielded a macronutrient distribution of approximately 81% fat, 18% protein and 1% CHO, over the course of 375 days. The subjects experienced a modest reduction in weight, which occurred during the first week; there were no restrictions on food portions, subjects ate to satisfy appetite. Interestingly, the researchers noted no vitamin deficiencies, no significant change in mental alertness or physical impairment, or any other deficit attributed to eating a high fat, all-meat diet.
One theory is that an extreme increase in cholesterol may be common in those undergoing rapid weight loss. This is because the fat cells we have stored in our adipose tissue contain high amounts of both triglycerides and cholesterol. When we begin to break down our stored fat to be metabolized for energy, cholesterol in the blood goes up temporarily.
Dietary fiber keeps you full longer and contains prebiotic nutrients that support a healthy gut flora, creating a win-win for weight loss. Getting insufficient dietary fiber (yes, I'm talking to you, all-meat carnivore or cave-man diet folks) adversely shifts your healthy gut flora, which will increase inflammation, insulin resistance, fat deposition around the middle, and weight gain. Leafy green and cruciferous vegetables, avocado, coconut, and berries make great fiber-rich, keto-friendly foods.
I was a Corpsman (not a corpse-man as some recent somewhat fanatical president would say), and I can tell you many stories of Marines and Sailors who maintained restrictive diets (aka picky eaters). Most obvious was lack of sustaining energy (hypoglycemia) at mile 15 (with 80lbs of gear including a 6.5lb rifle and 200 rnds of ammo, etc.) and depletion of essential vitamins, electrolyte imbalance. They were always the first to collapse and have to hear me scold “see I told you so.” An IV of D5W usually does the trick (D is for dextrose, OMG!)
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