The nutritional intervention was based on a commercial weight-loss program (PNK method®), as was described elsewhere [4]. Briefly, the intervention included an evaluation by the specialist physician conducting the study, an assessment by an expert dietician, and exercise recommendations. This method is based on high-biological-value protein preparations obtained from cow’s milk, soy, avian eggs, green peas, and cereals. Each protein preparation contained 15 g protein, 4 g carbohydrates, 3 g fat, and 50 mg docohexaenoic acid and provided 90–100 kcal.
We would like to thank A. Menarini Diagnostics Spain for providing, free of charge, the portable ketone meters for all the patients. We acknowledge the PronoKal Group® for providing the diet for all the patients free of charge and for support of the study. The funding source was not involved in the study design, recruitment of patients, study interventions, data collection, or interpretation of the results. The Pronokal personnel (I.S.) revised the final version of the manuscript, without intervention in the analysis of data, statistical evaluation and final interpretation of the results of this study.
Can’t you take ketone supplements? No. While it is possible to elevate ketones by taking them, “without the low-carb stimulus, there is no net increase in ketone production, no decrease in insulin, and no net increase in fat oxidation,” says Volek. Don’t trust trainers or “body hackers” who say you can induce ketosis quickly without changing your diet.
“I have personally followed a low-carb, keto diet for over 20 years for my own health, and have used it for over 15 years with patients, primarily for weight loss. Recently, I have found the medical version of the ketogenic diet to have antipsychotic effects and mood benefits in patients with chronic mental illness, so I am pioneering the clinical use of the ketogenic diet in psychiatry. I often recommend Diet Doctor to patients, friends, and family as a trustworthy resource for weight loss versions of the diet. For the treatment of serious mental illness, I recommend working with a trained clinician.”
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:
Rami co-founded Tasteaholics with Vicky at the start of 2015 to master the art of creating extremely delicious food while researching the truth behind nutrition, dieting and overall health. You can usually find him marketing, coding or coming up with the next crazy idea because he can’t sit still for too long. His favorite book is The 4-Hour Workweek and artist is Infected Mushroom.

I actually clicked on the story just to see if they included anything about it’s use in managing chronic migraine. I have chronic migraine, basically intractable. Nothing has helped. I’ve tried medications, meditations, and everything in between including a bunch of dietary changes. Keto is my next consideration. I’m happy to hear it helped you! Thanks for sharing

There are three sources of fuel your body uses for energy: carbohydrates, proteins and fats. Carbohydrates are broken down into glucose, or blood sugar, and are your body's primary fuel source. When carbohydrates aren't available, your body relies on fat for energy. Protein is the main building block for muscles and tissues. In a pinch, protein can also be converted to glucose and used for energy.
Use fat as a lever.  We’ve been taught to fear fat, but don’t! Both keto and low carb are high fat diets. Fat is our source of energy as well as satiety. The key to understand, though, is that fat is a lever on a low carb or keto diet. Carbs and protein stay constant, and fat is the one you increase or decrease (push the lever up or down) to gain or lose weight, respectively. So if your goal is weight loss, eat enough fat to be satisfied, but there’s no need to “get your fats in” once you’re satisfied.
Letting your blood sugar drop too low when following low-calorie diets -- often containing 1,000 to 1,200 calories daily for women and 1,200 to 1,600 calories a day for men -- can lead to headaches. Low blood sugar, which happens when too little glucose is in your bloodstream, can occur if you skip meals to reach your weight-loss calorie allotment. To help prevent headaches during weight loss, eat regular meals and snacks every few hours or so.
Seasonings and sauces are a tricky part of ketogenic diet foods, but people use them on a regular basis to add flavor to their meals. The easiest way to remain strict here is to avoid processed foods. There are many low carb condiments and products on the market, and there’s no way to list them all. A handful of them are great, but the majority use high glycemic index sweeteners – which you want to avoid.

It’s estimated that over 50% of people are deficient in Vitamin D worldwide[*]. Although Vitamin D doesn’t play a major role in whether or not you are in ketosis, it is responsible for regulating immunity, inflammation, hormones and helping with electrolyte absorption[*][*] — all factors important for weight loss and overall health. Additionally, studies support the direct benefits of vitamin D for weight loss[*][*][*]. You can check your Vitamin D levels with a simple blood test and then supplement accordingly. When supplementing, choose Vitamin D3 as it is the form that’s best absorbed by your body[*][*].

I’ve used the Atkins diet for almost 3 months now. Averaging 3/4 pounds a week loss. Never hungry and sometimes replace a meal with an Atkins shake (I make my own: One shake over ice, add 1/4 cup of heavy cream, one Splenda pack, stir and enjoy. Tastes like a milkshake! Carbs, 1 or 2. SECRET TO THE ATKINs DIET- YOU MUST drink your water! I also trim most of the fat off my meat and seldom eat bacon. Dairy – low/0 carb cheeses, mayo, some sour cream. I make wonderful veggie quiche (no crust) and a bread pudding quiche that everyone steals! Salad dressing is a breeze with mayo, mustard and Splenda. Zero carb (maybe 1/2 gram) & tastes like honey mustard. And, boy, if you could have one of my egg-batter, ham & cheese sandwiches. . .it’s to die for! I keep a bowl of steamed veggies in the fridge. Dipping in dressing makes a great snack. Atkin’s bars are a delicious way to get your sweets.I cut them up and nibble during the day. They also sell low carb breads now, very expensive, but the cost makes up for what I’m NOT buying to eat. Weight keeps dropping off, I feel great AND, every time I think of having a bowl of ice cream, I run to the closet and look at all the pretty clothes that soon I can wear again. Then I ‘strip’ and look in the mirror! Yikes! YOU TELL ME WHAT’S BETTER: being ‘fat’ or looking great? I was a model before gaining weight (due mostly to illness) and every pound I lose is totally worth it. I DON’T CARE WHAT ‘THEY’ SAY . . . ‘fat’ isn’t pretty, or acceptable. It’s your road to an early death and every organ in your body is suffering and struggling everyday. Lastly –


Ketone bodies synthesized in the body can be easily utilized for energy production by heart, muscle tissue, and the kidneys. Ketone bodies also can cross the blood-brain barrier to provide an alternative source of energy to the brain. RBCs and the liver do not utilize ketones due to lack of mitochondria and enzyme diaphorase respectively. Ketone body production depends on several factors such as resting basal metabolic rate (BMR), body mass index (BMI), and body fat percentage. Ketone bodies produce more adenosine triphosphate in comparison to glucose, sometimes aptly called a "super fuel." One hundred grams of acetoacetate generates 9400 grams of ATP, and 100 g of beta-hydroxybutyrate yields 10,500 grams of ATP; whereas, 100 grams of glucose produces only 8,700 grams of ATP. This allows the body to maintain efficient fuel production even during a caloric deficit. Ketone bodies also decrease free radical damage and enhance antioxidant capacity.
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.
Melinda – I’m afraid there’s no getting around the fact that one of the Keto requirements is to *calculate your macros,* based on the amount of calories you need to consume each day, in order to (a) maintain your current weight level, or (b) lose weight. Go to an online Keto macro calculator – there’s one linked to a good one on this site, further up the thread. They are generally very easy to use. Then stick to your calculated results, with trust and patience. It may be slow, but you will absolutely see results. I did – and I’ve tried absolutely everything. I barely have time to exercise, but I still lost at least a couple of dress sizes, and I feel absolutely amazing – no more brain fog, tons of energy – maybe too much energy! And best of all, I’m no longer miserable about food, because on Keto, everything is delicious! One final thing in the interest of full disclosure – I am an uber-clean-Keto advocate. I put in the work to eat only healthy fats and carbs from healthy sources. I’m pescatarian – no meats except seafood. I also carefully limit my saturated fat intake to 10% of total calories (the recommended daily allowance), to keep my genetically problematic cholesterol level from skyrocketing, as it did when I first began. This is all working well for me so far – I was able to cut 40 points from my abnormally high LDL (bad cholesterol) level within three months, And hope to get it down to normal levels in three more months. You do want to make sure you get your regular physical exams and monitor your blood work whenever you change your nutritional lifestyle. I wish you the best!
The understanding of “What is a Keto Diet” has become blurred thanks to the proliferation of Keto Diet “experts”. Many of these “experts” recommend several variants of Keto Diet and lifestyles which they claim can be modified to any walk of life. However, in most instances what they are actually recommending are Low-Carb lifestyle programs. These are neither weight loss programs, nor Ketogenic. With that said, there’s nothing wrong with adopting a Low-Carb lifestyle, but if your goal is weight loss, then changing your eating lifestyle should come after you’ve achieved your weight loss goals.
“I’ve studied LCHF nutrition for over 20 years for personal health benefits. In my medical practice, it has become integral to reversing many of modern society’s worst medical concerns including metabolic syndrome, obesity, and diabetes. It can be applied safely and effectively for nearly all of my patients and often results in dramatic restoration of good health.”
Helps to control type 2 diabetes and other metabolic disorders: If you have diabetes, you may be turning to the ketogenic diet as a way to control your insulin and glucose levels. Early research shows that the ketogenic diet can help you significantly improve insulin sensitivity levels (11). One study even shows that some diabetes patients were able to stop taking their diabetes medication altogether while on the keto diet (12)!

Bonnie J. Brehm, Randy J. Seeley, Stephen R. Daniels, and David A. D’Alessio, “A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” The Journal of Clinical Endocrinology & Metabolism: Vol 88, No 4; January 14, 2009. http://press.endocrine.org/doi/full/10.1210/jc.2002-021480.

RESULTS: After VLCKD1 were reduced: Body Mass Index (BMI) (Δ%=-11.1%, p=0.00), Total Body Water (TBW) (p<0.05); Android Fat Percentage (AFP) (Δ%=-1.8%, p=0.02); Android Fat Mass (AFM) (Δ%=-12.7%, p=0.00); Gynoid Fat Mass (GFM) (Δ%=-6.3%, p=0.01); Intermuscular Adipose Tissue (IMAT) (Δ%= -11.1%, p=0.00); Homeostasis Model Assessment of Insulin Re-sistance (HOMA-IR) (Δ%=-62.1%, p=0.01). After VLCKD1 a significant increase of uricemia, cre-atinine and aspartate aminotransferase (AST) (respectively Δ%=35%, p=0.01; Δ%=5.9%, p=0.02; Δ%=25.5%, p=0.03). After VLCKD2 were reduced: BMI (Δ%=-11.2%, p=0.00); AFM (Δ%=-14.3%, p=0.00); GFM (Δ%=-6.3%, p=0.00); Appendicular Skeletal Muscle Mass Index (ASMMI) (Δ%=-17.5%, p=0.00); HOMA-IR (Δ%=-59,4%, p=0.02). After VLCKD2, uricemia (Δ%=63.1%, p=0.03), and Vitamin D levels (Δ%=25.7%, p=0.02) were increased. No significant changes of car-diovascular disease (CVD) indexes were observed after DTs. No significant changes of PPARγ lev-el in any DTs.


My husband is doing this diet and I was making him bean soup with sausage for dinner, but I’m reading beans are a food to avoid, even being a high fiber food is that really true? Beans were always a good I was encouraged to eat in many other diets. I’m new to keto and don’t want to hinder his process. Would appreciate your advice because I’ve already got the beans cooking. Oh they are the dry beans, not canned.
“I recommend LCHF nutrition to all my patients to shift their metabolism to a more beneficial state. This nutrition is often enough to reverse diseases like obesity, diabetes and fatty liver disease, improving the health and quality of life of my patients. In my experience, other medical interventions also become much more efficacious. I recommend the Diet Doctor website, due to its panel of experts, to all my patients to make their transition easier.”
“I discovered the low-carb lifestyle after struggling myself with my obesity for many years. I was unsuccessful losing weight with the traditional low-fat diet plans that I used to recommend to patients. I researched and reviewed the studies of low-carb/keto eating and I lost weight, becoming a much healthier doctor. I am now passing on that experience onto my patients! When I counsel patients not familiar with low-carb living, I refer them to the Diet Doctor site for testimonials, recipes, and much more.”
My macros are 10-15% carbs, 20-25% protein and 60-70% fat, and my calories are between 1300 to 1500 but I'm still not in ketosis and only lost 1 lb so far. I'm making sure that my net carbs are below 25g. My fat usually ranges between 90g to 120g, and my protein ranges from 60g to 90g. for the past 5 days, test scripts are showing that i'm in small ketosis. It's not going up. My husband on the other hand is in Large Ketosis and lost about 5 lbs. He just started 1 day before me. Any advise to get int Ketosis and lose weight.

The accurate measurement of body composition changes is relevant to assess the contribution of the diet intervention, not only to total body weight but to the changes produced in FM, FFM, visceral fat tissue, and total body water (25, 27). To obtain such information, multicompartmental models that integrate information obtained from a single measurement (body density, total mineral mass, total body water) may be used to reduce the number of assumptions made on the stability of body characteristics (28). These models are of limited application in clinical practice, because they do not provide immediate results, are expensive, and require advanced analytical expertise (29, 30). For such reasons the 3 more widely used body composition analysis techniques were used in the present work. DXA is the most validated and commonly used technique to analyze body composition in obese patients and is based on the attenuation of a low-energy X-ray beam, depending on the tissue density and chemical composition. DXA is considered the gold standard technique by most groups working with body composition and was used as the reference method in the present work. Bioelectrical impedance techniques are low cost and readily available and rely on the use of population-specific equations to assess intracellular and extracellular water distribution. The MF-BIA system used in this study is a recently developed version that is not based on statistical population data and is capable of accurately assessing subjects with different body shapes and also obese subjects. Finally, ADP measures body density and is used more easily than other more complex systems for measuring body density, such as underwater weighing, and provides comparable results for obese subjects. Therefore, the use of 3 validated methods that use different principles was relevant for evaluating patients in different stages of a body weight reduction program.


“When the low-fat dietary advice I had been preaching for decades didn’t work for me in middle age, I changed to low-carb. After mentorship from Dr. Eric Westman, I introduced low-carb to my patients with astonishing results reversing diseases I had only been “managing”. In fact, more than 90% of patients who come to me on insulin are able to come off. I run a multidisciplinary medical weight loss clinic helping to restore health. This has brought the joy back into medicine for me. Diet Doctor has been an amazing resource to help me and my patients in this journey.”
“I see many patients whose wellbeing is affected by shortness of breath and sleep disorders. By adopting a low-carb, healthy fat lifestyle, many of these people feel better, avoid unnecessary medications and achieve great overall health. My family and I live this way and I love to inspire others to gain the same benefits. The Diet Doctor website is a great resource to help people adopt a LCHF lifestyle.”

There are so many tricks, shortcuts, and gimmicks out there on achieving optimal ketosis – I’d suggest you don’t bother with any of that. Optimal ketosis can be accomplished through dietary nutrition alone (aka just eating food). You shouldn’t need a magic pill to do it. Just stay strict, remain vigilant, and be focused on recording what you eat (to make sure your carb and protein intake are correct).


I think Tammy is asking about labeling on products. I have also found the percentages to be inconsistent. I think it is due to the way they companies calculate the grams in relation to the average daily intake- the result being different as the range  goes from 225-325 grams per day. At the end of the day the company decides how they calculate the percentage so the best way to solve this is to look at the grams instead.
A cyclic ketogenic diet (or carb-cycling) is a low-carbohydrate diet with intermittent periods of high or moderate carbohydrate consumption. This is a form of the general ketogenic diet that is used as a way to maximize fat loss while maintaining the ability to perform high-intensity exercise. A ketogenic diet limits the number of grams of carbohydrate the dieter may eat, which may be anywhere between 0 and 50g per day. The remainder of the caloric intake must come primarily from fat sources and protein sources in order to maintain ketosis (the condition in which the body burns fats and uses ketones instead of glucose for fuel).
My point here is that the warnings about the ketogenic principles are well taken and well documented. My concern is implications that this is a fad. I don’t use the word diet with my patients and I’m concerned that the principles behind the label and the real results that these readers have commented on might get minimized. I have found it best to encourage patients to read authors like: Stephen Phinney, Jeff Volek, Patricia Daly, and Charles Gant and the be partners with their doctors and check blood work as they move along. I am not for or against the article. If ketogenic principles offer people enduring, satisfying, and cohesive change then why not read about its potential and flexilbity?
“As a family physician, I have been recommending a low carbohydrate diet to all my patients. Truthfully, I cannot recommend any other diet with a clear conscience. I discovered the scientific benefits of a low-carb diet from Diet Doctor in 2011 when I was looking for new and better ways to manage my patients with diabetes, and I have never looked back since. My patients have benefited immensely from this diet, and it’s the best way to manage obesity, PCOS, metabolic syndrome, insulin resistance and diabetes. To me, Diet Doctor is the one-stop website for everything low-carb.”
There is a lot of information out there on the ketogenic diet, and sometimes that abundance of information can be confusing!  Do you need to count macros? What are macros anyway?!?  How many carbs can I eat on the Keto Diet?  What is keto flu?  How do you get enough electrolytes in your Keto Diet to avoid cramps and other keto flu symptoms?  How much water should you drink?  Is diet soda ok on keto?  What foods are keto approved?  Will I gain the weight back after keto?  Is the Keto Diet safe?
Minerals/Electrolytes: Adopting a ketogenic diet will change the way your body uses (and loses) certain minerals. Not replacing these minerals can lead to symptoms of the “keto flu” such as lightheadedness, headaches, constipation, muscle cramps and fatigue. Refer to this article for tips on how to replace common minerals such as sodium, potassium, magnesium and calcium.
Once your body adapts to using fat for fuel (can take anywhere from a couple of weeks to over a month) you'll find your apetite changes and it's very easy to eat very low calorie - you won't feel hungry as often and you'll have an easier time recognizing when you should stop eating. A lot of people on keto naturally fall in to some sort of intermittent fasting (eating only 1, 4, 6 or 8 hours of the day and fasting the rest) because they just aren't hungry.
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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