The PSQI questionnaire is a clinical sleep-behavior questionnaire that has been validated for use in patients with insomnia, cancer, Parkinson’s disease, and the general population [30]. The questionnaire is designed to assess indexes of sleep during the preceding month and contains 19 questions that use Likert scales from 0–3. All questions are categorized into the following 7 subvariables: duration of sleep, sleep disturbance, sleep latency, day dysfunction because of sleepiness, sleep efficiency, subjective sleep quality, and use of a sleeping medication. Each of these 7 variables is scored between 0 and 3 arbitrary units (au), which generates a summed total score of 0–21 au. This total score is termed the global sleep score (GSS) with >5 au associated with a poor sleep condition and ≤5 au associated with a good sleep condition.

If you can't see any ketones, be patient. It typically takes 2-3 days for your body to deplete glycogen stores, so don't expect to be in ketosis after just a day of low-carb. Remember, ketosis is a favourable condition and an indication that your body uses fat for fuel but you can lose weight even without being in ketosis. A diet high in fat, adequate in protein and low in carbohydrates is naturally sating, making you less hungry and, therefore, helps you lose weight.
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.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
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Requires an adaptation process. Getting keto adapted can take one to two weeks and the transition can be uncomfortable for some people. The “Keto Flu” is commonly used to describe flu-like symptoms associated with the transition process: headaches, fatigue, nausea, etc. Due to restricted carb intake, your body is not retaining as much water so loss of electrolytes is common. This can easily be rectified with taking mineral supplements or exogenous ketones, such as the beta hydroxybutyrate mineral salts in KetoLogic® BHB [16].
May cause irregularity. Dramatically increasing your fat intake while drastically cutting your carb intake may cause gastrointestinal issues, ranging from constipation to diarrhea. This is something that should resolve itself when your body gets fat-adapted [5]. There is also the potential for nausea, particularly when switching from a low-fat diet to the ketogenic diet. It can take a while for the gall bladder, pancreas, and liver to adapt to digesting high amounts of fat [17].

^ Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS, Kelly TN, He J, Bazzano LA (October 2012). "Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials". American Journal of Epidemiology. 176 Suppl 7 (Suppl 7): S44–54. doi:10.1093/aje/kws264. PMC 3530364. PMID 23035144.
Studies are needed to investigate whether the diet can specifically inhibit cancer cells, but the ketogenic diet is shown to reduce levels of insulin and IGF-1. For example, a 2017 study in which participants fasted, omitting carbohydrates during their fasting times, reduced their blood pressure, levels of inflammation, fasting blood glucose and levels of IGF-1.
Very low calorie diets are designed to bring on a mild form of ketosis, which means your body shifts from using primarily carbohydrates to fat as an energy source. The relative safety of ketosis is a hotly debated topic. In very low calorie diets, which are medically supervised diets, ketosis is supported for a short period of time to produce rapid weight loss in people who are extremely obese. It's not something you try at home simply because you want to lose a few pounds. Very low calorie diets and ketosis in people who are simply overweight can be dangerous.
“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.”

L-glutamine is an amino acid with many functions in your body including acting as a powerful antioxidant[*][*]. Research shows that L-glutamine can help stabilize blood glucose levels[*] and has been recommended to help reduce sugar cravings. Supplementing with L-glutamine (about ½-1 teaspoon powdered form or 500 mg dose) may help in reducing carb/sugar cravings and aid in your ketogenic weight-loss journey.


People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.
In one week my husband lost 1.5 kg because of Keto diet and recipes. Thank you for the insights and tips. I would like to have a complete recipe for meals everyday and hoping by subscribing I will receive try my mail. I will keep u posted. It takes 2 to tango. The one who wants to diet must be cooperative with the plan and execution while the other person who is preparing the food must be patient to the dieting person. Its not easy to change meals so patience is required
Most people will choose to begin their carb-up on Friday night and end it before bed on Saturday. This is usually most convenient as it's when you are off of work and can relax and enjoy the process. If you aren't overly concerned with fat loss and are just using this diet as a way to maintain blood sugar levels, you can likely eat whatever carbohydrate foods you like during this period. If you are worried about fat gain though, then you need the math.

With the help of keto-friendly ingredients, you can easily make yourself some delicious, fluffy pancakes. There are, in fact, several ways to make fantastic keto pancakes, but our favorite is the Faux “Buckwheat” Pancakes made with almond flour and flaxseed meal. Try them for yourself if you want low-carb pancakes that taste just like the real thing.
The keto diet (also known as ketogenic diet, low carb diet and LCHF diet) is a low carbohydrate, high fat diet. Maintaining this diet is a great tool for weight loss. More importantly though, according to an increasing number of studies, it helps reduce risk factors for diabetes, heart diseases, stroke, Alzheimer’s, epilepsy, and more1-6.On the keto diet, your body enters a metabolic state called ketosis. While in ketosis your body is using ketone bodies for energy instead of glucose. Ketone bodies are derived from fat and are a much more stable, steady source of energy than glucose, which is derived from carbohydrates.
First, don’t mistake a ketogenic diet (or the upgraded Bulletproof Diet) for the Atkins Diet. Whereas the Atkins Diet is extremely high in protein, a keto diet contains moderate amounts of protein. On a keto diet, large amounts of protein can turn into glucose in a process called gluconeogenesis, thus taking you out of ketosis. That’s why fatty cuts of meat are better than, say, chicken breast, which is high in protein and low in fat. Vast amounts of protein also tax the liver and lead to inflammation. By contrast, a ketogenic diet is anti-inflammatory; burning fat for fuel creates far less inflammation than burning sugar does[2], and ketones themselves turn off inflammatory pathways[3]. Because of this, ketogenic diets may in fact help prevent chronic diseases that are caused by inflammation. (Fun fact: The ketogenic diet is used to keep epileptic patients from having seizures.)
When you’re eating the foods that get you there (more on that in a minute), your body can enter a state of ketosis in one to three days, she adds. During the diet, the majority of calories you consume come from fat, with a little protein and very little carbohydrates. Ketosis also happens if you eat a very low-calorie diet — think doctor-supervised, only when medically recommended diets of 600 to 800 total calories.
Thank you, Dr. Jockers. I really appreciate your reply. I was wondering if insulin resistance would make my cholesterol go up on the ketogenic diet from a total of 220 before I went on it to 378 after being on it for six months. I have always been in a healthy weight range for my height, but I have always been extremely hungry most of the time. I really got on the ketogenic diet hoping that this would be regulated after being on it for some time, but it hasn’t helped that much. Would this signify that insulin resistance may be the culprit for my sudden rise in cholesterol even though I am following the ketogenic diet perfectly?
“As a reproductive endocrinologist, I have been studying nutrition and fertility for over 15 years. I advise all my patients, both women and men, to adopt a low-carb ketogenic diet both prior to pregnancy to improve their fertility and during pregnancy to improve fetal and maternal health. This way of eating has been shown repeatedly in my practice to improve all measures of health for women and men. We refer all our patients to Diet Doctor which in our opinion is the best online resource for our patients to find all the information, recipes and meal plans they need to be successful.”

The biggest shifts in your daily habits will be how you food shop and how you cook, and recipes that are ketogenic need to be followed rather than just low-carb. You will require the healthy fats in order to get into ketosis and have enough energy without the carbs. And you will be considerably more energetic and healthier when cooking your own keto-friendly food rather than buying supposedly keto foods off the shelf.
Though technically a fruit, avocados offer a rich source of heart-healthy monounsaturated fatty acids (MUFAs). They're also packed with fiber to bolster digestive health. One-half of an avocado contains 161 calories, 2 grams (g) of protein, 15 g of fat, 9 g of total carbs, and 7 g of fiber (bringing it to 2 g of net carbs), notes the U.S. Department of Agriculture (USDA). 

The end result of the “ketone diet” is staying fueled off of circulating high ketones (which are also sometimes called ketone bodies) — which is what’s responsible for altering your metabolism in a way that some people like to say turns you into a “fat-burning machine.” Both in terms of how it feels physically and mentally, along with the impact it has on the body, being in ketosis is very different than a “glycolytic state,” where blood glucose (sugar) serves as the body’s energy source.
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[35] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[36] However, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.[9] Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[37]
In theory, a ketogenic diet that increases carbohydrate loads for cardio exercise seems perfect. However, the side effects of a ketogenic diet can include dehydration, malnutrition and constipation. According to the Mayo Clinic website, ketogenic plans also can lead to kidney stones. In addition, the ketogenic diet does not give you the nutrition you need to be healthy. Instead, try cutting portion sizes and counting calories; this also can force your body to burn fat while still providing you with balanced nutrition, including proteins, carbohydrates, fiber and fat. As with any diet, you should discuss a ketogenic diet with your doctor.
But there is evidence that low-carb diets may increase metabolism, according to a paper published November 14 in BMJ. Researchers found that overweight adults who lowered carbohydrates and added more fat into their diets burned about 250 calories more each day than people on high-carb, low-fat diets. The study is impressive because it's the largest, most expensive, and controlled study of its kind.
While in ketosis, your body effectively uses fat for fuel. In general, the daily intake of net carbs required to enter ketosis could vary from 20 to 100 grams per day. Most people, who have experienced ketosis, claim to have reached that state at about 20-50 grams of net carbs per day. I'd suggest you start at 20-30 grams and see how you can adjust it for your needs.

The popular belief that high-fat diets cause obesity and several other diseases such as coronary heart disease, diabetes, and cancer has not been observed in recent epidemiological studies. Studies carried out in animals that were fed high-fat diets did not show a specific causal relationship between dietary fat and obesity. On the contrary, very-low-carbohydrate and high-fat diets such as the ketogenic diet have shown to beneficial to weight loss.


Thank you, Dr. Jockers. I really appreciate your reply. I was wondering if insulin resistance would make my cholesterol go up on the ketogenic diet from a total of 220 before I went on it to 378 after being on it for six months. I have always been in a healthy weight range for my height, but I have always been extremely hungry most of the time. I really got on the ketogenic diet hoping that this would be regulated after being on it for some time, but it hasn’t helped that much. Would this signify that insulin resistance may be the culprit for my sudden rise in cholesterol even though I am following the ketogenic diet perfectly?
Carbohydrates are your body's favorite fuel source; it breaks them down into glucose. Without a steady intake of carbohydrates, your body turns to using protein for fuel. But if you also are limiting how much protein you eat, your body is forced to burn stored fat as its primary source of fuel. That can result in weight loss, and ketones are a byproduct of burning fat.
The likely reason they were able to keep the weight off, researchers say, is their resting metabolic rate (RMR) was maintained, and they retained their lean muscle mass. RMR is a measure of metabolism (meaning how your body uses energy), while immobile, and it plays an important role in sustaining weight loss, according to other research, published in August 2016 in the journal Obesity.
Thanks for this inputs. 20 years ago I gain 17 pounds a year for 5 years. I was healthy but my dr told me start diet, any diet just come back in a month I want to see you start loosing… I started Atkins and lost 7 pound in a month. She was checking my progress every six months and checking my condition. I lost 64 pounds in 3 years. Now I started eating out of control. I am eating healthy but too much… I gain 40 pound back after 20 years. Now I will start again my Atkins to take off 30 pounds…

The KD stands in stark contrast to current macronutrient recommendations for both health promotion, as well as enhancement of athletic performance (7,21). The KD is characterized by a macronutrient distribution ratio consisting of approximately 70 – 80% fat, 10 – 20% protein and <5% carbohydrate (CHO), with daily CHO intake limited to ≤50 grams. Two of the most prominent and vocal researchers of the KD, Jeff Volek, PhD and Stephen Phinney, MD, PhD, in their book The Art and Science of Low Carbohydrate Performance, recommend protein consumption of 0.6 – 1.0 grams per lb of lean body mass, a figure which almost perfectly matches the commonly recommended protein intake for athletes (i.e., 1.2 – 2.0 g/kg bodyweight) (21,26). With CHO intake radically restricted and protein within the commonly recommended range, fat becomes the primary macronutrient target for manipulation.
You’re very welcome, Judy! I’m glad it’s helpful. If you are keto (as opposed to low carb), unfortunately peaches would not allow you to stay in ketosis. You can check my keto food list to help determine what is keto friendly. Of course, there are worse things than fresh fruit 🙂 but in the end our bodies still see the sugar. That being said, it doesn’t mean you sabotaged the whole day. Just pick up again – you got this!! (And for next time, try some fresh berries in moderation when you’re craving fruit.)
Carbohydrate: Most of what determines how ketogenic a diet is will depend on how much carbohydrate is eaten, as well the individual's metabolism and activity level. A diet of less than 50 or 60 grams of net (effective) carbohydrate per day is generally ketogenic. Some sources say to consume no more than 20 grams of carbohydrates per day, while others cite up to 50 grams, and many recommend no more than 5 percent of calories from carbs. However, athletes and people with healthy metabolisms may be able to eat 100 or more grams of net carbohydrate in a day and maintain a desired level of ketosis. At the same time, an older sedentary person with Type 2 diabetes may have to eat less than 30 net grams to achieve the same level.

“I am a physician with type 1 diabetes. I have been using a low-carb, ketogenic diet to treat my own diabetes for the past 16 years. Evidence shows that low-carb diets are safe and effective. With the potential to reverse type 2 diabetes, control type 1 diabetes and even stop, slow down, or reverse complications, a low-carb diet can be life changing. Diet Doctor provides the most accurate and relevant materials for a healthy, easy and fun low-carb experience.”

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