Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.
You can usually use a mix of multiple flours to get a realistic texture in baking recipes. Combining flours and experimenting with your baking can lead to much lower net carb counts in recipes. We think these lemon poppyseed muffins (a mix of almond flour and flaxseed meal) make a great texture when combined with the fats from the heavy cream and butter.
Cyclical ketogenic diet (CKD): If you find it difficult to stick to a very low-carb diet every day, especially for months on end, you might want to consider a carb-cycling diet instead. Carb cycling increases carbohydrate intake (and sometimes calories in general) only at the right time and in the right amounts, usually about 1–2 times per week (such as on weekends).
At the core of the classic keto diet is severely restricting intake of all or most foods with sugar and starch (carbohydrates). These foods are broken down into sugar (insulin and glucose) in our blood once we eat them, and if these levels become too high, extra calories are much more easily stored as body fat and results in unwanted weight gain. However, when glucose levels are cut off due to low-carb intake, the body starts to burn fat instead and produces ketones that can be measured in the blood (using urine strips, for example).
If you talk to keto aficionados, you’ll find many save leftovers from dinner for the next day’s lunch. Cook once, eat twice—your keto diet menu for lunch is solved. If you don’t like leftovers or if you’re craving something different for lunch, the mid-day meal can be as simple as a scoop of chicken salad. Or, hit the salad bar at a local grocery store and top a bowl of greens with some good-fat goodies. You can also try one of these simple keto lunches:
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
Body composition was first measured by dual-energy X-ray absorptiometry (DXA; GE Healthcare Lunar, Madison, WI, USA). Daily quality control scans were acquired during the study period. No hardware or software changes were made during the trial. Subjects were scanned using standard imaging and positioning protocols, while wearing only light clothing. For this study, the values of bone mineral density, lean body mass, and FM were directly measured by the GE Lunar Body Composition Software option. Some derivative values, such as bone mineral content, regional lean mass, FFM, fat mass percentage (FM%), and visceral fat mass, were also calculated.
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.
Low-carbohydrate diets or carbohydrate-restricted diets (CRDs) are diets that restrict carbohydrate consumption. Foods high in carbohydrates (e.g., sugar, bread, pasta) are limited or replaced with foods containing a higher percentage of fats and moderate protein (e.g., meat, poultry, fish, shellfish, eggs, cheese, nuts, and seeds) and other foods low in carbohydrates (e.g., most salad vegetables such as spinach, kale, chard and collards), although other vegetables and fruits (especially berries) are often allowed.

Weight loss is a common target for disease management, as well as health promotion. The prevalence of obesity remains high among U.S. adults (36.5%) (5), as well as children and adolescents (17%) (6). Importantly, obesity is a significant contributor to increased morbidity and mortality, as well as being a primary driver of increasing medical expenses (4). Despite much effort and cost, there has been little success on this front and obesity remains a public health crisis.
First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48]
As an addiction specialist, I recommend Diet Doctor as a resource for my patients, many of whom are addicted to sugar. Diet Doctor offers recipes that are delicious and remove the addictive elements from food. I encourage high-fat and low-carb food plans only – because they work: You can lose weight, keep it off and be free from food obsession. Freedom tastes great!”
“We know that when we have fats in our diet like MUFAs, they not only fill us up but keep cholesterol levels lower,” says Keatley. Olive oil is great for light sauteing, using in dressings, or drizzling over cooked meats or vegetables as a finishing oil. One tablespoon (tbsp) offers 119 calories and 13.5 g of fat, only 2 g of which are saturated fat, according to the USDA.
To find out whether you have achieved ketosis, you can test your blood or urine for the presence of ketone bodies. Depending on your diet, your activity level, and your body type, it can take a couple of days to a couple of weeks to reach ketosis. Testing for ketosis is a personal preference. For some, it’s an added inconvenience; for others, it provides added incentive to stay on track.
“I encounter many patients who are interested in LCHF and are finding benefit in weight reduction, better diabetes control, improved endurance and energy levels, and improved lipid profiles. There is a great deal of confusion out there about the diet, much of it based on outdated science or an incomplete understanding of the topic. I feel that I owe it to patients to be informed about LCHF so that I can advise them on the risks and benefits it could have for them.”

Ariel Warren is a Registered Dietitian, Diabetes Educator, graduate from Brigham Young, and was diagnosed with Type 1 at the age of 4 years old. Ariel understands diabetes and enjoys working with clients to improve their blood sugar management, healthy eating, weight loss, fitness, and pregnancy. For coaching from a T1D Dietitian, you can contact Ariel directly, through her website: arielwarren.com.
At this point, we don’t know how long is safe to remain in ketosis. Based on the clinical trials, I recommend a trial of ketosis for up to 6 months, under the care of a knowledgeable functional medicine physician. There are some clinical trials up to 12 months, so that would be the maximum I would recommend under the watchful eyes of a collaborative professional and expert.
Unfortunately, there’s no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.
Very low calorie diets, or VLCDs, are supervised medical programs designed to bring about rapid weight loss in people who are dangerously overweight or morbidly obese. They typically involve you taking specially prepared formulas, usually liquid shakes, to replace all your meals for several weeks to a few months. Because they are meal replacements, they also contain a balance of nutrients to provide you with all the vitamins and minerals you need, but also just enough calories to prevent your body to clinging to fat because it thinks you are starving. By definition, a VLCD involves consuming about 800 calories per day.
Dr. Josh Axe, DNM, DC, CNS, is a doctor of natural medicine, clinical nutritionist and author with a passion to help people get well using food as medicine. He’s the author of the books “Eat Dirt: Why Leaky Gut May Be the Root Cause of Your Health Problems,” “Essential Oils: Ancient Medicine” and the upcoming “Keto Diet: Your 30-Day Plan to Lose Weight, Balance Hormones, Boost Brain Health, and Reverse Disease” (February 2019, published by Little, Brown Spark). He’s a co-founder of Ancient Nutrition, a health company where the mission is to restore health, strength and vitality by providing history’s healthiest whole food nutrients to the modern world.
At Diet Doctor, we don’t recommend counting calories. First of all, it’s impossible to know exactly how many calories you’re getting from a specific food, let alone precisely what your body will do with those calories. It’s far more important to choose foods that promote the release of hormones that reduce hunger, help keep you satisfied, and make it easier to achieve a healthy weight.
“It all started with Good Calories, Bad Calories by Gary Taubes. I read the book twice, the second time reading many of the referenced articles. Since then, I have recommended low-carb and keto diets with and without intermittent fasting to almost all of my patients who have lifestyle-related chronic conditions. I often suggest that patients start their journey at Diet Doctor. Professionally, the most difficult issue remains dietary modifications for patients in the hospital. As more data is collected I hope we see a change in institutional culture — cheese omelets instead of cornflakes and skim milk for breakfast!”
61. Thomson C.A., Morrow K.L., Flatt S.W., Wertheim B.C., Perfect M.M., Ravia J.J., Sherwood N.E., Karanja N., Rock C.L. Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity. 2012;20:1419–1425. doi: 10.1038/oby.2012.62. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Ketosis was determined by measuring ketone bodies, specifically β-hydroxy-butyrate (β-OHB), in capillary blood by using a portable meter (GlucoMen LX Sensor, A. Menarini Diagnostics, Neuss, Germany; sensitivity <0.2 mmol/L). As with anthropometric assessments, all the determinations of capillary ketonemia were made after an overnight fast of 8 to 10 h. These measurements were performed daily by each patient during the entire VLCK diet, and the corresponding values were reviewed on the machine memory by the research team to control adherence. Additionally, β-OHB levels were determined at each visit by the physician in charge of the patient. Glucose, insulin, HbA1C were performed using an automated chemistry analyzer (Dimension EXL with LM Integrated Chemistry System, Siemens Medical Solutions Inc. (Tarrytown, NY, USA). Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were measured by chemiluminescence using ADVIA Centaur (Bayer Diagnostics, Tarrytown, NY, USA). The overnight fasting plasma levels of ghrelin and leptin were measured using commercially available ELISA kits (Millipore, Burlington, MA, USA). The fasting plasma levels of dopamine was tested by high pressure liquid chromatography (HPLC; Reference Laboratory, Barcelona, Spain).
The severe reduction in body weight was mainly a result of FM reduction, as assessed by DXA scan; the −20.2 kg of weight reduction at the end of the study was in large part due to the −16.5 kg reduction in FM. When the FM compartment was assessed by MF-BIA, the result was very similar (−18.2 kg) and was further corroborated by the ADP analysis [−17.7 kg; Fig. 2(A)], without statistical differences among the results. It was remarkable that 3 methods of evaluating body composition, which operate through different principles, yielded such similar results. FM loss represents nearly 85% of the total weight loss achieved across the study.
Julie Hand is a certified holistic health and nutrition counselor (Institute for Integrative Nutrition), personal fitness trainer (National Personal Training Institute), and yoga teacher (Kripalu Center for Yoga & Health). Though she can’t resist trying every science-backed health tip, she also has a penchant for crystals and astrology (don’t judge). You can find her walking the beach (coffee in hand, of course) and practicing the ukulele on weekends.
“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.”
Most vegetables are low- or moderate-carbohydrate foods (in some low-carbohydrate diets, fiber is excluded because it is not a nutritive carbohydrate). Some vegetables, such as potatoes, carrots, maize (corn) and rice are high in starch. Most low-carbohydrate diet plans accommodate vegetables such as broccoli, spinach, kale, lettuce, cucumbers, cauliflower, peppers and most green-leafy vegetables.[21]
“As a pediatrician practicing for the past 24 years, I spend most of my clinical time caring for children with chronic behavioral, developmental, psychological or metabolic conditions (ADHD, depression, anxiety, OCD, Tourette’s Syndrome, autism, autoimmune disease, obesity, NAFLD, etc.). A well-planned, low-carbohydrate (and in many cases ketogenic) nutrition plan is a very powerful tool that I use with my patients to address both physical and mental health. I so appreciate Diet Doctor and reference it frequently for my patients as the best resource for this topic. This site is commercial free, well-supported, referenced and frequently updated.”
HDL is still low and stuck on 45 even after hoping strongly with more healthy saturated fats organic bone broth from lamb bones, etc. LDL way up 170 and triglycerides a a record high of 170, Non HDL choleseterol at 203. Kinda surprizd I cannot more that HDL number aftyer all the keto stuff. And unsure why the LDL has exploded since stress has always been with me these last 9 years.
Very low calorie diets are not something you should try alone. Consuming over-the-counter meal replacement products is not the same kind of treatment your doctor will provide you. In addition, ketones are not the ideal energy supplier — but rather a "will do" supplier — and this underscores how important it is that VLCDs are short in duration and guided by a qualified health care professional. In addition, many VLCD treatments involve supplementing with prescription medications to help with weight loss, which provides a measure of effectiveness you are not likely to get by going it alone.

The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals, and calcium-rich foods. In particular, the B vitamins, calcium, and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[18] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises three small meals and three small snacks:[28]
“I am a medical practitioner who has type 1 diabetes. Since adopting a very low-carb lifestyle I have found that day-to-day diabetes management has become so much easier with the added bonus of normal HbA1c. As a result of smaller insulin doses, I am not tied down to strict meal times and can eat when I choose. Similarly, glucose control with exercise is far more predictable. Very low carb for me gives as near to a ‘normal’ life as someone with diabetes can get.”

Various mechanisms may explain the variations in body water. For example, glycogen depletion induced by VLCK diets could cause a marked increase in diuresis, given that glycogen is usually stored together with water (39, 40). Water loss might also be associated with ketonuria, because ketone bodies increase the renal sodium and water loss as a result (39, 41). These assumptions seem reasonable considering that the peak water loss coincides with the phase of maximum ketosis. However, the mechanisms explaining the diuresis observed with VLCK and with most hypocaloric diets are not known at present (30). Contrary to previous observations (42, 43), DXA analysis evidenced a maintenance in bone mineral density in the current study.
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]

While you’re focusing on fat, protein, and carbs, you should also make sure you’re getting adequate fiber. “People often assume that they should only eat things like meat and butter on the ketogenic diet,” says Farshad Fani Marvasti, MD, an associate professor and director of Public Health, Prevention, and Health Promotion at the University of Arizona College of Medicine in Phoenix. “You should make sure you are eating enough vegetables because you need the fiber.”
Here’s encouragement…it’s not all about weight in the beginning. As you ween off of sugar (which is really poison to your body), your body has to start getting rebooted. I had a solid week or more of serious detox. I knew that getting the poison out of my body was going to be significant, and it was. Don’t be discouraged. It’s well worth it to truly rid your gut and body of cancer-causing poison, not to mention your ability to fight disease. The acid level will change. Your arthritis (joints) will improve. Stick with it and don’t give up. Your family is worth it!
“I recommend low-carb nutrition for the majority of my patients and clients. And I send them all to Diet Doctor for the best recipes, instructional videos and written guides for everything someone needs to get started and to thrive on a low-carb lifestyle. Diet Doctor doesn’t have anything to sell you; its only goal is to provide you with the highest quality, evidence-based information to help you improve your life. That is hard to find in today’s ad-driven and product-driven internet. In fact, I loved Diet Doctor so much, I decide to work for them hosting their podcast!”
Boosts energy levels. The sluggishness and lethargy you feel after a heavy carb-filled meal is due to the insulin spike and reactive sharp drop in blood sugars. Eating a high-fat diet provides steady energy and helps you avoid crashes that are associated with eating a high-carb diet. Additionally, since ketones are the brain’s preferred source of energy, a ketogenic diet leaves you feeling more alert and mentally energized without having to supply a steady stream of caloric intake [13].

“As a family doctor, I not only lost weight and improved my own health with the low-carb diet, I also inspired colleagues and patients alike to follow this lifestyle and reap its benefits. It has now become a powerful tool I use in my daily practice to help treat and reverse obesity, diabetes, fatty liver, PCOS, and chronic pain. I refer all my English-speaking patients to the Diet Doctor website and I also use it during visits as a counseling tool. Inspired by Diet Doctor, I have created my own website to cater to French-speaking patients!”


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!

Similar to our results, three studies noted that diabetes medications were reduced in some participants[6,8,9], although details were provided in only one study. We also discontinued diuretic medications during diet initiation because of concern for additional diuresis incurred by the diet. This concern was based on the theoretical effects of the diet [17], observed effects of the diet on body water by bioelectric impedance [18], and practical experience with the diet [19]. Until we learn more about using low carbohydrate diets, medical monitoring for hypoglycemia, dehydration, and electrolyte abnormalities is imperative in patients taking diabetes or diuretic medications.
The primary outcome, hemoglobin A1c, decreased from 7.5 ± 1.4% at baseline to 6.3 ± 1.0% at week 16 (p < 0.001), a 1.2% absolute decrease and a 16% relative decrease (Table ​(Table4).4). All but two participants (n = 19 or 90%) had a decrease in hemoglobin A1c (Figure ​(Figure1).1). The absolute decrease in hemoglobin A1c was at least 1.0% in 11 (52%) participants. The relative decrease in hemoglobin A1c from baseline was greater than 10% in 14 (67%) participants, and greater than 20% in 6 (29%) participants. In regression analyses, the change in hemoglobin A1c was not predicted by the change in body weight, waist circumference, or percent body fat at 16 weeks (all p > 0.05).
We’re going full on fats with breakfast, just like we did last week. This time we’ll double the amount of ketoproof coffee (or tea) we drink, meaning we double the amount of coconut oil, butter, and heavy cream. It should come to quite a lot of calories, and should definitely keep us full all the way to dinner. Remember to continue drinking water like a fiend to make sure you’re staying hydrated.
“I discovered the ketogenic diet in 2017 and since then I have come to truly believe it is the metabolic and nutritional pathway to overall health. Hippocrates once stated, ‘All disease begins in the gut” and I now truly believe the right food can cure. I am now discouraging patients from undergoing bariatric surgery too soon and advising them to try the keto diet first. Diet Doctor gives people the knowledge they need. It is a place where everyone can go to learn and have fun with this nutritional approach.”
Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
^ Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. (2018). "Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)". Diabetes Care. 41 (12): 2669–2701. doi:10.2337/dci18-0033. PMC 6245208. PMID 30291106. Low-carbohydrate, low glycemic index, and high-protein diets, and the Dietary Approaches to Stop Hypertension (DASH) diet all improve glycemic control, but the effect of the Mediterranean eating pattern appears to be the greatest
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