Dr. Jockers, thank you so much for this clear and detailed article! I began a keto-style diet around August 2019. By late November, I had fallen from 197 lbs. to under 175 lbs., dropped from 28% to 18% body fat, and anecdotally felt much better in all aspects of my health. All of this occurred exclusively due to diet, I believe– I had almost no exercise routine to speak of, and my desk-based job is pretty sedentary. My family practice doc was surprised and happy with the results as well when I met with him in January… until my blood work came back showing total cholesterol at 257, triglycerides at 236, LDL-C at 162, and HDL at 50.
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.”
Hi Courtney, I’m currently working on a 21-Day Keto Meal Plan. Unfortunately, it’s super time-consuming. And after buying a keto cookbook yesterday and returning it the same day because it wasn’t well researched and the recipes clearly not created specifically for the Keto diet you wouldn’t want me to rush this. I want to make sure the Meal Plan is SPOT on and the recipes complement each other and make eating Keto easy. Give me another month or two and I’ll hopefully have more news on progress. Currently working on a rough sketch but still have to test all recipes and photograph them, too. You definitely don’t need nuts to be able to eat Keto. For now, I recommend to keep it as simple as possible. You can eat my 1-day meal plan 4 days a week and find other recipes you like to build another similar day and then keep switching between mine and the other.
Hey David, You will definitely want to do everything you can to mitigate the mold issue. If you cannot remove it from your environment (or yourself from that environment) then you will want to use things like glutathione, liver support, activated charcoal, and daily detoxification strategies as much as possible. For the LDL testing, this is one of the best I know of https://drjockers.com/cardiopower-testing/
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.
Because visceral fat is physiologically and clinically more relevant than total FM, special emphasis was placed on its analysis. The VLCK diet led to a significant reduction in visceral fat that can be seen in assessment by either new DXA software (−1.2 ± 0.7 kg) or by MF-BIA [−60.8 ± 20.7 cm2; Fig. 2(B) and 2(C)]. Therefore, when evaluated by different methods, the VLCK diet induced a significant body weight reduction by targeting total FM and visceral FM [Fig. 2(A–C)].
When ketone bodies accumulate in the blood, this is called ketosis. Healthy individuals naturally experience mild ketosis during periods of fasting (e.g., sleeping overnight) and very strenuous exercise. Proponents of the ketogenic diet state that if the diet is carefully followed, blood levels of ketones should not reach a harmful level (known as “ketoacidosis”) as the brain will use ketones for fuel, and healthy individuals will typically produce enough insulin to prevent excessive ketones from forming.  How soon ketosis happens and the number of ketone bodies that accumulate in the blood is variable from person to person and depends on factors such as body fat percentage and resting metabolic rate. 
Participants completed take-home food records (4 consecutive days, including a weekend) collected at baseline and at weeks 2, 8, and 16 during the study. Participants were given handouts with examples of how to complete the records. A registered dietician analyzed the food records using a nutrition software program (Food Processor SQL, ESHA Research, Inc., Salem, OR).
Something that makes the keto diet different from other low-carb diets is that it does not “protein-load.” Protein is not as big a part of the keto diet as fat is. Reason being: In small amounts, the body can change protein to glucose, which means if you eat too much of it, especially while in the beginning stages, it will slow down your body’s transition into ketosis.
Gluconeogenesis is the endogenous production of glucose in the body, especially in the liver primarily from lactic acid, glycerol, and the amino acids alanine and glutamine. When glucose availability drops further, the endogenous production of glucose is not able to keep up with the needs of the body and ketogenesis begins in order to provide an alternate source of energy in the form of ketone bodies. Ketone bodies replace glucose as a primary source of energy. During ketogenesis due to low blood glucose feedback, stimulus for insulin secretion is also low, which sharply reduces the stimulus for fat and glucose storage. Other hormonal changes may contribute to the increased breakdown of fats that result in fatty acids. Fatty acids are metabolized to acetoacetate which is later converted to beta-hydroxybutyrate and acetone. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained. This metabolic state is referred to as "nutritional ketosis." As long as the body is deprived of carbohydrates, metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-threatening condition where ketone bodies are produced in extremely larger concentrations, altering blood ph to acidotic a state.
Although these are just some studies on the low carb high fat and ketogenic diets, it is also important to mention there are thousands of published studies on this topic and many, many more are still in progress and unpublished. With time and as technology advances, we can find more proofs that the Ketogenic Diet’s benefits will be further cemented.
Supporting these results, Naude et al. (15) found a similar outcome in obese adults with and without type 2 diabetes. This meta-analysis of 19 randomized, controlled trials compared dietary interventions using standard CHO recommendation (i.e., 45 – 65%), low-carbohydrate/high protein (LCHP) and low-carbohydrate/high fat (this group, although not specifically stated, met the criteria for KD). Results demonstrated significant weight loss among all groups in the short-term (3 – 6 months) and long-term (1 – 2 years), with no significant difference among dietary interventions. The authors concluded that weight loss interventions using CHO restriction are equally effective as isocaloric diets of standard CHO recommendation.
Hello, I am doing IF 16:8 & my eating window is in the evening. I’m confused as to what to eat during those 8 hours. I’ve been eating 1 meal & a snack. Is this enough? I’ve been doing Keto dieting for 6 months. Initially lost 5 #. (Realize it was water #) Now I weigh more than I ever have, as of today!! Drink loads of water, eat healthy fats, mod protein & limited carbs, non processed. Can you help? Thanks!!
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more