Patients were invited to complete a battery of psychological tests to assess performance in the domains of food cravings, quality of life (QoL), daytime sleepiness and sleep quality, sexual functioning, and physical activity through the course of the nutritional intervention. The psychological tests were selected for availability of multiple test versions, well-stablished psychometric properties, and accepted clinical use.
Food craving refers to an intense desire to consume a specific food. The food cravings questionnaires (FCQs) [24] assess food cravings on a trait and a state level and on a specific food item. The FCQ-trait was derived from a total of 88 statements that were generated using 10 theoretical dimensions of trait food cravings. Participants were asked to indicate how frequently each statement “would be true for you in general” using a 6-point scale that ranged from “Never” or “Not Applicable” to “Always”. The FCQ-state was derived from a total of 60 statements representing seven dimensions of state food cravings. Participants were asked to indicate the extent to which they agreed with each statement “right now, at this very moment” using a Likert scale that ranged from “Strongly Agree” to “Strongly Disagree”.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]

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.

Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose).[19] Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.[56]

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.
You may also want to try a cyclical keto diet, or carb cycling. You follow the standard keto diet for 6 days of the week, when you eat less than 50 grams of net carbs a day. But on one day of the week, you increase your carb intake to roughly 150 grams of net carbs. Doing this satisfies any carb cravings you might have, making it easier to sustain keto in the long-run. Learn more about the benefits of carb cycling and weight loss here.

–These easy low carb blender pancakes will brighten your morning with the sunny taste of lemons and mixed berries. A fabulous gluten-free breakfast treat. My kids all seem to have one track minds, just like their old mum. Turns out that they dream about food as much as I do. Maybe it's a hereditary trait, passed on through the genes of food-obsessed people. Or maybe it's taught when they are really young and impressionable, watching as their mother thinks and schemes and daydreams about her next meal. However it's passed on, my kids all surely have caught that bug.All Day I Dream About Food


One of the absolute worst things conventional medicine does is treat type 2 diabetics with insulin. This only exacerbates the problem. The key to treating and reversing type 2 diabetes is to cut down on net carbs, replacing them with high amounts of healthy fats and moderate amounts of protein. Dr. Tim Noakes has researched reversal of type 2 diabetes in South Africans, coming to the same conclusion.
First, a little background: Eric Westman, MD, director of the Duke Lifestyle Medical Clinic, explained to Health in a previous interview that in order to successfully follow the keto diet, you need to eat moderate amounts of protein, reduce your carb intake, and increase fats. When you reduce your carb consumption, your body turns to stored fat as its new fuel source—a process called ketosis. To stay in ketosis, followers of the keto diet must limit their carbs to 50 grams a day, Dr. Westman says.
After 4 months the VLCK diet induced a −20.2 ± 4.5 kg weight loss, at expenses of reductions in fat mass (FM) of −16.5 ± 5.1 kg (DXA), −18.2 ± 5.8 kg (MF-BIA), and −17.7 ± 9.9 kg (ADP). A substantial decrease was also observed in the visceral FM. The mild but marked reduction in fat-free mass occurred at maximum ketosis, primarily as a result of changes in total body water, and was recovered thereafter. No changes in muscle strength were observed. A strong correlation was evidenced between the 3 methods of assessing body composition.
Protein can turn into carbohydrates via a metabolic process called gluconeogenesis (making new carbs) and will do in people at varying degrees. Protein turning into carbohydrates means you’re not in ketosis. However, this is generally an overblown statement that only happens at the extreme cases when you are drinking a lot of liquid protein shakes. 
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 ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][10]
You can approach keto in a number of different ways. On some keto diets, like dirty keto, it doesn’t matter where your fats, protein, and carbs come from. So dinner could be a bunless cheeseburger with extra bacon. Eating bad fats like low-quality vegetable oils, packaged low-carb snacks, and processed cheese dials up inflammation, making weight loss more challenging.[8]

A Ketogenic diet is one that is high in healthy fats and proteins, and extremely low in carbohydrates.  Typically, it takes around 100g of carbohydrates per day to keep up with the average person's brain and organ function.  When you eat between 20-50 g of net carbohydrates (total carbohydrates – fiber) your body has to switch over to using fat to fuel itself instead of carbohydrates.  This process is called Ketosis, and it's a perfectly natural state of humans to exist in.

“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 have been on the Keto diet for approximately 2 months. I have lost 18 lbs, but have about 20 more to lose. I definitely notice certain foods, even tho they are Keto friendly stall my weight loss. I am feeling a lot better about myself already and don’t see a reason why I won’t be able to stick with this diet. However, I am stressing about what I will eat on Thanksgiving being that my family does not follow my same eating habits.
Collagen is a type of protein that has been shown to suppress appetite[*], provide fullness compared to other proteins like whey, casein, or soy[*], help retain muscle mass[*] and even help to reduce the appearance of cellulite due to it’s ability to improve skin elasticity and thickness[*]. Refer to this article for more information on the benefits of collagen and the best way to supplement it in 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.”
There is a lack of evidence of the usefulness of low-carbohydrate dieting for people with type 1 diabetes.[1] Although for certain individuals it may be feasible to follow a low-carbohydrate regime combined with carefully-managed insulin dosing, this is hard to maintain and there are concerns about potential adverse health effects caused by the diet.[1] In general people with type 1 diabetes are advised to follow an individualized eating plan rather than a pre-decided one.[1]
WY conceived, designed, and coordinated the study; participated in data collection; performed statistical analysis; and drafted the manuscript. MF assisted with study design, performed data collection, and helped to draft the manuscript. AC analyzed the food records. MV assisted with study/intervention design and safety monitoring. EW participated in the conception and design of the study, and assisted with the statistical analysis. All authors read and approved the final manuscript.
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.
“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.”
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.
Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920's, the mainstay of therapy was dietary modification. Diet recommendations in that era were aimed at controlling glycemia (actually, glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes [1,2]. For example, the Dr. Elliot Joslin Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat [3]. A similar diet was advocated by Dr. Frederick Allen of the same era [4].

Our highly processed and high fat with high carbs diets and sedentary ways are going to kill off many of our kids. A study just done says this generation will probably be less healthy and die earlier than their parents. I did Atkins years ago and did splendidly. I went back to my foolish habits and suffered. I’m on a ketogenic diet which has already reaped many benefits in this 65 year old body. Better mood, less joint pain, less fatigue, and more energy. Loving it.
How often you eat is also up to your personal preference. "For most people, I recommend three to four meals per day with a few healthy keto snacks in between," says Dr. Axe. "This ensures that you're getting a good mix of protein and fat all day long to keep you feeling energized and satisfied." That being said, he encourages people to listen to their bodies and tune in to when they're truly hungry. "If you find that you feel better eating five to six smaller meals spread throughout the day, do what works best for you."
Vegetables: This isn’t a diet that allows you to eat veggies to your heart’s content. Most of your vegetables should come from leafy greens like lettuce, spinach, and bok choy. You can also fit in some asparagus, cauliflower, and broccoli. As a rule of thumb if it’s a colour other than green, avoid it. Here's a full list of vegetables to eat on a Keto diet.
Epilepsy is one of the most common neurological disorders after stroke,[7] and affects around 50 million people worldwide.[8] It is diagnosed in a person having recurrent, unprovoked seizures. These occur when cortical neurons fire excessively, hypersynchronously, or both, leading to temporary disruption of normal brain function. This might affect, for example, the muscles, the senses, consciousness, or a combination. A seizure can be focal (confined to one part of the brain) or generalised (spread widely throughout the brain and leading to a loss of consciousness). Epilepsy can occur for a variety of reasons; some forms have been classified into epileptic syndromes, most of which begin in childhood. Epilepsy is considered refractory (not yielding to treatment) when two or three anticonvulsant drugs have failed to control it. About 60% of patients achieve control of their epilepsy with the first drug they use, whereas around 30% do not achieve control with drugs. When drugs fail, other options include epilepsy surgery, vagus nerve stimulation, and the ketogenic diet.[7]
We have a super supportive group of “squeakers” over on Facebook who love helping newbies with questions and cheering on everyone’s weight loss progress and Non Scale Victories (NSV’s). Join us over there and see the radical results the SCKC is having on so many people!  And stay tuned for my new book Squeaky Clean Keto – which will include over 120 new SCKC and Whole 30 friendly recipes, and at least 4 weeks of new meal plans!

Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 

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.
Although studies have shown that the keto diet can reduce seizures for children with epilepsy, there is no evidence indicating that keto helps with other brain disorders or improves mental cognition, according to Harvard Health Publishing. Some studies show that keto may lower blood sugar for people with type 2 diabetes, but there is not enough long-term research to determine whether it’s safe and effective for diabetics.
When the craving for alcohol was evaluated, no statistically significant changes were observed in the MACS scores through the nutritional intervention, taking all patients together (Table S1). However, when the analysis was performed considering the gender of participants in the study, men experienced a significant decrease in the total score through the study (p = 0.047). This decrease was more notable in the maximum ketosis phase as compared with baseline (−15.14; p = 0.047). Moreover, a statistically significant reduction was observed in the lack of inhibition item (−27.19; p = 0.042).
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