If there’s any excess glucose, it’s converted to glycogen and stored in either our muscles or liver. If we already have enough stored glycogen, excess glucose is converted and stored as fat. This is why when our hand reaches down into a biscuit tin that was full just hours before only to meet its cold steel bottom, we have not successfully fueled our bodies. We have successfully fueled our waistlines.
10. Crujeiras A.B., Morcillo S., Diaz-Lagares A., Sandoval J., Castellano-Castillo D., Torres E., Hervas D., Moran S., Esteller M., Macias-Gonzalez M., et al. Identification of an episignature of human colorectal cancer associated with obesity by genome-wide DNA methylation analysis. Int. J. Obes. (Lond.) 2018 doi: 10.1038/s41366-018-0065-6. [PubMed] [CrossRef] [Google Scholar]
36. NCD Risk Factor Collaboration (NCD-RisC) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: A pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–2642. doi: 10.1016/S0140-6736(17)32129-3. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
“I am determined to shatter the chiding “eat less, exercise more” obesity medicine paradigm. Obesity is not a personal failure, but a chronic health condition unfolding in our country and around the world. It is a result of the “carboholic” society we live in. Through a holistic approach, I arm patients with knowledge, tools, and skills to manage their weight as well as their overall health.”
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
The premise of the ketogenic diet for weight loss is that if you deprive the body of glucose—the main source of energy for all cells in the body, which is obtained by eating carbohydrate foods—an alternative fuel called ketones is produced from stored fat (thus, the term “keto”-genic). The brain demands the most glucose in a steady supply, about 120 grams daily, because it cannot store glucose. During fasting, or when very little carbohydrate is eaten, the body first pulls stored glucose from the liver and temporarily breaks down muscle to release glucose. If this continues for 3-4 days and stored glucose is fully depleted, blood levels of a hormone called insulin decrease, and the body begins to use fat as its primary fuel. The liver produces ketone bodies from fat, which can be used in the absence of glucose. [1]
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10]
“I have been applying low carb solutions to metabolic problems since the moment I closed the cover of Good Calories, Bad Calories. I share with my low-carb colleagues the wonderful experience of offering effective advice and seeing real results. In addition to metabolic and hormonal problems, I have more recently focused on flexible low-carb approaches for Alzheimer’s and other neurodegenerative conditions. I greatly enjoy the lively online low-carb community and rely on Diet Doctor as a resource for myself and my patients.”
A computer program such as KetoCalculator may be used to help generate recipes.[47] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[37]
If you’re one of the lucky people that have a dehydrator, you can take serious advantage of it by dehydrating thin slices of vegetables overnight (normally 12 hours) to get crisp, perfect vegetables that you can eat as snacks. Do this with zucchini, radish, or jicama. If you’re not lucky enough to have a dehydrator (like me), then you can easily make cheese chips in the oven and flavor them with your own spices!
Protein is generally considered the most satiating macronutrient, but it’s mostly used for cell repair, maintenance and growth. Thus protein intake is mostly important in order to fill your body’s protein needs. Protein is not very effective as a fuel (i.e. as calories). Excess protein has to first be converted to glucose in the liver, in order to be used as fuel. Eating protein in excess of your body’s needs is not necessarily a good thing, and it can reduce the effect of a strict low-carb diet. Learn more
There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.
Eat fats with all your meals. Fats are the cornerstone of the ketogenic diet, and will encourage your body to burn fatty ketones for fuel. Typically, calories from fat should comprise 80 – 90% of your meals.[10] (However, you cannot eat unlimited fats on a ketogenic diet; the calories can still add up and cause weight gain.[11]) Examples of fatty foods include:
The benefits above are the most common ones. But there are others that are potentially even more surprising and – at least for some people – life changing. Did you know that a keto diet can help treat high blood pressure, may result in less acne, may help control migraine, might help with certain mental health issues and could have a few other potential benefits?
The weight-loss program has five steps and adheres to the most recent guidelines of the 2015 EFSA on total carbohydrate intake [22]. The first three steps consist of a VLCK diet (600–800 kcal/day), low in carbohydrates (<50 g daily from vegetables), and lipids (only 10 g of olive oil per day). The amount of high biological-value proteins ranged between 0.8 and 1.2 g per each kg of ideal body weight to ensure that patients were meeting their minimum body requirements and to prevent the loss of lean mass. In step 1, the patients ate high-biological-value protein preparations five times a day and vegetables with low glycemic indexes. In step 2, one of the protein servings was substituted with a natural protein (e.g., meat or fish) either at lunch or at dinner. In step 3, a second serving of low-fat natural protein was substituted for the second serving of biological protein preparation. Throughout these ketogenic phases, supplements of vitamins and minerals, such as K, Na, Mg, Ca, and omega-3 fatty acids, were provided in accordance with international recommendations [23]. These three steps were maintained until the patient lost the target amount of weight, ideally 80%. Hence, the ketogenic steps were variable in time depending on the individual and the weight-loss target. The total ketosis state lasted for 60–90 days only.
Twenty calories a day times the 365 days in a year comes to a little more than seven thousand calories stored as fat every year—two pounds of excess fat. If it were true that our adiposity is determined by calories-in/calories-out, then this is one implication: you only need to overeat, on average, by twenty calories a day to gain fifty extra pounds of fat in twenty years. You need only to rein yourself in by this amount—undereat by twenty calories a day—to undo it. Twenty calories is less than a single bite of a McDonald’s hamburger or a croissant. It’s less than two ounces of Coke or Pepsi or the typical beer. Less than three potato chips. Maybe three small bites of an apple. In short, not very much at all. Twenty calories is less than 1 percent of the daily caloric intake that the U.S. National Academy of Sciences has recommended for a middle-aged woman whose idea of regular physical activity is cooking and sewing; it’s less than half a percent of the daily quota of calories recommended for an equally sedentary middle-aged man. That it’s such an insignificant amount is what makes it so telling about the calories-in/calories-out idea.
Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre's experience with 76 children up to the year 2009) also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.[18][50]
Hi Kim, there are several factors for developing autoimmune diseases, including Hashimoto's. I believe that in my case it was a combination of high-carb & low-calorie dieting that have contributed to it. I found out by accident because I went for allergy testing where they discovered I had thyroid antibodies. You should definitely avoid following a low-calorie diet (1000 kcal is not enough). Have a look at this tool: KetoDiet Buddy - Easy Macro Calculator for the Ketogenic Diet
The liquid diets involved with VLCDs often bring on ketosis, a condition that involves a buildup of ketone bodies in the blood as well as urine. Ketones are a byproduct that is created when your body has to switch to fat as an energy source. It means your store of glycogen, or carbohydrates, has been depleted. One of the consequences of ketosis is a loss of appetite, which helps make it easier to follow a VLCD. Ketosis also causes you to shed excessive amounts of sodium, potassium and water, which can cause dehydration, sluggishness, constipation and gas. However, your body can adjust to changes in your electrolytes.
The weight-loss program has five steps and adheres to the most recent guidelines of the 2015 EFSA on total carbohydrate intake [22]. The first three steps consist of a VLCK diet (600–800 kcal/day), low in carbohydrates (<50 g daily from vegetables), and lipids (only 10 g of olive oil per day). The amount of high biological-value proteins ranged between 0.8 and 1.2 g per each kg of ideal body weight to ensure that patients were meeting their minimum body requirements and to prevent the loss of lean mass. In step 1, the patients ate high-biological-value protein preparations five times a day and vegetables with low glycemic indexes. In step 2, one of the protein servings was substituted with a natural protein (e.g., meat or fish) either at lunch or at dinner. In step 3, a second serving of low-fat natural protein was substituted for the second serving of biological protein preparation. Throughout these ketogenic phases, supplements of vitamins and minerals, such as K, Na, Mg, Ca, and omega-3 fatty acids, were provided in accordance with international recommendations [23]. These three steps were maintained until the patient lost the target amount of weight, ideally 80%. Hence, the ketogenic steps were variable in time depending on the individual and the weight-loss target. The total ketosis state lasted for 60–90 days only.

Some fruits may contain relatively high concentrations of sugar, most are largely water and not particularly calorie-dense. Thus, in absolute terms, even sweet fruits and berries do not represent a significant source of carbohydrates in their natural form, and also typically contain a good deal of fiber which attenuates the absorption of sugar in the gut.[20]


If you're new to keto, watch out for hidden carbs. Generally, dairy products and nuts are a good way to meet your daily fat intake, but know that some of those items may contain more carbohydrates than you think. For example, yogurt topped with nuts may seem like a great keto-friendly snack, but a 5.3 ounce serving of plain yogurt has 12 grams of carbohydrates. Vanilla flavored yogurt has 24 grams of carbohydrates. Add an ounce of cashews, weighing in at nearly nine grams of carbs, and you’re up to 21 to 33 grams of carbs for that snack, which could knock you out of ketosis. Be sure to read nutrition labels carefully and pay careful attention to serving sizes. Track foods using a keto-specific app like Senza or KetoDiet can help you stay within your recommended daily carb intake.
d) Or does the entire question revert back to a classic calorie counting exercise? In this case, I’ll eat the minimum amount of protein that is needed to prevent my muscles from being cannibalized (for energy) and for the rest, I’ll limit my dietary fat intake per day to a level, where its energy + energy currently obtained from adipose tissue match my total energy need? (I’ll leave gluconeogenesis out of this equation for simplicity.) If this is the case, I’ll lose adipose tissue, i.e. lose weight, but the interesting question still remains: How much energy can my body extract from the adipose tissue at its best? How can I maximize the share of energy coming from adipose tissue instead of dietary fat?
Participants returned every other week for 16 weeks for further diet counseling and medication adjustment. When a participant neared half the weight loss goal or experienced cravings, he or she was advised to increase carbohydrate intake by approximately 5 g per day each week as long as weight loss continued. Participants could choose 5 g carbohydrate portions from one of the following foods each week: salad vegetables, low-carbohydrate vegetables, hard or soft cheese, nuts, or low-carbohydrate snacks. Diabetes medication adjustment was based on twice daily glucometer readings and hypoglycemic episodes, while diuretic and other anti-hypertensive medication adjustments were based on orthostatic symptoms, blood pressure, and lower extremity edema.
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.
The observation that the VLCK diet severely reduced FM while preserving muscle mass was reinforced by the maintenance of its physiological action (i.e., muscle strength). Despite a slight reduction in ALM and ASLM, as determined by DXA and MF-BIA, respectively, crude HG remained unchanged during the study (Table 1). Moreover, HG/ALM and HG/ASLM showed a moderate increase in comparison with baseline [Fig. 3(C)].
How it’s done: Warm up the LEVL or Ketonix meter by plugging it in. Blow into it and wait for the flashing light indicating it’s reading your acetone levels. The software or the color and speed of the flashing light would tell your reading: green for least acetone, red for most acetone, less flashing for less acetone per color, more flashing for more acetone per color.
Weight loss often means feeling hungrier and fighting off more cravings, but that doesn’t always seem to be the case when you go keto. People report less hunger and a diminished desire to eat after adopting a ketogenic diet, according to an analysis of 26 studies. Experts don’t fully understand why, but it’s thought that very low carb diets could suppress the production of hunger hormones like ghrelin.
Hi Kim, there are several factors for developing autoimmune diseases, including Hashimoto's. I believe that in my case it was a combination of high-carb & low-calorie dieting that have contributed to it. I found out by accident because I went for allergy testing where they discovered I had thyroid antibodies. You should definitely avoid following a low-calorie diet (1000 kcal is not enough). Have a look at this tool: KetoDiet Buddy - Easy Macro Calculator for the Ketogenic Diet
There is also a common worry the ketogenic diet may cause ketoacidosis, which occurs when the acidity in the blood increases. Diabetic ketoacidosis is a life-threatening condition caused by very high blood sugars and a deficiency of insulin in insulin-dependent diabetics, a very different state from ketones produced by a fat-burning metabolism on a low-carb, high-fat diet.

During the ketosis phase of the nutritional intervention, the IWQOL-Lite scores did not change for the sexual life, social anxiety, and work area domains (Table S1). A significant improvement was observed in the physical function and self-esteem scores during this phase. When comparing the visit of reduced ketosis and endpoint with baseline, a significant improvement was found in all domains, except for social anxiety, which did not change throughout the nutritional intervention.


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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.
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.

A meta-analysis of 13 randomized controlled trials following overweight and obese participants for 1-2 years on either low-fat diets or very-low-carbohydrate ketogenic diets found that the ketogenic diet produced a small but significantly greater reduction in weight, triglycerides, and blood pressure, and a greater increase in HDL and LDL cholesterol compared with the low-fat diet at one year. [10] The authors acknowledged the small weight loss difference between the two diets of about 2 pounds, and that compliance to the ketogenic diet declined over time, which may have explained the more significant difference at one year but not at two years (the authors did not provide additional data on this).
Since dehydration is a contributor to headaches, drink plenty of water when following a low-calorie, weight-loss diet -- especially if you exercise regularly. Drinking water, especially before meals, also helps fill you up and makes it easier to stick with a lower daily calorie allotment. The Institute of Medicine reports that adequate intake levels are about 16 cups of water daily for men and 11 cups a day for women. These amounts include water in other beverages and foods. The University of Rochester Medical Center reports that about 80 percent of your water intake comes from water and beverages, and 20 percent generally comes from food.

Many unhealthy foods easily meet keto’s low-carb, high-fat criteria. However, that doesn’t mean you can or should eat them freely. “A huge benefit to following the keto diet is that the vast majority of processed food is removed with the removal of grains,” Santo says. “Unfortunately, poor-quality dairy, meat, and veggies may fill the gap.” Look for healthier sources of protein and fat, such as grass-fed meats, and limit processed dairy (think cheese singles) as much as possible.
“Each person’s journey is different, and therefore each person deserves a highly-specialized and individualized treatment plan to help them reach their optimal health. I recommend low-carb and ketogenic lifestyles to my patients and find ways to make them reasonable and sustainable for each person. Diet Doctor is a wonderful resource for my patients and provides wonderful recipes and invaluable information.”

Psychological well-being and hunger and food control are two relevant factors involved in the success of weight-loss therapy in treating obesity. Thus, this study aims to evaluate food and alcohol cravings, physical and sexual activity, sleep, and life quality (QoL) in obese patients following a very low-calorie ketogenic (VLCK) diet, as well as the role of weight lost and ketosis on these parameters. A battery of psychological test was performed in twenty obese patients (12 females, 47.2 ± 10.2 year and BMI of 35.5 ± 4.4) through the course of a 4-month VLCK diet on four subsequent visits: baseline, maximum ketosis, reduced ketosis, and endpoint. Each subject acted as their own control. Relevantly, the dietary-induced changes in body composition (7.7 units of BMI lost, 18 kg of fat mass (1.2 kg of visceral fat mass)) were associated with a statistically significant improvement in food craving scores, physical activity, sleepiness, and female sexual function. Overall, these results also translated in a notable enhancement in QoL of the treated obese patients. Therefore, the rapid and sustained weight and fat mass (FM) loss induced by the VLCK diet is associated with good food control and improvements in the psychological well-being parameters in obese subjects, which could contribute to the long-term success of this therapy.
“I have been a supporter of a low-carb lifestyle that includes intermittent fasting for myself and my patients for years. I am part of our health systems Medicine Residency program. I teach physicians-in-training and medical staff to utilize low-carb and keto dieting to improve the health of their patients and reduce their need for medications. Diet Doctor is an excellent resource for patients and physicians to help patients help themselves to promote a healthy lifestyle.”

Vegan ketogenic diet or vegetarian diet: Yes, both are possible. Instead of animal products, plenty of low-carb, nutrient-dense vegan and/or vegetarian foods are included. Nuts, seeds, low-carb fruits and veggies, leafy greens, healthy fats and fermented foods are all excellent choices on a plant-based keto diet. There’s also a similar plan called ketotarian, which combines keto with vegetarian, vegan and/or pescatarian diets for supposedly greater health benefits.
While there are delicious-looking ketogenic recipes and meal plans online, experts like Weaver warn that you’ll want to avoid relying too much on artificial sweeteners and unhealthy foods for your keto diet menu. Make sure your grocery list includes healthy fats like avocados, coconut oil, olive oil. This is what really happens to your body on the keto diet.
High-protein ketogenic diet (HPKD): This version of the keto diet is often followed by folks who want to preserve their muscle mass like bodybuilders and older people. Rather than protein making up 20 percent of the diet, here it’s 30 percent. Meanwhile, fat goes down to 65 percent of the diet and carbs stay at 5 percent. (Caution: folks with kidney issues shouldn’t up their protein too much.)

Ketosis suppresses ghrelin–a hormone that increases hunger,18 while high levels of the ketone beta-hydroxybutyrate may act directly as a satiety signal.19 Exogenous ketosis induced by HVMN Ketone, a ketone ester drink, also decreases appetite and ghrelin.20 If you're looking for a fasting aid, HVMN Ketone is the perfect tool. Our flagship product puts you into nearly immediate ketosis without the need to diet or fast for weeks–try it here.
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.
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31] 
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