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].
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Women were also invited to complete a questionnaire on sexual function (the Female Sexual Function Index—FSFI). The FSFI consists of 19 questions, divided into 6 domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Each answer is rated on a scale ranging from 0 to 5 or 1 to 5 (0 means no sexual activity in the four preceding weeks) [28]. The total FSFI score, obtained from the sum of the items in each domain multiplied by the domain factor (0.6 for desire, 0.3 for arousal and lubrication, and 0.4 for orgasm, satisfaction, and pain), may range from 2.0 to 36.0. Lower scores indicate poorer sexual function. A total FSFI score less than 26.55 is indicative of sexual dysfunction [28].
A typical keto diet is comprised of 80 percent fat, 15 percent protein, and a mere 5 percent of calories from carbohydrates. If you consume 2,000 calories a day, that means just 100 of them are coming from carbs—including healthy carbs like fruits and vegetables. When you eat this way, it triggers ketosis, which means your body has burned through all its carbs and needs to begin burning fat for energy.
“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.”
A recent randomized, double-blind, placebo-controlled trial found that subjects who received 400 mg garlic powder tablets twice a day lost significantly more fat than the control group. Although there are many confounding variables in this trial, animal studies back up the human findings by providing us with evidence that garlic supplementation can have anti-obesogenic effects (i.e., garlic prevents weight gain) in mice.
The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.
Hi Cyn, The numbers are general guidelines but will vary depending on many factors, such as activity level, insulin resistance, weight and more. There is no single magic number, just conventional recommendations that are a good starting point. I will have a macro calculator coming soon that will help determine what is best for each person, but even then it’s an approximation. The only way to know for sure is to test. If keto is your goal, it’s usually best to start lower and then see if you can stay in ketosis when increasing.
This is a wealth of information. My husband and I are starting the keto diet tomorrow and I knew nothing about it. When I sat down to look up information about it, I found this. Thank you! This is everything I need to know in one place. We are not as healthy as we’d like to be and I am optimistic this will help us obtain our goals, along with an exercise plan.
“As an American board-certified endocrinologist who moved back to Mumbai, I saw India’s diabetes epidemic and dogma through a different lens. Low carb plus intermittent fasting has proven very effective in the reversal of insulin resistance, fatty liver, PCOS, reduced fertility, obesity, metabolic syndrome, hypertension and even early diabetic neuropathy and nephropathy. I conduct Diabetes Self-Management classes every month while looking at the whole lifestyle: stress, sleep, exercise, mindfulness, self-care and nutrition. This works even in India’s predominantly vegetarian culture! I often refer patients to DietDoctor for low-carb recipes and FAQ’s.”
Excessive ketone bodies can produce a dangerously toxic level of acid in the blood, called ketoacidosis. During ketoacidosis, the kidneys begin to excrete ketone bodies along with body water in the urine, causing some fluid-related weight loss. Ketoacidosis most often occurs in individuals with type 1 diabetes because they do not produce insulin, a hormone that prevents the overproduction of ketones. However in a few rare cases, ketoacidosis has been reported to occur in nondiabetic individuals following a prolonged very low carbohydrate diet. [4,5]
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
A lot of people on the keto diet tend to go absolutely overboard with the unhealthy food that they pack into their plan. Sure a bunch of cheese, mayonnaise and bacon will fit into a seventy-five percent fat allowance, however, for your health these foods are not always the best option. Your day to day seventy-five percent fat allowance is meant to be used for healthy sources of fat such as such avocados, coconut oil, whole eggs, nuts and fats found in unprocessed meats such as beef, salmon, chicken thighs, ground pork or turkey.
Food reward regions in the brain programmed much of this physical dependence on processed foods and refined starches. But the body can reverse it. Acute bouts of aerobic exercise have been shown to significantly suppress appetite and hunger while increasing satiety and fullness.6 Exercise in the form of resistance (weight) training can enhance insulin sensitivity,7 which results in reduced insulin secretion.8 Less insulin helps bodies favor fat burning over fat storage.
This is a diet that requires a fair amount of attention to macronutrient quantities in order to work. Unlike the Atkins diet, which only restricts carbs, the ketogenic diet also restricts protein based on your activity level, so that extra protein doesn’t get converted into glucose. When people first go on nutritional ketosis, they sometimes focus on getting their carbs super low (i.e., less than 20 grams per day), and that can cause hormone and mood problems, especially in women. They make up the difference with too much protein, which then converts into sugar. So if you over-restrict carbs and eat too much protein, ketosis may not work. It’s not just a certain amount of carbs you want to target, but the right combination of fat, carbs, and protein for YOU.
Getting into ketosis is a critical component of the ketogenic diet. You can achieve ketosis by fasting, cutting carbs drastically (typically under 50 grams a day), and/or taking keto supplements, such as BHB (exogenous ketones) and MCT-based meal replacement shakes. After becoming fat-adapted, incorporating intermittent fasting (IF) can help boost weight loss or break weight loss plateaus. The most common method is 16:8 where you go 16 hours without eating, and consume all of your calories during an 8-hour eating window.

The FCQ-inventory was based on the validated FCQ-inventory containing 28 item foods. Participants were instructed to indicate how often, in the last month, they have experienced food cravings for each item on a Likert scale where 1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 = always/almost every day. There were 3 subscales that categorized foods of similar composition: simple sugars/trans fats, complex carbohydrate/proteins, and saturated fats/high caloric content. To calculate each subscale score, the values given for the corresponding items were summed, and the mean was recorded. A higher score in the FCQ indicated greater food cravings.

The insulin theory of obesity, in short, declares that the primary cause of obesity is higher carbohydrate diets because these diets increase insulin secretion more than any other diet. When insulin levels are high, fat storage will increase significantly and “starve” muscles and organs of energy.   This causes increased hunger and overeating that results in obesity.


Often caused by lymph node removal or damage due to cancer treatment, lymphedema occurs because there’s a blockage in the lymphatic system and results in the swelling in leg or arm. A 2017 study involved patients who suffered from obesity and lymphedema and who embarked on a 18-week ketogenic diet. Weight and limb volume was significantly reduced. (5)
Gottfried recommends the keto diet (as it’s commonly called) to help with a range of brain and focus issues—she finds ketones to be “very efficient fuel for the brain”; she also says it works well for some patients (not all) who want to lose weight but have trouble kicking sugar cravings. We talked to her about who the keto diet is right for (and whom, or when, it isn’t); the nutritional ins and outs of mastering it; and which keto-friendly meals are healthy for practically everyone, regardless of what diet we do (or don’t) practice.
Hi Martina thanks for sharing. I've been in keto for a good 2 years now. From 138lbs my weight is now at 118-120lbs and I am 5'4 ft 38 years old. I never felt better in my life since i decided to do keto. I really like that i can enjoy eating "Lechon" without the guilt. On the weekends i could do Cheatdays by drinking beer. Ketodiet is still new here in the Philippines, and alot of my friends are very skeptical about the diet. I will be sharing your blog and your story and hope that i could shed some enlightenment to my peers.
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.
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.
Wondering what fits into a keto diet — and what doesn’t? “It’s so important to know what foods you’ll be eating before you start, and how to incorporate more fats into your diet,” says Kristen Mancinelli, RD, author of The Ketogenic Diet: A Scientifically Proven Approach to Fast, Healthy Weight Loss, who is based in New York City. We asked her for some guidelines.
Carbohydrate has been wrongly accused of being a uniquely "fattening" macronutrient, misleading many dieters into compromising the nutritiousness of their diet by eliminating carbohydrate-rich food.[26] Low-carbohydrate diet proponents emphasize research saying that low-carbohydrate diets can initially cause slightly greater weight loss than a balanced diet, but any such advantage does not persist.[26][6] In the long-term successful weight maintenance is determined by calorie intake, and not by macronutrient ratios.[7][6]
By discriminating the components of the FFM as determined by DXA, it was observed that these variations were mainly due to changes in lean mass, whereas bone mineral content remained unchanged from baseline (0.003 ± 0.066 kg at visit C-2; −0.018 ± 0.066 kg at visit C-3; and −0.028 ± 0.066 kg at visit C-4; P > 0.05). Given that DXA technique is unable to discriminate the composition of lean mass, the question was raised as to whether the observed reductions in lean mass were at the expense of muscle mass or body water content. Therefore, further analysis was performed by MF-BIA , which is able to discriminate these 2 variables. Remarkably, the measurements performed by MF-BIA showed that the initial loss of FFM at visit C-2 (−3.1 ± 1.5 kg) was mostly due to total body water loss (−2.3 ± 1.1 kg), both intra- (−1.5 ± 0.7 kg) and extracellular [−0.8 ± 0.5 kg; Fig. 3(B)], probably because of the intense diuresis that occurs in the first phase of any VLCK diet. In subsequent visits, a slight recovery of intra- and extracellular water was observed, similar to the recovery observed with total FFM. This means that reductions attributable to muscle mass were, depending on the method used, around 1 kg throughout the 4-month study; only 5% of the total 20.2 kg of weight lost was FFM.
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.
Great point – the literature shows that ketogenic macro splits are very protein sparing for weight loss and the body will typically burn fat and glucose and spare lean mass. Dr. Jason Fung makes the analogy that it would be like stacking firewood for the winter and then when winter hits, deciding not to use the firewood and instead use the living room couch!
^ Schwingshackl L, Chaimani A, Schwedhelm C, Toledo E, Pünsch M, Hoffmann G, et al. (2018). "Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis". Crit Rev Food Sci Nutr (Systematic Review): 1–14. doi:10.1080/10408398.2018.1463967. PMID 29718689.
Great information and questions! I finish eating before 6 and don’t have anything until noon or sometimes later, the next day! I do drink water and plain herbal tea. I take Omega 3’s, 2 Tbsps. of cold pressed virgin olive oil with lemon in water, in the morning! Around noon I have my BP coffee with butter and coconut cream. Primarily eggs, avocado, chicken, stir fry’s, nuts (mostly almonds), etc.
Dinner: In a small sauce pan bring 2-3 cups of water to the boil. Cook a large egg in rolling boil for 5 minutes, then transfer to ice bath (a bowl with cold water and ice cubes in it). Wash and spin dry butter lettuce, top with sliced avocado and hemp seed. Serve soft boiled egg with cherry tomatoes, butter lettuce salad and mayonnaise as dressing.
My uric acid is way high at 7.6 with last test at 3.5 and this is obviously a big deal. I am putting strong efforts into fixing this and the bubbles in my urine likely uric acid although previous testing of 24 hour urine showed protein in the urine. No doctor will see my as a kidney patient. I am back to juicing and going low protein since I sense I have kidney issues with kidney pains and too much urination. Maybe it is all just the mold?
Hey Donna, yes frozen veggies are totally fine! And my best advice would be to just jump right back into it and not dwell on the past! I would recommend tracking your carbs and making sure they are low enough to get back into keto, maybe try some intermittent fasting as well. It will take a few days to get back on track but just stick with it and focus on your goals!
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.

Make things yourself. While it’s extremely convenient to buy most things pre-made or pre-cooked, it always adds to the price per pound on items. Try prepping veggies ahead of time instead of buying pre-cut ones. Try making your stew meat from a chuck roast. Or, simply try to make your mayo and salad dressings at home. The simplest of things can work to cut down on your overall grocery shopping.
A keto diet works for almost anyone since you can be vegan or vegetarian and still achieve ketogenesis. As a rule of thumb, focus on foods that are naturally high in fat and avoid highly processed foods that are labeled with trans-fats as much as possible. Eat fruits that are low on the glycemic index but are still rich in fiber and, eat other foods like avocados (also for the fat) and berries. Additionally, eat lots of green, yellow and red vegetables.
The opposing viewpoint maintains that calories still count, but the type of food consumed has a trickle-down effect on the amount of energy expended, and what foods the body craves. It takes way more energy to process and store protein than it does carbohydrate or fat–this is called the thermic effect of food. Essentially, one burns more energy digesting protein because it requires more energy for the body to process. In one study, twice as much energy was expended after meals on a high-protein diet versus a high carbohydrate, low-fat diet.1
What a great post. I thought i would add about the selection of food you eat on keto and that everyone is different. Some food gives you energy and some doesnt, this varies person to person. I started and quit keto 3 times before i managed to find my balance. The first few times it made be poorly, from the shock of diet change. However, you can wean yourself into the diet which i did the last time when i had the most success.
In a fantastic online review of the study, Dr. Stephan Guyenet, a nutritional research expert, notes the study's thoroughness and that the results, at face value, support the researchers’ initial hypothesis that a ketogenic diet promoted greater fat loss. Compared with the higher carbohydrate diet, the keto diet coincided with increased energy expenditure, meaning the subjects appeared to burn more calories when their carbohydrate levels were cut, thought they were consuming the same amount of calories as they were on the high carbohydrate diet.
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.

After increasing water intake and replacing electrolytes, it should relieve most all symptoms of Keto Flu. For an average person that is starting a ketogenic diet, eating 20-30g of net carbs a day, the entire adaptation process will take about 4-5 days. My advice is to cut your carbs to fewer than 15g to ensure that you are well on your way into ketosis within one week. If you are experiencing any more keto flu symptoms, double check your electrolyte intake and adjust.
“I see many patients whose wellbeing is affected by shortness of breath and sleep disorders. By adopting a low-carb, healthy fat lifestyle, many of these people feel better, avoid unnecessary medications and achieve great overall health. My family and I live this way and I love to inspire others to gain the same benefits. The Diet Doctor website is a great resource to help people adopt a LCHF lifestyle.”

After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]

If this all sounds like way too much work, consider intermittent fasting. It is a simpler way to achieve cyclic ketosis and has many of the same benefits. Anecdotally, it has worked better for me for weight loss than nutritional ketosis, and has many of the same health benefits. I prefer a 16/8 or 18/6 protocol, where you confine your eating (with no change in calories) to a 6- to 8-hour window, then fast overnight. For instance, I finish eating by 6 p.m., then eat again at noon the next day. For weight loss, I recommend following this protocol two to seven days per week. [Stay tuned for more on goop.]
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.

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).
I have been on Keto for 5 days no. I eat about twice a day. I am not having issues with fasting and I love veggies, but since I’ve been on this diet, I feel nauseated at the thought of veggies and mushrooms. Especially spinach, pak choi and broccoli. These are veggies I adore so I am concerned. How long will this nauseating feeling last? I really worry. I also take supplements: oregano tablets, bio curcurmin, probiotics, L-lysine and zinc. Please please advise.
A lot of people on the keto diet tend to go absolutely overboard with the unhealthy food that they pack into their plan. Sure a bunch of cheese, mayonnaise and bacon will fit into a seventy-five percent fat allowance, however, for your health these foods are not always the best option. Your day to day seventy-five percent fat allowance is meant to be used for healthy sources of fat such as such avocados, coconut oil, whole eggs, nuts and fats found in unprocessed meats such as beef, salmon, chicken thighs, ground pork or turkey.
Hello, following a Keto diet with IF but cholesterol ratios not proper. Diet fats come mainly from olive oil, avocado oil, once a week beef, no butter, bacon etc. Had to go back on statins. Goal is stay away from drugs. Is there a doctor/clinic in the Boston area that you can recommend that understands/tests what you explain in this article? Please advise.
1. Reduce carbs. How much? The short answer is to eat 20 to 25 grams each day for weight loss, and 25 to 30 for weight maintenance. (You must use a nutrition calculator for macronutrients to get it right because thinking in terms of grams is not intuitive, and nutritional ketosis is less likely to be successful if you try to “eyeball” the amounts.) The long answer is: it depends. I encourage people to limit carbs until they are in ketosis, as confirmed with a blood ketone meter (see below), and then try increasing the amount of carbs by 5 grams to see if they stay in ketosis.
Bonnie J. Brehm, Randy J. Seeley, Stephen R. Daniels, and David A. D’Alessio, “A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” The Journal of Clinical Endocrinology & Metabolism: Vol 88, No 4; January 14, 2009. http://press.endocrine.org/doi/full/10.1210/jc.2002-021480.

“Net carbs” and “impact carbs” are familiar phrases in ketogenic diets as well as diabetic diets. They are unregulated interchangeable terms invented by food manufacturers as a marketing strategy, appearing on some food labels to claim that the product contains less “usable” carbohydrate than is listed. [6] Net carbs or impact carbs are the amount of carbohydrate that are directly absorbed by the body and contribute calories. They are calculated by subtracting the amount of indigestible carbohydrates from the total carbohydrate amount. Indigestible (unabsorbed) carbohydrates include insoluble fibers from whole grains, fruits, and vegetables; and sugar alcohols, such as mannitol, sorbitol, and xylitol commonly used in sugar-free diabetic food products. However, these calculations are not an exact or reliable science because the effect of sugar alcohols on absorption and blood sugar can vary. Some sugar alcohols may still contribute calories and raise blood sugar. The total calorie level also does not change despite the amount of net carbs, which is an important factor with weight loss. There is debate even within the ketogenic diet community about the value of using net carbs.


Some patients constantly graze on "legal" keto foods that can stall fat loss. Intermittent fasting is the answer here: You naturally reduce your caloric intake and give your gut a break. By not eating, you're allowing inflammation to quiet down in your body, which helps with blood sugar balance and weight loss. As an example, some plans combine daily fasting with a ketogenic diet. Have a big dinner, close up the kitchen, and push breakfast as far back the next morning as you can. I talk more about this type of keto diet, which I call a Cyclitarian plan, here.
On a ketogenic diet, you’re generally eating a diet that’s high in fat (roughly 70 percent of your total calories come from fat), moderate in protein (about 20 percent of your calories), and low in carbohydrate (about 5 percent of calories). By limiting carbohydrates (to usually less than 45 grams for the average person), your body lacks the glucose (from carbs) that it normally uses for energy, so it eventually switches over to burning fat as its primary fuel source instead; through a metabolic process called ketosis, the liver converts the fat into fragments of fatty acids called ketones, which power the brain and other organs and tissues.
The remaining calories in the keto diet come from protein — about 1 gram (g) per kilogram of body weight, so a 140-pound woman would need about 64 g of protein total. As for carbs: “Every body is different, but most people maintain ketosis with between 20 and 50 g of net carbs per day,” says Mattinson. Total carbohydrates minus fiber equals net carbs, she explains.
There are vegetables that are high in carbs and others low in carbs. The keto diet recommends sticking to the ones low on carbs but encourages you to eat a lot of them. Best vegetables are all green ones to make it easy. And vegetables that grow above the ground (e.g. lettuce) are always better than the ones that grow below the ground (e.g. potatoes)
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