The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.[3]
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
While CHO is almost universally regarded as necessary for both health and athletic performance, many studies have called into question the absolute necessity of dietary CHO. As early as 1930 there was evidence demonstrating the efficacy of long-term CHO restriction (14). In an audacious attempt to demonstrate proof-of-concept, arctic explorers Dr. Viljalmur Stefansson and K. Anderson, agreed to participate in a study that involved one year of eating a diet that consisted solely of “meat.” The diet, which consisted of beef, pork, lamb, and chicken, also included significant portions of animal fat, as well as organ meat. This dietary regimen yielded a macronutrient distribution of approximately 81% fat, 18% protein and 1% CHO, over the course of 375 days. The subjects experienced a modest reduction in weight, which occurred during the first week; there were no restrictions on food portions, subjects ate to satisfy appetite. Interestingly, the researchers noted no vitamin deficiencies, no significant change in mental alertness or physical impairment, or any other deficit attributed to eating a high fat, all-meat diet.
“The cleaner, the better when it comes to the keto diet,” says Jadin. Focus on “whole” and “unprocessed.” Also, strive for a mix of saturated and unsaturated fats for balance. Note: Tipping the scale toward too much protein is a common pitfall many people make on the keto diet. Mind your protein intake, since too much can kick you out of ketosis, says Jadin.
The following measurements were made every other week: anthropometric and vital sign measurements; urine testing for ketones; and assessment for hypoglycemic episodes and other symptomatic side effects. Weight was measured on a standardized digital scale while the participant was wearing light clothes and shoes were removed. Skinfold thickness was measured at 4 sites – the average of 2 measurements at each site was entered into an equation to calculate percent body fat [12]. Waist circumference was measured at the midpoint between the inferior rib and the iliac crest using an inelastic tape; 2 measurements were averaged in the analysis. Blood pressure and heart rate were measured after the participant had been seated quietly without talking for 3 minutes. Certified laboratory technicians assessed urine ketones from a fresh specimen using the following semi-quantitative scale: none, trace (up to 0.9 mmol/L [5 mg/dL]), small (0.9–6.9 mmol/L [5–40 mg/dL]), moderate (6.9–13.8 mmol/L [40–80 mg/dL]), large80 (13.8–27.5 mmol/L [80–160 mg/dL]), large160 (>27.5 mmol/L [160 mg/dL]). Hypoglycemic episodes and symptomatic side effects were assessed by direct questioning of the participant and by self-administered questionnaires.

First, don’t mistake a ketogenic diet (or the upgraded Bulletproof Diet) for the Atkins Diet. Whereas the Atkins Diet is extremely high in protein, a keto diet contains moderate amounts of protein. On a keto diet, large amounts of protein can turn into glucose in a process called gluconeogenesis, thus taking you out of ketosis. That’s why fatty cuts of meat are better than, say, chicken breast, which is high in protein and low in fat. Vast amounts of protein also tax the liver and lead to inflammation. By contrast, a ketogenic diet is anti-inflammatory; burning fat for fuel creates far less inflammation than burning sugar does[2], and ketones themselves turn off inflammatory pathways[3]. Because of this, ketogenic diets may in fact help prevent chronic diseases that are caused by inflammation. (Fun fact: The ketogenic diet is used to keep epileptic patients from having seizures.)
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]
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)].
“I discovered the low-carb, ketogenic diet some four years ago and saw huge improvements in my own health. After establishing that it is based on sound scientific principles I felt compelled to offer it to my patients. We recommend the Diet Doctor website as it offers an unbiased, contemporary source of reliable low-carb ketogenic advice. It is easy to use and you can rely on its integrity.” 

If you’re a newbie planning your weekly keto diet menu, make the meals as easy as possible. A keto breakfast, for example, can take advantage of many classic breakfast foods, including eggs, bacon, sausage, and ham. Eggs are real winners in the keto world. They’re extremely versatile, easy to cook, and have just half a gram of carbs but 6 g of protein and 5 g of fat.
You can receive the FULL benefit of the 3-Week Ketogenic Diet without adding any exercise during the 3-weeks you'll be following the plan. If you choose to incorporate at least an hour of metabolic exercise during the week using my personal-trainer guided exercise videos, you'll see up to THREE times the results. Exercise contributes to hormonal balance, blood sugar stability, and lean muscle growth.

Protein: When people first reduce carbohydrates in their diets, it doesn't seem as though the amount of protein they eat is as important to ketosis as it often becomes later on. For example, people on the Atkins diet often eat fairly large amounts of protein in the early stages and remain in ketosis. However, over time, some (perhaps most) people need to be more careful about the amount of protein they eat as (anecdotally) the bodies of many people seem to "get better" at converting protein into glucose (gluconeogenesis). At that point, each individual needs to experiment to see if too much protein is throwing them out of ketosis and adjust as necessary.
It seems strange that a diet that calls for more fat can raise “good” cholesterol and lower “bad” cholesterol, but ketogenic diets are linked to just that. It may be because the lower levels of insulin that result from these diets can stop your body from making more cholesterol. That means you’re less likely to have high blood pressure, hardened arteries, heart failure, and other heart conditions. It's unclear, however; how long these effects last.
At 469 pounds I restricted myself to a daily calorie intake between 1k-1.5k a day. Often I would even go down to 800 (not advocating this!). Well, i'm still alive today, down a ton of weight and I restrict myself to about 1.5-2k per day now. As others said, calorie restriction is required to lose, but generally speaking I just go by how I feel. If im full of energy, feeling great and not hitting my calories it's not really a big deal to me.
Nurse practitioners (NP) are advanced practice registered nurses that manage acute and chronic medical conditions, both physical and mental, through history and physical exam and the ordering of diagnostic tests and medical treatments. NPs are qualified to diagnose medical problems, order treatments, perform advanced procedures, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions within their scope of practice. Their education includes a Bachelor of Science in Nursing (BSN) or other undergraduate degree, and requires a license as a registered nurse (RN) and experience as an RN in a health care setting. They must graduate from an accredited graduate (MSN) or doctoral (DNP) program and achieve a board certification.
Some negative side effects of a long-term ketogenic diet have been suggested, including increased risk of kidney stones and osteoporosis, and increased blood levels of uric acid (a risk factor for gout). Possible nutrient deficiencies may arise if a variety of recommended foods on the ketogenic diet are not included. It is important to not solely focus on eating high-fat foods, but to include a daily variety of the allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals (iron, magnesium, zinc)—nutrients typically found in foods like whole grains that are restricted from the diet. Because whole food groups are excluded, assistance from a registered dietitian may be beneficial in creating a ketogenic diet that minimizes nutrient deficiencies.
Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[56]

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]
It was recently reported that the consumption of diets with low percentages of carbohydrates over a long period of time (>25 years) are associated with higher mortality [63]. This association was mitigated when the substitutions were plant-based [63]. In the current study, patients were exposed to a low carbohydrate intake during less than 90 days and the source of carbohydrate was from vegetables. Moreover, the strong weight loss induced a decrease in the burden of obesity-related disease [6]. Thus, the strength of the current study is reinforced with the consistence of the results with that of previous research, regardless of the strong dietary energy restrictions induced by a VLCK diet.
The nutritional intervention was based on a commercial weight-loss program (PNK method®), as was described elsewhere [4]. Briefly, the intervention included an evaluation by the specialist physician conducting the study, an assessment by an expert dietician, and exercise recommendations. This method is based on high-biological-value protein preparations obtained from cow’s milk, soy, avian eggs, green peas, and cereals. Each protein preparation contained 15 g protein, 4 g carbohydrates, 3 g fat, and 50 mg docohexaenoic acid and provided 90–100 kcal.
“When I treat cancer patients in my clinic, I need a diet program for them. After researching it, I found the ketogenic diet is the best way to reduce inflammation and suppress the cancer’s growth so I have applied the diet to my patients. It’s the most effective diet not only for cancer patients, but also for diabetes and obesity treatments. I recommended Diet Doctor website to my patients because it is easy to understand the theory and application of the ketogenic diet.”
But what does the science say? Results are mixed. In one Spanish study of 20 obese adults, participants were put on a low-calorie keto diet and lost an average of 40 pounds over four months. Another small experiment had a similar outcome. In a six-month Experimental & Clinical Cardiology study of 83 obese adults, those on the keto diet lost an average of 33 pounds, while lowering their bad (LDL) cholesterol levels and increasing their good (HDL) cholesterol.
“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.”
MCT oil powder is a unique form of dietary fat rapidly absorbed by the body and has a wide range of health benefits. Supplementation with MCT powder can help combat fatigue, suppress appetite[*], enhance thermogenesis (aka ‘fat burning’)[*] and help your body adapt to using ketones for fuel. A recent scientific review showed that MCTs can effectively decrease body weight, total body fat, hip circumference, waist circumference, total subcutaneous fat and visceral fat[*]. Check out this articlefor more information on how to supplement with MCTs.
Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD, MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP; Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD, DrPH, “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat,” Arch Intern Med. 2004;164(19):2141-2146. http://archinte.jamanetwork.com/article.aspx?articleid=217514.
A CKD offers a way to combat this. It offers a cyclical "refeed" (sometimes also called a carb-up). During this phase, the diet consists mostly of complex carbohydrates, with limited fat, sucrose and fructose. Since the glycogen stores in the liver and muscles are depleted, these carbohydrates go straight to refilling them instead of being added to the body's fat stores. For this reason, the amount of calories consumed during a refeed can be far above an individual's usual dietary intake. While a typical CKD consists of 50g or less of carbohydrate per day, the typical refeed consists of 450-600g of carbohydrate. A weight gain of 1-2 lbs is usually reported during refeeding; this is mainly water and normally lost in 2–4 days.
The findings below have been limited to research specific to the ketogenic diet: the studies listed contain about 70-80% fat, 10-20% protein, and 5-10% carbohydrate. Diets otherwise termed “low carbohydrate” may not include these specific ratios, allowing higher amounts of protein or carbohydrate. Therefore only diets that specified the terms “ketogenic” or “keto,” or followed the macronutrient ratios listed above were included in this list below. In addition, though extensive research exists on the use of the ketogenic diet for other medical conditions, only studies that examined ketogenic diets specific to obesity or overweight were included in this list. (This paragraph was added to provide additional clarity on 5.7.18.)

Dear Martina, I wasn’t sure how to contact you. I am a final year undergraduate Human Nutrition student. I was also a keto diet follower and your app and blogs were a great help. For my final year project I‘ve chosen to study the present awareness of the ketogenic diet. I would like to ask if you would be interested to present my questionnaire to your followers. I will of course send you the questionnaire personally first for your approval. Please let me know if you are interested. Thank you for your hard work. You are a great help for many of us.
“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.”

Animal proteins (meat, fish, etc.) have very little, if any, carbs. You can consume them in moderate amounts as needed to control hunger. Overall, choose fattier cuts of meat rather than leaner ones. For example, chicken thighs and legs are preferable to chicken breasts because they contain much more fat. We’ve got quick keto diet chicken recipes to help.

A ketogenic diet helps control blood sugar levels. It is excellent for managing type 2 diabetes, sometimes even leading to complete reversal of the disease. This has been proven in studies. It makes perfect sense since keto lowers blood-sugar levels, reduces the need of medications and reduces the potentially negative impact of high insulin levels.
10 pound weight loss , chicken broth works to relieve . But have to be careful of salt intake . I retain fluid, Dr gave script for dieuretic before I even started Keto . I have had the retention problem for a long time , when I took the dieuretic on a normal high carb diet ( I would drop 4 lbs ) but would make me really tired , afraid if I take it now on Keto I will pass out. Any idea what I should try other than the chicken broth
There is evidence that the quality, rather than the quantity, of carbohydrate in a diet is important for health, and that high-fiber slow-digesting carbohydrate-rich foods are healthful while highly-refined and sugary foods are less so.[4] People choosing diet for health conditions should have their diet tailored to their individual requirements.[19] For people with metabolic conditions, in general a diet with approximately 40-50% high-quality carbohydrate is compatible with what is scientifically established to be a healthy diet.[19]
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[35] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[36] However, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.[9] Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[37]
Experts are split on whether the keto diet is a good idea. On the one hand, Lori Chang, registered dietitian and a supervisor at the Center for Healthy Living at Kaiser Permanente West Los Angeles, says using a “cleaner” source of energy—ketones rather than quick-burning carbohydrates—can improve mood and energy levels. When you eat refined carbohydrates or just too many carbs in general, the blood is flooded with excess insulin, Chang says. "This can lead to a blood sugar rollercoaster that stresses the body and negatively impacts energy levels and mood. When you’re in a state of ketosis, however, ketone bodies don’t require insulin to cross the blood-brain barrier, which wards off unfavorable blood sugar levels."
Depending on how you choose your fats, the keto diet can contain an abundance of saturated fat, which raises levels of dangerous LDL cholesterol and causes atherosclerosis, the buildup of fats and cholesterol in the arteries. If you decide to go keto, have a doctor monitor your cholesterol levels monthly to ensure you remain within a healthy range.

To figure out how many fat grams specifically you want, you would take the total number of calories it takes to maintain your body weight (normally around 14-16 calories per pound of body weight). Subtract your protein calories from that number and then divide by 9 (number of calories per gram of fat). This should give you how many total fat grams you need to eat per day.
Yes, you'll lose weight but only because you're consuming fewer calories. There's no real magic to the keto diet. The weight-loss equation remains the same: You lose weight when you consume fewer calories than you use each day. You're not burning more fat than other diets, or at a faster rate. On the keto diet, you eat high-fat meals with protein, which keeps you feeling full for longer and cuts down on your overall eating throughout the day.
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.
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 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.
After reading the FAQ (which is really great, btw), one of the things I'm wondering about is whether the low calorie approach works well in conjunction with Keto. I like the general idea, but with my weight, I'm thinking I would like to try to keep my overall calorie intake low, in addition to cutting carbs, refined sugars, etc. out of my diet. It doesn't seem to be expressly forbidden, but it doesn't seem to be what many people do, based on what i've read so far. Basically, I think in addition to this approach to nutrition, I'd also like to keep my calorie deficient high. I think both would go a long way towards helping me be healthier.
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.

Muscular strength was measured with a Jamar handgrip dynamometer (Lafayette Instruments, Lafayette, IN). After a brief demonstration and verbal instructions, the test was performed in the standing position with the wrist in the neutral position and the elbow flexed to 90 degrees. Patients were given verbal encouragement to squeeze as hard as possible and to apply maximal effort for at least 3 seconds. Two trials were allowed in the dominant limb, and the highest score was recorded as peak grip strength (kg). Considering possible influences on the muscular strength of changes in body composition, handgrip strength (HG) was divided by appendicular lean mass (ALM) determined by DXA (HG/ALM) and by appendicular soft lean mass (ASLM) determined by MF-BIA (HG/ASLM).
–As with most of our recipes, you can alter them to fit your tastes. Don’t like cheddar? Use mozzarella, or feta, or even brie! Feel free to use turkey bacon, salami or perhaps even mushrooms for a vegetarian spin. These Bacon Egg & Cheese Cups are so versatile!And, since we know people are going to ask – yes, you can make 1 giant Bacon, Egg & Cheese Cup in the form of a pie! Just lay that bacon along the bottom of your pan, prebake it a bit in the oven and assemble one giant cup! Use a pie pan, cheesecake pan or small casserole dish (note: depending on your bakeware, you may need to double the ingredients)!Tasteaholics
Hi Stacey, I can’t give medical advice and definitely recommend following your doctor’s recommendations. You can ask him/her if low carb would be better suited for you. Also, you may want to double check with him/her if the kidney concern was related to high protein, because that is a common misconception about keto – it is not a high protein diet/lifestyle.
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]
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