While you’re focusing on fat, protein, and carbs, you should also make sure you’re getting adequate fiber. “People often assume that they should only eat things like meat and butter on the ketogenic diet,” says Farshad Fani Marvasti, MD, an associate professor and director of Public Health, Prevention, and Health Promotion at the University of Arizona College of Medicine in Phoenix. “You should make sure you are eating enough vegetables because you need the fiber.”
From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A1c.
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.
1. Aragon AA, Schoenfeld BJ, Wildman R, Kleiner S, VanDusseldorp T, Taylor L, Earnest CP, Arciero PJ, Wilborn C, Kalman DS, Stout JR, Willoughby DS, Campbell B, Arent SM, Bannock L, Smith-Ryan AE, and Antonio J. International Society of Sports Nutritionists Position Stand: Diets and body composition. Journal of the International Society of Sports Nutrition 14:16, 2017.

The keto diet is a high-fat and low-carb (HFLC) diet. I would actually describe it as extremely low-carb—you're allowed to eat just 20 grams in a day. Some people on keto follow a net-carb plan (you can subtract the grams of fiber from a food's total carbs) and you're allowed to eat more carbs in a day. For my 30-day diet and for the sake of simplicity, I stuck with total carbs.


“As a pediatrician practicing for the past 24 years, I spend most of my clinical time caring for children with chronic behavioral, developmental, psychological or metabolic conditions (ADHD, depression, anxiety, OCD, Tourette’s Syndrome, autism, autoimmune disease, obesity, NAFLD, etc.). A well-planned, low-carbohydrate (and in many cases ketogenic) nutrition plan is a very powerful tool that I use with my patients to address both physical and mental health. I so appreciate Diet Doctor and reference it frequently for my patients as the best resource for this topic. This site is commercial free, well-supported, referenced and frequently updated.”
“At the Duke Diet and Fitness Center, our residential clients can choose from three levels of carb intake that happen to be aligned with the Diet Doctor’s levels of liberal low-carb, moderate low-carb and keto low-carb. The alignment is not by chance, however. It’s because we have separately come to the same conclusions after carefully and objectively reviewing the evidence and gathering information from experienced clinicians and patients. The Diet Doctor website is very unique in that regard, and a great resource for our patients!”
Diego Gomez-Arbelaez, Diego Bellido, Ana I. Castro, Lucia Ordoñez-Mayan, Jose Carreira, Cristobal Galban, Miguel A. Martinez-Olmos, Ana B. Crujeiras, Ignacio Sajoux, Felipe F. Casanueva, Body Composition Changes After Very-Low-Calorie Ketogenic Diet in Obesity Evaluated by 3 Standardized Methods, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 2, 1 February 2017, Pages 488–498, https://doi.org/10.1210/jc.2016-2385
Melinda – I’m afraid there’s no getting around the fact that one of the Keto requirements is to *calculate your macros,* based on the amount of calories you need to consume each day, in order to (a) maintain your current weight level, or (b) lose weight. Go to an online Keto macro calculator – there’s one linked to a good one on this site, further up the thread. They are generally very easy to use. Then stick to your calculated results, with trust and patience. It may be slow, but you will absolutely see results. I did – and I’ve tried absolutely everything. I barely have time to exercise, but I still lost at least a couple of dress sizes, and I feel absolutely amazing – no more brain fog, tons of energy – maybe too much energy! And best of all, I’m no longer miserable about food, because on Keto, everything is delicious! One final thing in the interest of full disclosure – I am an uber-clean-Keto advocate. I put in the work to eat only healthy fats and carbs from healthy sources. I’m pescatarian – no meats except seafood. I also carefully limit my saturated fat intake to 10% of total calories (the recommended daily allowance), to keep my genetically problematic cholesterol level from skyrocketing, as it did when I first began. This is all working well for me so far – I was able to cut 40 points from my abnormally high LDL (bad cholesterol) level within three months, And hope to get it down to normal levels in three more months. You do want to make sure you get your regular physical exams and monitor your blood work whenever you change your nutritional lifestyle. I wish you the best!
In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week.

“As a physician, I see daily the tremendous impact that our pandemic of chronic nutritional disease is having on people and the health care system, despite our best conventional efforts over the last 40 years. I now focus my time and energy on counseling, supporting and guiding patients on the power of real food as medicine. Using the core principles of low-carb, high-fat eating and intermittent fasting, we see great improvements in diabetes, obesity, metabolic syndrome, polycystic ovary syndrome, NAFLD and many more chronic diseases. Diet Doctor is a great resource for my patients to help them in their journey.”
As your body breaks through the carb cycle and enters ketosis (where you rely on ketones, instead of carbs, for energy), you may experience fatigue, mental fogginess, even irritability. My "keto flu" only lasted a day, and once I passed it, I never experienced the symptoms again. I even ate a cookie one day during the diet to celebrate my birthday. I certainly came out of ketosis when I ate that treat, but I didn't experience any repercussions for it. 

Hi Courtney, I’m currently working on a 21-Day Keto Meal Plan. Unfortunately, it’s super time-consuming. And after buying a keto cookbook yesterday and returning it the same day because it wasn’t well researched and the recipes clearly not created specifically for the Keto diet you wouldn’t want me to rush this. I want to make sure the Meal Plan is SPOT on and the recipes complement each other and make eating Keto easy. Give me another month or two and I’ll hopefully have more news on progress. Currently working on a rough sketch but still have to test all recipes and photograph them, too. You definitely don’t need nuts to be able to eat Keto. For now, I recommend to keep it as simple as possible. You can eat my 1-day meal plan 4 days a week and find other recipes you like to build another similar day and then keep switching between mine and the other.
^ Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, saccharin and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1).[17] The eggnog may also be cooked to make a custard, or frozen to make ice cream.[37]

Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.
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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