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.
Ketone bodies synthesized in the body can be easily utilized for energy production by heart, muscle tissue, and the kidneys. Ketone bodies also can cross the blood-brain barrier to provide an alternative source of energy to the brain. RBCs and the liver do not utilize ketones due to lack of mitochondria and enzyme diaphorase respectively. Ketone body production depends on several factors such as resting basal metabolic rate (BMR), body mass index (BMI), and body fat percentage. Ketone bodies produce more adenosine triphosphate in comparison to glucose, sometimes aptly called a "super fuel." One hundred grams of acetoacetate generates 9400 grams of ATP, and 100 g of beta-hydroxybutyrate yields 10,500 grams of ATP; whereas, 100 grams of glucose produces only 8,700 grams of ATP. This allows the body to maintain efficient fuel production even during a caloric deficit. Ketone bodies also decrease free radical damage and enhance antioxidant capacity.
Carbohydrate-restricted diets are no more effective than a conventional healthy diet in preventing the onset of type 2 diabetes, but for people with type 2 diabetes they are a viable option for losing weight or helping with glycemic control.[11][12][13] There is little evidence that low-carbohydrate dieting is helpful in managing type 1 diabetes.[1] The American Diabetes Association recommends that people with diabetes should adopt a generally healthy diet, rather than a diet focused on carbohydrate or other macronutrients.[13]
“I've always been the big girl. That was my thing. I was the big girl. Turns out, being the big girl means excessive sweating and heart problems. Things needed to change. I tried it the old fashioned way, but nothing really helped. I saw something about in a magazine, so I started doing research. I talked to my doctor, he suggested I try . And honestly, it's been a life changer. I'm down over a hundred pounds and still losing! ” - Stella Bitters

In relation to overall caloric intake, carbohydrates comprise around 55% of the typical American diet, ranging from 200 to 350 g/day. The vast potential of refined carbohydrates to cause harmful effects were relatively neglected until recently. A greater intake of sugar-laden food is associated with a 44% increased prevalence of metabolic syndrome and obesity and a 26% increase in the risk of developing diabetes mellitus. In a 2012 study of all cardiometabolic deaths (heart disease, stroke, and type 2 diabetes) in the United States, an estimated 45.4% were associated with suboptimal intakes of 10 dietary factors. The largest estimated mortality was associated with high sodium intake (9.5%), followed by low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%), low intake of omega-3 fats (7.8%), low intake of vegetables 7.6%), low intake of fruits (7.5%), and high intake of artificially sweetened beverages (7.4%). The lowest estimated mortality was associated with low polyunsaturated fats (2.3%) and unprocessed red meats (0.4%). In addition to this direct harm, excess consumption of low-quality carbohydrates may displace and leave no room in the diet for healthier foods like nuts, unprocessed grains,  fruits, and vegetables.

The data are presented as mean (standard deviation). All statistical analyses were carried out using Stata statistical software, version 12.0 (Stata, College Station, TX). A P < 0.05 was considered statistically significant. Changes in the different variables of interest from baseline and throughout the study visits were analyzed following a repeated measures design. A repeated measures analysis of variance test was used to evaluate differences between different measurement times, followed by post hoc analysis with Tukey’s adjustment for multiple comparisons. In addition, linear regression analyses were used to evaluate the accuracy of MF-BIA and ADP in comparison with DXA, because DXA is considered the reference technique in the estimation of body composition in clinical research (26). Finally, the Bland-Altman approach was also used to assess the accuracy of MF-BIA and ADP against DXA in the estimation of FM%.
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)].
The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.
^ Another publication of similar regimen was Hill LW, Eckman RS (1915). The Starvation Treatment of Diabetes with a series of graduated diets as used at the Massachusetts General Hospital. Boston: W.M. Leonard. This was so well received that it went into revised editions, eventually becomingThe Allen (Starvation) Treatment of Diabetes with a series of graduated diets (4th ed.). Boston. 1921. p. 140.
“I follow and recommend a low-carb or keto lifestyle, with and without intermittent fasting, to all of my patients whether or not they have lifestyle-related chronic conditions. I do this because of the health benefits to anyone who follows them, but also because of the science behind them and the impressive clinical results I have seen in my patients. I have recommended the Diet Doctor website for the past 5-6 years as a first-stop to find completely trustworthy information, delicious recipes, great visuals and excellent videos.”

A: The most common ways to track your carbs is through MyFitnessPal and their mobile app. You cannot track net carbs on the app, although you can track your total carb intake and your total fiber intake. To get your net carbs, just subtract your total fiber intake from your total carb intake. I have written an article on How to Track Carbs on MyFitnessPal.
Hey David, You will definitely want to do everything you can to mitigate the mold issue. If you cannot remove it from your environment (or yourself from that environment) then you will want to use things like glutathione, liver support, activated charcoal, and daily detoxification strategies as much as possible. For the LDL testing, this is one of the best I know of https://drjockers.com/cardiopower-testing/
If you choose to make your sauces and gravies, you should consider investing in guar or xanthan gum. It’s a thickener that’s well known in modern cooking techniques and lends a hand to low carb by thickening otherwise watery sauces. Luckily there are many sauces to choose from that are high fat and low carb. If you’re in need of a sauce then consider making a beurre blanc, hollandaise or simply brown butter to top meats with.

It’s no secret that carbs—especially refined ones like sugary cereals, white bread and pasta, or sweet drinks—cause your blood sugar to spike and dip. So it makes sense that eating less of them can help keep things nice and even. For healthy people, this can translate to more steady energy, less brain fog, and fewer sugary cravings, Mancinelli explains.
The association between the physical and psychological changes in the measures of the study was estimated with bivariate Pearson’s correlation. Due to the strong dependence, the relevance of these coefficients was not based on a significance test (low samples sizes tended to report nonsignificant R-coefficients, which effect size could be considered high), effect size was considered poor for |R| > 0.10, medium for |R| > 0.24, and large for |R| > 0.37 (these thresholds correspond to Cohen’s-d of 0.20, 0.50 and 0.80, respectively) [34].
As ingested CHO is broken down by the stomach and absorbed through the small intestine, rising blood sugar creates a feedback loop which results in secretion of insulin. The primary role of insulin is to “dispose” of excess blood sugar by signaling tissues to “uptake” more glucose from the circulating supply. In this manner insulin serves a prominent role in glucose regulation. This concept also provides the basis for the glycemic index, a concept which attempts to quantify the impact CHO foods have on blood sugar response. For example, foods rich in simple CHO (i.e., “sugars”), which are absorbed quickly, trigger a rapid rise in blood sugar (and subsequently insulin response), whereas foods rich in complex CHO, such as fiber-rich legumes, exert a relatively blunted response on blood glucose.
One area where food tracking can be especially helpful, though, is ensuring that you're hitting the right ratios of macronutrients—protein, carbs, and fat. "The most researched version of the ketogenic diet derives 70 percent of calories from healthy fats, 20 percent from protein, and only 10 percent from carbs," explains Charles Passler, D.C., nutritionist, and founder of Pure Change. "In the ideal world, each keto meal and snack should have that same (70/20/10) ratio of macronutrients, but studies have shown that you'll still achieve great results even if each meal varies slightly from that ratio, just as long as you don't exceed 50 grams per day of carbs, or eat those carbs in one sitting," says Passler. In order to achieve these ratios without a preset meal plan from a dietitian or doctor, some food tracking is probably going to be necessary. But once you get the hang of things, you may not need it anymore.
Yeah so there definitely is a sweet spot for maintaining ketosis and the weight loss benfits(via body getting energy by burning fat for ketones and fatty acids as opposed to carbohydrates for glycogen.) yet still consuming enough carbs where you aren’t suffering from malnutrition or whatever it is that’s causing your fatigue every afternoon. Their are are couple ways to find and ride within this “golden” range. Possibly easiest is to take some coconut oil or similar high fat, high calorie, medium chain triglyceride supplement. This will likely ensure sufficient caloric intake and you can also eat more carbs while maintaing a sufficient fat:carb ratio to remain in ketosis. I hesitate to toss out a number but maybe 40-50g net carbs per day will be okay as long as your taking the supplement. Another way(the one I’d probably reccomend) is to slowly increase your carb intake 5g / day / week. As you do this continue to test ketone levels in the pee to determine at which amount of carbs per day you slip out of ketosis then just eat a little less carbs per day then that number. This is best because it requires no supplement, you’ll learn more about your body, and it will lower ketone levels which, although good for the brain in smaller amounts, in large amounts WILL cause ketoacidosis and raise the bloods Ph in which can cause kidney stones via bone demineralization along with a whole host of other complications including coma (likely one of the reasons you’ve been feeling crappy-too many ketones) third: eat the amount of carbs just above your ketosis inducing threshold level, you’ll still likely lose weight because even at carb levels just above ketosis range you’ll still experience less hunger sensations(a benefit of burning ketones and fatty acids for energy and not glycogen) and so eat less. I hope you find this helpful. *note: I am not a medical professional this information is the result of personal curiosity and independent reaearch.

Hi Sara, it depends on if your husband eats cold food or not. The lunch suggested here is great to take to work, the chicken can be enjoyed cold, or he can reheat it in a pan if his office has a small kitchen. If he doesn’t like cold chicken and he has no option to reheat you could change the lunch and dinner options suggested in this meal plan. He can eat the egg and salad for lunch. It’s a great lunch to enjoy cold and then the chicken and baby spinach for dinner instead. Great cold lunches that are keto friendly in general are always hard-boiled eggs with veggies, or turkey/cheese roll-ups and raw veggies, or salad greens with shredded chicken or shredded pork with homemade mayo on the side to then mix up at the moment as a salad dressing.


Collagen is a type of protein that has been shown to suppress appetite[*], provide fullness compared to other proteins like whey, casein, or soy[*], help retain muscle mass[*] and even help to reduce the appearance of cellulite due to it’s ability to improve skin elasticity and thickness[*]. Refer to this article for more information on the benefits of collagen and the best way to supplement it in your diet.
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.
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[58] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[56]
The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.
Except : I feel like [email protected]! Almost everyday... not all day but at some point mid afternoon onwards I start feeling discombobulated, uncomfortable, weak and a little anxious  ... electrolytes, more fat or calories i tweaked everything to no avail. it's a weird discomfort in my body and I'm wondering if it just doesn't enjoy ketosis. Last night I felt so bad like i was about to collapse I ate 4 spoons of plain white rice just to kick myself out of keto ( was still only 40gr of total carbs though ) and I felt significantly better and as per keto sticks I'm still dark pink.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]

The popular low-carb diets (such as Atkins or Paleo) modify a true keto diet. But they come with the same risks if you overdo it on fats and proteins and lay off the carbs. So why do people follow the diets? "They're everywhere, and people hear anecdotally that they work," McManus says. Theories about short-term low-carb diet success include lower appetite because fat burns slower than carbs. "But again, we don't know about the long term," she says. "And eating a restrictive diet, no matter what the plan, is difficult to sustain. Once you resume a normal diet, the weight will likely return."
The goal of the KD is to sufficiently deprive the body of CHO to achieve physiological or “nutritional ketosis,” a metabolic state which is characterized by blood ketone levels between 0.5 and 3.0 mmol/L (26). This “switch over” point, however, is not seamless and may take up to several weeks for individuals to become “keto adapted” (18). Supporting this idea is a significant amount evidence indicating that a “keto adapted” body has little reliance on glucose for CNS function (8,14,16) or as a source of energy for exercise (17,18,25,27).
More Sustained Energy: 90-120 minutes after you eat carbohydrates, your body doesn’t have readily available energy produced from the mitochondria in your cells, so you start “crashing” or lowering your energy. When you are in ketosis, your body can run off your body fat, which is an essentially limitless source of fuel. This prevents any type of crash.

My Husband and I started doing Keto July 2018. We got over weight after we got out of the Marine Corps. It has been hard to workout because I became disabled, but my diet was not good. After our friend Amber recommended your site and support group, we found a lot of helpful information to get us started on a successful journey. So far it’s been one month and we have lost 18 pounds each!

#TRANSFORMATION STORY PLEASE READ: I used to be severely overweight for a period of my life (probably considered obese). Some people have known me a long time and have seen my #progress, but some only know me now and don't know what I used to be. There are a few years of my life with zero to very few pictures of me because I hated the way I looked. After getting out of a toxic relationship (when I ate my feelings out of depression), I was able to lose a little bit on my own by focusing on #me and getting back into activities I loved (musical theater) and overall being happy again. But I was still overweight and sort of hit a plateau, so I gave up on trying because nothing seemed to be working. It wasn't until October of 2016 that I learned about the #ketogenic lifestyle and started that way of eating and was able to lose 10 pounds in 2 months, just from making better food choices. In January of 2017, I began a fitness regime, going to the #gym about 4-5 days a week doing a mix of weight lifting and cardio. My plan was to hit my #goal weight within one year. (To be honest, I didn't think I was going to do it, but told myself I'd be happy if I got close.) It's been one year since I did my first #workout on my own and I am so excited to say that I did it...I HIT MY GOAL WEIGHT!!! From June 2015 to now, I have lost about 76 pounds/7 dress sizes and I'm a happier, healthier, and stronger version of myself than I ever was before! It's not just about the number and how I look, but I've learned that I need to take care of my body from the inside out for #health reasons too. I now have more energy and I feel absolutely amazing. I finally feel like the version of myself that I always envisioned in my head. This has been a long and hard #journey and there were many times I thought I might give up. I'm sharing these pictures not out of vanity, but because I'm just so #happy that I did it and I want people to know that you can do whatever you set your mind to!! 💪🏼💪🏼💪🏼 #follow
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.
Early studies reported high success rates; in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).[19]
“I encourage my patients to do fasting coupled with a very-low-carbohydrate, whole-foods diet because of the astounding biochemical and clinical improvements these interventions provide, in terms of managing chronic metabolic illnesses like diabetes, hypertension, and obesity. I invite my patients to go to Diet Doctor because it is a very reliable source of information for people following a low-carbohydrate diet.”
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]
As someone who has hypothyroidism (Hashimoto's), I can confirm that a low-carb, whole foods based diet has not made my condition worse. In fact, it had the opposite effect and my thyroid function has improved. Although I still have to take levothyroxine, I feel better and my antibody values went down. I'm not saying that LCHF eating can reverse hypothyroidism but I'm willing to try and see if it improves my condition even further.
“The totality of evidence is very clear: A low-carbohydrate dietary approach is the most effective way to manage the insulin resistance syndrome which is that single biggest driver of obesity, type 2 diabetes and cardiovascular disease. Diet Doctor has been instrumental in providing extremely useful, clear and educational material to all who want to implement this dietary approach in to their lives. That’s why I recommend the website to all my at-risk patients.”
H. Guldbrand, B. Dizdar, B. Bunjaku, T. Lindström, M. Bachrach-Lindström, M. Fredrikson, C. J. Östgren, F. H. Nystrom, “In Type 2 Diabetes, Randomisation to Advice to Follow a Low-carbohydrate Diet Transiently Improves Glycaemic Control Compared with Advice to Follow a Low-fat Diet Producing a Similar Weight Loss,” Diabetologia (2012) 55: 2118. http://link.springer.com/article/10.1007/s00125-012-2567-4.
Kristin Parker is an American temporarily living in South Korea. Her role with Team Diet Doctor is customer service. If you have a question or a comment on our social media platforms, website or our Facebook group, she will likely be the one to answer you back! Kristin cooks for a family of four, including two hungry teenage sons. Her keto meal plan yields generous servings of substantial, hearty meals that they all like.
Nutritional ketosis has been proposed as a mechanism through which hunger may be suppressed. A recent meta-analysis investigated the impact of diet on appetite and shed some light on this possible phenomenon (11). The meta-analysis included 12 studies which investigated the effect of either a very low energy diet (VLED: defined as <800 calories per day) or ketogenic low-carbohydrate diet (KLCD: defined as CHO consumption of <10% of energy or <50 g/day, but ad libitum consumption of total energy, protein and fat). Interventions ranged from 4 – 12 weeks and weight loss was from 5.0 to 12.5 kg. In all studies nutritional ketosis was confirmed in VLED and KLCD via circulating levels of β-hydroxybutyrate. Interestingly, both groups reported decreases in appetite. The results of this meta-analysis are noteworthy in two regards. The VLED groups were clearly and significantly hypocaloric, suggesting a state in which hunger should be increased, not decreased. Similarly, the KLCD groups experienced simultaneous reductions in weight and appetite, while eating an ad libitum diet. The results of this meta-analysis provide support for the theory that nutritional ketosis may exert an appetite suppressing effect.
To find out whether you have achieved ketosis, you can test your blood or urine for the presence of ketone bodies. Depending on your diet, your activity level, and your body type, it can take a couple of days to a couple of weeks to reach ketosis. Testing for ketosis is a personal preference. For some, it’s an added inconvenience; for others, it provides added incentive to stay on track.
This work was supported by grants from the Fondo de Investigacion Sanitaria, (PI14/01012 and PI17/01167) research projects and CIBERobn (CB06/003), from the Instituto de Salud Carlos III (ISCIII), Fondo Europeo de Desarrollo Regional (FEDER) Spanish. DGA is grateful to the Colombian Department of Science, Technology and Innovation—COLCIENCIAS as a recipient of their pre-doctoral scholarship to support his work. Ana B Crujeiras is funded by a research contract “Miguel Servet” (CP17/00088) from the ISCIII.

Of the 28 participants enrolled in the study, 21 completed the 16 weeks of follow-up. Reasons for discontinuing the study included unable to adhere to study meetings and unable to adhere to the diet; no participant reported discontinuing as a result of adverse effects associated with the intervention. All but one of the 21 participants were men; 62% (n = 13) were Caucasian, 38% (n = 8) were African-American (Table ​(Table1).1). The mean age was 56.0 ± 7.9 years.


“I started a low-carb, high-fat diet for myself in an attempt to treat my own health problems. Since then, I have seen significant health benefits not only in myself but also in many of my patients using a LCHF/ketogenic approach. Diet Doctor gives a simple but very effective evidence-based resource that I confidently recommend to all my patients. And the recipes are great!”
The first signs of ketosis are known as the “keto flu” where headaches, brain fogginess, fatigue, and the like can really rile your body up. Make sure that you’re drinking plenty of waterand eating plenty of salt. The ketogenic diet is a natural diuretic and you’ll be peeing more than normal. Take into account that you’re peeing out electrolytes, and you can guess that you’ll be having a thumping headache in no time. Keeping your salt intake and water intake high enough is very important, allowing your body to re-hydrate and re-supply your electrolytes. Doing this will help with the headaches, if not get rid of them completely. 
×