I have great respect for Harvard Medical School. I notice that they support their readers posting comments and I am most appreciative of the article and all the many thoughtful comments by the readers. The readers seem to have the most expertise here and I hope that the doctor who wrote the article will think long and hard about the comments by readers. After 35 years of clinical practice in mental health, I notice that all issues of emotion involve medical issues, nutrition, and the gut bacteria. I would say that these issues and all of the executive brain functions seem to improve with ketogenic principles. For those that apply it in a flexible and smart manner, it appears to improve every area of their lives. I strongly encourage the author of the article to take one class via The Institute for Functional Medicine. If he is open to more learning he can take more classes and get certified. I’m sure a fine doctor, he will be an even better doctor and personally healthier, if he gets more training. Are we all open to new learning(especially us healthcare providers)?
In part, keto diet weight loss is a real thing because high-fat, low-carb diets can both help diminish hunger and boost weight loss through their hormonal effects. As described above, when we eat very little foods that supply us with carbohydrates, we release less insulin. With lower insulin levels, the body doesn’t store extra energy in the form of fat for later use, and instead is able to reach into existing fat stores for energy.
Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre's experience with 76 children up to the year 2009) also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.[18][50]
Measuring blood ketones is the most reliable method. There is a home blood test you can use, but the strips can be very expensive. An alternative is to measure ketones in the urine with a dipstick test, which is much more accessible and inexpensive. However, this method is much less reliable and as time goes on and the body adapts to ketosis, it becomes even less reliable.
All of the patients followed a VLCK diet according to a commercial weight loss program (PNK Method), which includes lifestyle and behavioral modification support. The intervention included an evaluation by the specialist physician conducting the study and assessment by an expert dietician. All patients underwent a structured program of physical exercise with external supervision (16). This method is based on high-biological-value protein preparations obtained from cow milk, soya, avian eggs, green peas, and cereals. Each preparation contained 15 g protein, 4 g carbohydrates, 3 g fat, and 50 mg docosahexaenoic acid, and provided 90 to 100 kcal (16).

Everyone — not just those on a keto diet — should stay away from consuming added trans fats. While these are naturally found in some meat and milk (though you’re probably avoiding milk on keto because of its higher carb count), according to the USDA, they’re often added to processed foods. “If you’re eating a lot of packaged products, you’re probably getting more trans fats than you think you are,” says Keatley.


The accurate measurement of body composition changes is relevant to assess the contribution of the diet intervention, not only to total body weight but to the changes produced in FM, FFM, visceral fat tissue, and total body water (25, 27). To obtain such information, multicompartmental models that integrate information obtained from a single measurement (body density, total mineral mass, total body water) may be used to reduce the number of assumptions made on the stability of body characteristics (28). These models are of limited application in clinical practice, because they do not provide immediate results, are expensive, and require advanced analytical expertise (29, 30). For such reasons the 3 more widely used body composition analysis techniques were used in the present work. DXA is the most validated and commonly used technique to analyze body composition in obese patients and is based on the attenuation of a low-energy X-ray beam, depending on the tissue density and chemical composition. DXA is considered the gold standard technique by most groups working with body composition and was used as the reference method in the present work. Bioelectrical impedance techniques are low cost and readily available and rely on the use of population-specific equations to assess intracellular and extracellular water distribution. The MF-BIA system used in this study is a recently developed version that is not based on statistical population data and is capable of accurately assessing subjects with different body shapes and also obese subjects. Finally, ADP measures body density and is used more easily than other more complex systems for measuring body density, such as underwater weighing, and provides comparable results for obese subjects. Therefore, the use of 3 validated methods that use different principles was relevant for evaluating patients in different stages of a body weight reduction program.
When your body goes into ketosis, it will start to produce by-products called ketones. This includes acetone—yes, the same chemical found in nail polish remover, which your body actually naturally makes on its own, according to a 2015 review of research. Because acetone is a smaller molecule, it tends to make its way into your lungs. You’ll eventually exhale them out, resulting in “keto breath.” Your mouth might also have a metallic taste, but it won’t last forever as you adjust to the diet. Just be diligent about brushing your teeth!
Ok when you see the % sign it means the daily percentage from a 2000 calorie diet. That one says you should have 300g a day. This is the standard nutrition value in most if not all products. If you want to try a low carb diet ignore that part, at least the number with % on the side. Concentrate on the number with the letter g next to it. That is the grams per serving. To that number substract the amount of fiber it has (also the number with the g next to it not the one with % symbol) That gives you the net carbs for that specific product. The rest is just math with whatever you eat. Good Luck.
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.
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!
In a 2004 study, overweight and obese adults consumed a low-fat diet and a low-carb diet for one week each. Both diets were designed to reduce each person’s calorie intake by 500 calories per day. However, people lost more weight and body fat after the low-carb week than the low-fat week – even though the men averaged higher calorie intake during the low-carb phase.
“As a physician who developed type 1 diabetes in 1998 at the age of 38, I struggled to manage my blood sugar with conventional medical advice. I met Dr. Andreas Eenfeldt at a medical meeting in 2012 and have used Diet Doctor as an excellent source of information for both myself and my patients ever since. The low-carb diet resulted in a marked improvement in my blood sugar control and my entire outlook on life. I provide online coaching to people with diabetes who need individualized attention.”

Dieters and healthy eaters are programmed to get vegetables at every meal in order to reach their daily plant quota, but Mancinelli says the cumulative total can blow through your daily net carbs. “They have vegetables in their breakfast omelet, big salads, snack on celery and carrot sticks, and have big sides of leafy greens in place of rice at dinner,” she says. “The carbs in all those vegetables add up. A few carbs here and there with cheese, nuts, and seeds, and you can really miss the mark for ketosis.” Start smart by cooking with these low-carb vegetables.
In the absence of glucose, which is normally used by cells as a quick source of energy, the body starts to burn fat and produces ketone bodies instead (it’s why the keto diet is often referred to as the ketone diet). Once ketone levels in the blood rise to a certain point, you enter into a state of ketosis — which usually results in quick and consistent weight loss until you reach a healthy, stable body weight. See this keto diet review, a before and after trying keto for 30 days.
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]
Try to replace all soda and juice consumption with something that has no sugar or only trace amounts of sugar. Switch out fruit juices for low-carb smoothies and tea. Tea comes in a variety of flavors that can help you get through the day if you get tired of water. There are a variety of different smoothies you can make for a meal replacement or as a quick snack as well.

My macros are 10-15% carbs, 20-25% protein and 60-70% fat, and my calories are between 1300 to 1500 but I'm still not in ketosis and only lost 1 lb so far. I'm making sure that my net carbs are below 25g. My fat usually ranges between 90g to 120g, and my protein ranges from 60g to 90g. for the past 5 days, test scripts are showing that i'm in small ketosis. It's not going up. My husband on the other hand is in Large Ketosis and lost about 5 lbs. He just started 1 day before me. Any advise to get int Ketosis and lose weight.

63. Seidelmann S.B., Claggett B., Cheng S., Henglin M., Shah A., Steffen L.M., Folsom A.R., Rimm E.B., Willett W.C., Solomon S.D. Dietary carbohydrate intake and mortality: A prospective cohort study and meta-analysis. Lancet Public Health. 2018;3:e419–e428. doi: 10.1016/S2468-2667(18)30135-X. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
In order to transition and remain in this state, aiming for about 30–50 net grams is typically the recommended amount of total carbs to start with. This is considered a more moderate or flexible approach but can be less overwhelming to begin with. Once you’re more accustomed to “eating keto,” you can choose to lower carbs even more if you’d like (perhaps only from time to time), down to about 20 grams of net carbs daily. This is considered the standard, “strict” amount that many keto dieters aim to adhere to for best results, but remember that everyone is a bit different.
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.
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.
White sugar, honey, and most traditional sugars are out when you’re eating keto because of the high carb counts. While many artificial sweeteners deliver sweetness sans a single carb, that doesn’t mean you should eat them, Crandall says. “We have demonized sugar—rightly so—for causing unneeded insulin spikes,” Crandall says, but “many artificial sweeteners do the exact same thing.” One study found that eating artificial sweeteners may increase cravings—especially for sweet things. This can stymie your weight-loss intentions. Discover how one woman totally kicked her sugar habit by trying the keto diet.
Psychological well-being and hunger and food control are two relevant factors involved in the success of weight-loss therapy in treating obesity. Thus, this study aims to evaluate food and alcohol cravings, physical and sexual activity, sleep, and life quality (QoL) in obese patients following a very low-calorie ketogenic (VLCK) diet, as well as the role of weight lost and ketosis on these parameters. A battery of psychological test was performed in twenty obese patients (12 females, 47.2 ± 10.2 year and BMI of 35.5 ± 4.4) through the course of a 4-month VLCK diet on four subsequent visits: baseline, maximum ketosis, reduced ketosis, and endpoint. Each subject acted as their own control. Relevantly, the dietary-induced changes in body composition (7.7 units of BMI lost, 18 kg of fat mass (1.2 kg of visceral fat mass)) were associated with a statistically significant improvement in food craving scores, physical activity, sleepiness, and female sexual function. Overall, these results also translated in a notable enhancement in QoL of the treated obese patients. Therefore, the rapid and sustained weight and fat mass (FM) loss induced by the VLCK diet is associated with good food control and improvements in the psychological well-being parameters in obese subjects, which could contribute to the long-term success of this therapy.
Conceptualization, A.I.C., A.B.C., P.L.-J., F.F.-A. and F.F.C.; Data curation, A.I.C. and D.G.-A.; Formal analysis, R.G., Z.A. and S.J.-M.; Investigation, A.I.C., D.G.-A., A.B.C. and F.F.C.; Methodology, A.B.C., I.S., F.F.-A. and F.F.C.; Supervision, F.F.C.; Writing—original draft, A.I.C., D.G.-A., A.B.C. and F.F.C.; Writing—review & editing, A.I.C., D.G.-A., A.B.C., R.G., Z.A., S.J.-M., I.S., P.L.-J., F.F.-A. and F.F.C.
“As a psychiatrist who practices traditional and holistic (integrative) psychiatry, I find my patients are always looking for non-pharmacological ways to improve both their psychological and physical health. Diet Doctor has proven to be an excellent and reliable resource to help my patients develop and maintain healthy lifestyle choices with low-carb and ketogenic diets. My patients are thrilled with the extensive variety of recipe options that are easy to prepare as well as the informative videos on relevant health issues. I am equally thrilled with the positive benefits in my patients’ mood, anxiety, and cognitive clarity.”
Pattern B LDL, on the other hand, has a much smaller particle size and is much more prone to oxidation. Another thing about pattern B LDL is that it is small enough to enter into the endothelial lining of the artery where it can become oxidized and more likely to form plaque.  There is a high association between these small dense particles and cardiovascular disease.
Unfortunately, there’s no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.
Low-carbohydrate diet advocates including Gary Taubes and David Ludwig have proposed a "carbohydrate-insulin hypothesis" in which carbohydrate is said to be uniquely fattening because it raises insulin levels and so causes fat to accumulate unduly.[8][28] The hypothesis appears to run counter to known human biology whereby there is no good evidence of any such association between the actions of insulin and fat accumulation and obesity.[6] The hypothesis predicted that low-carbohydrate dieting would offer a "metabolic advantage" of increased energy expenditure equivalent to 400-600 kcal/day, in accord with the promise of the Atkin's diet: a "high calorie way to stay thin forever".[8]
People suffering from diabetes and taking insulin or oral hypoglycemic agents suffer severe hypoglycemia if the medications are not appropriately adjusted before initiating this diet. The ketogenic diet is contraindicated in patients with pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. People on a ketogenic diet rarely can have a false positive breath alcohol test. Due to ketonemia, acetone in the body can sometimes be reduced to isopropanol by hepatic alcohol dehydrogenase which can give a false positive alcohol breath test result. 
In general, people on ketogenic diets tend to consume a lot of foods high in monounsaturated and saturated fats such as olive oil, butter (often butter from grass-fed cows is recommended), avocado, and cheeses. The high oleic types of safflower and sunflower oils (but not the regular forms of these oils) are also good choices, as they are high in monounsaturated fats and low in polyunsaturated fats.

Not in the mood for cake? Brownies definitely come second on that list of delicious treats that we want once we turn to a ketogenic diet. You can easily make keto brownies that you can fully enjoy without having to fight against the craving to have more. Besides using almond flour and other mixtures of flours, you can make them out of avocado as well.


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).
Excess fat mass (FM), especially visceral fat, is associated with a variety of pathological conditions such as hypertension, dyslipidemia, diabetes, and even cancer (1–4), as well as an increase in overall and cardiovascular mortality (2, 5). Very-low-calorie diets are commonly used as obesity treatments; however, a primary concern in using such diets is the amount of fat-free mass (FFM; i.e., muscular tissue) that is lost together with the FM (6). This could produce so-called sarcopenic obesity, that is, the coexistence of an excess of FM and a decline in FFM that yields a near-normal body weight (7). Sarcopenic obesity constitutes a double impact on the health of patients, because the reduction in muscle mass and muscle strength is also a cause of cardiometabolic disorders, such as myocardial infarction and stroke, and other adverse health outcomes (5, 7–9). For these reasons, it is of primary interest to find weight loss strategies that promote preferential loss of FM and preservation of muscle mass and its functional status (i.e., muscle strength) (10–12).
Questionnaires were used to evaluate food craving as a trait, as a state, and to different nutrients. Statistically significant decreases were observed in the global score of trait and state when comparing all visits with baseline (Figure 2A). More specifically, the eight items of the FCQ-T (Table S1) decreased with statistical significances since the visit of maximum ketosis, except for the positive and negative reinforcement, which exhibited differences since the visit of reduced ketosis. Relevantly, a negative correlation was observed between B-OHB levels and the intention to eat (r = −0.46; p < 0.05) and feelings of hunger (r = −0.30; p < 0.05) during the phase of maximum ketosis. However, these effects on feelings of hunger were not evidenced at circulating levels of ghrelin, which showed no statistically significant changes during the intervention (data not shown).

We’re going full on fats with breakfast, just like we did last week. This time we’ll double the amount of ketoproof coffee (or tea) we drink, meaning we double the amount of coconut oil, butter, and heavy cream. It should come to quite a lot of calories, and should definitely keep us full all the way to dinner. Remember to continue drinking water like a fiend to make sure you’re staying hydrated.
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