“I first began recommending a low-carbohydrate approach to diet and lifestyle in 2017 after discovering personal success with this way of eating. Since then, I’ve helped many patients adopt a LCHF diet and seen substantial clinical improvements — particularly with insulin resistance and diabetes — with this approach. Eating whole, nutritious food is good for everyone and results in the remission of disease and restoration of both physical and mental health.”
The ketogenic diet, or even just a higher-fat, low-carb diet, has now gained massive support as a modern-day healing strategy. In fact, our ideas about fats and cholesterol seem to have been almost completely reversed in recent years. That being said, many people see their cholesterol go up after beginning more of a ketogenic lifestyle. Some people get concerned when this happens, so in this article, I am going to address the phenomena of high cholesterol on a ketogenic diet.
“I started gaining weight in college. Too Much Beer. And it didn't stop, sitting at a desk job all day, going out to dinner ever night. I packed on the pounds. I knew something had to change. My friend recommened to me. I suddenly had energy again! I started taking the stairs at work. Biking on the weekend. I've been using it for 18 months now - and let me tell you - I'm back baby! ” - Carlos Thomas

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.

“I have been applying low carb solutions to metabolic problems since the moment I closed the cover of Good Calories, Bad Calories. I share with my low-carb colleagues the wonderful experience of offering effective advice and seeing real results. In addition to metabolic and hormonal problems, I have more recently focused on flexible low-carb approaches for Alzheimer’s and other neurodegenerative conditions. I greatly enjoy the lively online low-carb community and rely on Diet Doctor as a resource for myself and my patients.”
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.
Keto is a healthy state for some, but not all. It is most proven for epilepsy and other brain problems like Alzheimer’s, mild cognitive impairment, and Parkinson’s disease. There are more safety concerns for people trying keto for fat loss or performance. In humans, there are reports of adverse reactions to keto, including menstrual irregularities, gut dysbiosis, change in circadian rhythm, hair loss, constipation, mood disorders, and thyroid dysfunction; and in rodents, insulin resistance and nonalcoholic fatty liver.
Here’s a nutritional list of some of the more commonly consumed vegetables on keto. Keep in mind that the weights are the same of everything listed so that it will impact the skew of the carb counts. For example, in a meal you may have 6 oz. of broccoli in the side, but you would not have 6 oz. worth of berries in the morning. You may mix 6 oz. of berries into a pudding with 4 servings.
“I have been working as an internal medicine doctor and diabetologist for over 20 years, focusing on gestational diabetes mellitus (GDM), and also teaching future doctors and nutritionists. In 2016, we corrected our official dietary guidelines for GDM, removing the minimum recommended intake of carbohydrates and setting a maximum at 200 grams a day, with low-carbohydrate diets as an option. I would like to thank GDM dietitian Lily Nichols, Dr. Andreas Eenfeldt at Diet Doctor and the entire LCHF community for improving outcomes of Czech women with GDM and other patients with type 1 and type 2 diabetes or metabolic syndrome.”
27. O’Connor D.B., Corona G., Forti G., Tajar A., Lee D.M., Finn J.D., Bartfai G., Boonen S., Casanueva F.F., Giwercman A., et al. Assessment of sexual health in aging men in Europe: Development and validation of the european male ageing study sexual function questionnaire. J. Sex. Med. 2008;5:1374–1385. doi: 10.1111/j.1743-6109.2008.00781.x. [PubMed] [CrossRef] [Google Scholar]

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.
“I recommend low-carb nutrition for the majority of my patients and clients. And I send them all to Diet Doctor for the best recipes, instructional videos and written guides for everything someone needs to get started and to thrive on a low-carb lifestyle. Diet Doctor doesn’t have anything to sell you; its only goal is to provide you with the highest quality, evidence-based information to help you improve your life. That is hard to find in today’s ad-driven and product-driven internet. In fact, I loved Diet Doctor so much, I decide to work for them hosting their podcast!”
Participants met with researchers 10 times over a four-month period. During 4 of the 10 visits, researchers analyzed participants’ blood and body fat for changes in body weight, hormones, ketone bodies (which are produced during ketosis), and muscle losses. After 60 to 90 days, participants were gradually taken off ketosis and placed on a low-calorie diet consisting of between 800 and 1,500 calories per day, and then a maintenance diet consisting of 1,500 and 2,000 calories, depending on the participant. Out of the 20 participants enrolled in the study, 12 completed the regimen and lost about 44.5 pounds each.
The importance of dietary CHO is so well ingrained that the concept is taken for granted. In fact, basic macronutrient guidelines are predicated upon the idea that the central nervous system (CNS) requires a minimum of ~130 grams (~520 kcal) per day to function properly (i.e., to maintain optimal cognitive function). As a result, the minimum recommended daily intake of CHO reflects this idea (7). Similarly, most contemporary texts on sports nutrition emphasize the outsized role of CHO in optimizing both athletic performance and recovery (9). Frequently referred to as the “master fuel,” recommendations range from 3 – 12 grams per kilogram of bodyweight, per day. As an example, the recommended daily intake for a 180-lb athlete would be 246 – 982 grams, with a caloric equivalent of 984 – 3,928 calories. In marked contrast, the KD would recommend a maximum of just 50 grams (~ 200 calories) per day for the same individual.
“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.
Take a multivitamin. “Because you are removing grains, the majority of fruit, some vegetables, and a significant amount of dairy from your menu, a multivitamin is good insurance against any micronutrient deficiencies,” says Jadin. Depending on what your individual overall diet looks like, Jadin says you might also need to add a calcium, vitamin D, and potassium supplement.
Health experts think that the first law is relevant to why we get fat because they say to themselves and then to us, as the The New York Times did, “Those who consume more calories than they expend in energy will gain weight.” This is true. It has to be. To get fatter and heavier, we have to overeat. We have to consume more calories than we expend. That’s a given. But thermodynamics tells us nothing about why this happens, why we consume more calories than we expend. It only says that if we do, we will get heavier, and if we get heavier, then we did.
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.
The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy.[26][27] It is approved by national clinical guidelines in Scotland,[27] England, and Wales[26] and reimbursed by nearly all US insurance companies.[28] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][29] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[5][30]
Effect of the nutritional intervention with a very low-calorie-ketogenic diet on physical activity pattern (A) and sleep disturbances (B). Data represent mean ± standard error of changes from baseline. (ƚ) Denotes statistically significant differences through the intervention (p for trend < 0.05) evaluated by means of repeated-measures ANOVA. (*) Denotes statistically significant differences (p < 0.05) from baseline after post-hoc pairwise comparisons employing the Tukey’s adjustment for multiple comparisons. IPQA, International Physical Activity Questionnaire.
“I am a hospitalist/primary care doctor and also a specialist in obesity. As I see it, nutrition and other lifestyle factors are at the root of most of the diseases I treat. My own health issues corrected with LCHF. I went on to recommend LCHF to my patients, who have since experienced a wide variety of improved outcomes. Face-to-face time with patients is frustratingly short so simply writing “DietDoctor.com” on slip of paper and handing it to patients is a great way to set them in the direction of trustworthy diet information.”
Ketogenesis results in the production of ketone bodies, a product of fatty acid catabolism performed primarily by the liver, in the absence of adequate CHO availability. Three primary ketone bodies are produced; acetone, acetoacetate and β-hydroxybutyrate. Even though trace amounts of ketones are always present in the blood, it is only during periods of inadequate CHO availability that significant ketone production will occur. This accumulation of ketone bodies in the blood is commonly referred to as ketosis.
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.

However, it is important to know that these aren’t the only health-promoting keto foods. There are plenty of other keto-friendly ingredients that can take your keto diet results to the next level. In my diet, for example, I’ve been experimenting a lot more with shirataki noodles and avocado lately. They have been providing a much-needed change of pace for my palate and my health.
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.
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“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.”
Most condiments below range from 0.5–2 net carb grams per 1–2 tablespoon serving. Check ingredient labels to make sure added sugar is not included, which will increase net carbs. (Stevia and erythritol will become your go-to sweeteners because neither raise your blood sugar — combine for a more natural sweet taste and, remember, a little goes a long way!)
Sleep quality was evaluated by determining sleep propensity and quality by means of the PSS and PSQI, respectively. Overall, participants showed a poor sleep condition with a total score >5 au (Table S1). Thus, a significant improvement in sleepiness (PSS) was observed when comparing the visit of reduced ketosis with baseline, a point that coincided with maximum loss of fat mass (Figure 3B). By contrast, no statistically significant effect was observed on sleep quality and duration (PSQI; Figure 3B). Accordingly, plasma levels of dopamine showed no statistically significant changes (data not shown).
Seasonings and sauces are a tricky part of ketogenic diet foods, but people use them on a regular basis to add flavor to their meals. The easiest way to remain strict here is to avoid processed foods. There are many low carb condiments and products on the market, and there’s no way to list them all. A handful of them are great, but the majority use high glycemic index sweeteners – which you want to avoid.
Dieter beware: U.S. News & World Report, in its high-profile January cover story on "best diets," calls the DASH and Mediterranean diets tops for health, though these regimens represent the failed nutritional status quo of the last 50 years. It's clear that U.S. News — which employed an expert panel to rate 40 diets on various criteria — merely recapitulated questionable dietary advice that has gone by a succession of names since the 1970s — "low-fat," "DASH," "USDA-style," "plant-based." The basic set of recommendations have remained the same, emphasizing plant foods (grains, cereals, fruits and vegetables) over animal products (eggs, regular dairy, meat), and vegetable oils over natural animal fats such as butter. According to government data, Americans have largely followed these recommendations over the last 50 years, notably increasing their consumption of grains, vegetables and fruits and eating less whole milk, butter, meat and eggs. The outcome? In that time, rates of obesity and Type 2 diabetes have skyrocketed. Something has gone terribly wrong. Why would 25 doctors, dietitians and nutritionists on the U.S. News panel choose a dietary philosophy that has — so far, at least — failed us?
Cutting back on protein is one of the largest challenges to the diet. Because high levels of protein in the diet can turn into glucose in a process called gluconeogenesis, the keto theory says too much protein in the diet can mean too much glucose, whisking you out of ketosis. That’s why bacon, which has a ton of fat but not a lot of protein is a preferred food over chicken breast, which is high in protein with very little fat.
I am just starting the Keto diet and I eat a banana or a little pineapple in cottage cheese once a day as part of my lunch or a snack will this be bad at the start of my diet or should I cut it out all together? I’m so disappointed that my favorite fruits are high in carbs,especially bananas, once I heard the help with anxiety I have been eating one almost every day and I think it lifts my mood.
“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.”
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.
There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[7]
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]
The liquid diets involved with VLCDs often bring on ketosis, a condition that involves a buildup of ketone bodies in the blood as well as urine. Ketones are a byproduct that is created when your body has to switch to fat as an energy source. It means your store of glycogen, or carbohydrates, has been depleted. One of the consequences of ketosis is a loss of appetite, which helps make it easier to follow a VLCD. Ketosis also causes you to shed excessive amounts of sodium, potassium and water, which can cause dehydration, sluggishness, constipation and gas. However, your body can adjust to changes in your electrolytes.
I ate a lot of bacon, cheese, eggs and meat (steak and chicken mostly). For a person whose eating philosophy is typically more plant-based and whole-food-focused, eating processed pork products every morning took a lot of personal persuasion. It also took a complete mental shift, because eating multiple pieces of bacon every day for weeks on end goes against everything I've been taught for personal health.
Now that we have discussed the role of the primary cholesterol molecules, you should have a better understanding of how they work together. Having high LDL isn’t necessarily bad, given that you have adequate HDL to help clear it from the blood stream and that you are not dealing with chronic inflammation. It is also important to have large particle LDL (pattern A) rather than small particle LDL (pattern B).
Which leads us to your personality. You need to be VERY strong willed to follow this diet. It follows very strict rules and you need to be able to commit to this. It makes it hard to eat out with friends or eat with friends in general. It’s hard to find food that fits this diet in common restaurants, but and this takes us to the next point, your health goals might be more important.
Health experts think that the first law is relevant to why we get fat because they say to themselves and then to us, as the The New York Times did, “Those who consume more calories than they expend in energy will gain weight.” This is true. It has to be. To get fatter and heavier, we have to overeat. We have to consume more calories than we expend. That’s a given. But thermodynamics tells us nothing about why this happens, why we consume more calories than we expend. It only says that if we do, we will get heavier, and if we get heavier, then we did.
WY conceived, designed, and coordinated the study; participated in data collection; performed statistical analysis; and drafted the manuscript. MF assisted with study design, performed data collection, and helped to draft the manuscript. AC analyzed the food records. MV assisted with study/intervention design and safety monitoring. EW participated in the conception and design of the study, and assisted with the statistical analysis. All authors read and approved the final manuscript.
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.
But according to the International Society of Sports Nutrition, it won’t. Two groups of resistance-trained and semi-fit men were put on the same training schedule. Half of them followed a 'Western diet' (55% carbs, 25% fat, 20% protein), and the other half followed a keto diet (5% carbs, 75% fat, 20% protein). Both groups consumed the same number of calories. After 11 weeks, not only did participants in the keto group lose more body fat, they also gained more lean muscle mass.
The ketogenic diet has grown to become extremely popular over the last few years. It’s ideal for those of you that are looking to lose a considerable amount of weight. This diet is essentially a very low carb, high fat diet. While it has many similarities to the Atkins diet when on the keto diet, your body mostly gets its calories from proteins and fat, not from carbohydrates. The video below will give you an idea of what you can expect when moving to a ketosis lifestyle.
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.
Eat fats with all your meals. Fats are the cornerstone of the ketogenic diet, and will encourage your body to burn fatty ketones for fuel. Typically, calories from fat should comprise 80 – 90% of your meals.[10] (However, you cannot eat unlimited fats on a ketogenic diet; the calories can still add up and cause weight gain.[11]) Examples of fatty foods include:
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