I have been researching the Ketogenic Diet and Peleo Keto Diet since May. This is probably the most through article that I have seen on it and I thank you. Wish I had seen it 3 months ago. Now I can get back on track. I am still chuckling over the one comment above about seeing why you lose weight, as you can’t eat anything…it does appear so at first. Just have to be committed to being careful and monitoring the good fats, low carbs, lean non-processed protein,NO sugars and which vegetables that aren’t too starchy to be included. It is overwhelming at first, but able to be done if in the right mindframe. Evelyn, Chicago, IL
These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
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.
(60/60) 17.5 inches 👇 and I lost 23 pounds!!! . Today is a BIG, BIG deal for me. I'm celebrating #60daysketo and I've lost and gained so many things! . What I've lost on #keto : 👉23 pounds 👉2.25 inches on arms 👉3 inches on waist 👉 5.5 inches on pooch 👉3.5 inches on hips 👉1.75 inches on each thigh 👉1.5 inches on each calf . YOU GUYS, I lost 23#, and more than 17.5 inches in only 60 days in #ketosis !!! . Because of having surgery only a couple of weeks into my 60 day goal, I wasn't even able to work out much, and so I'm just now getting back into the swing of #powerlifting again, so almost ALL of this is by diet alone. . I didn't count calories, I only counted my carb and stayed below 40 net carbs every day. . So what comes next? . Well first, new swimsuits. Mine are falling off, and I can see baby abs coming through, so HELLO TWO PIECE! . I am also sticking with keto a bit longer, because @matthewlindow is still on it to lose weight for the military (I'll post his progress pics soon) but after that I'm going to be doing #modifiedketo where I consume about 25 g of carbs 30 minutes before my workout for a couple of months, and the guage if I'm still losing fat and gaining muscle. . My body is an experiment right now, but worst case scenario I'll be unhappy with adding in more carbs and will go back to keto . . . . . . . . . . . . . . #gains #muscle #fitness #fitspo #weightloss #fitnessfriday#cardio #obesetobeast #fitfam #fattofit#noexcuses #flexfriday #flex#weightlossjourney #bodyrecomposition#fitnessmotivation #thickfit #girlswholift#goals #legendary #health #diet#countingcalories #weightlossmotivation#foodisfuel
You can have a completely smooth transition into ketosis, or…not. While your body is adapting to using ketones as your new fuel source, you may experience a range of uncomfortable short-term symptoms. These symptoms are referred to as “the keto flu.” Low-sodium levels are often to blame for symptoms keto flu, since the kidneys secrete more sodium when you’re in ketosis, says Volek. A few side effects:
“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.”
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.
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.
Physical activity was determined by means of the International Physical Activity Questionnaire (IPAQ), which is used worldwide to indirectly evaluate an individual’s volumes of sedentary behavior and moderate to vigorous physical activity throughout the last seven-day week [26]. It is readily available, very cost-effective, and can generate large data sets. The IPAQ comprises a set of 4 questionnaires. In this study, the short form of the IPAQ was employed (7 items). This measure assesses the types of intensity of physical activity and sitting time that people do as part of their daily lives, which is used to estimate total physical activity in metabolic equivalent task minutes per week (MET-min/week) and time spent sitting [26].
A CKD on the other hand is a diet where you will eat a minimum amount of carbohydrates per day (that 30-50 gram number) and then on the weekend (or at a time that is appropriate for you) do a large 'carb-up' phase where you will eat a large amount of carbohydrates in an effort to refill your muscle glycogen stores so you can continue to workout the coming week.
PATIENTS AND METHODS: Randomized cross-over trial with placebo. The study had no. 2 dietary treatment (DT), conducted in two arms: (1) VLCKD1 in which 50% of protein intake is replaced with synthetic amino acids; (2) VLCKD2 with placebo. The VLCKDs (<800 kcal day-1) were different in term of protein content and quality each arm lasted three weeks (wks). Between the two arms a 3-wks washout period was performed to avoid additive effects on DT to follow. At the baseline, at start and end of each arm, all the subjects were evaluated for their health and nutritional status, by anthropometric analysis, body composition (Dual X-ray Absorptiometry (DXA), Bioimpedentiometry, biochemical evaluation, and Peroxisome Proliferator-Activated Receptor γ (PPAR) γ expression by transcriptomic analysis.

Hi Kelly, All packaged foods will have a nutrition label that list the macros per serving, including fat, protein and cabrohydrates. Net carbs, which is what most people look at for low carb and keto, are total carbs (the amount on the label) minus fiber and sugar alcohols, as explained in the article above. I have a low carb food list here that gives you a full list of all the foods you can eat, and the net carbs in each. You can also sign up above to be notified about the meal plans, which are a great way to get started.


This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?

“We know that when we have fats in our diet like MUFAs, they not only fill us up but keep cholesterol levels lower,” says Keatley. Olive oil is great for light sauteing, using in dressings, or drizzling over cooked meats or vegetables as a finishing oil. One tablespoon (tbsp) offers 119 calories and 13.5 g of fat, only 2 g of which are saturated fat, according to the USDA.
Transformation Tuesday::: I wore shorts once last year, i felt good because they were a size 16 I think, down from a size 20. My size 2 shorts in the after picture are now too big. About a year between these pictures and at least 100lbs. I was working out, but @coach_jmo had just had the food conversation with me. It was vacation time and I was sad about not being beach ready in a little over 3 months. 😂 I was still making bad choices to help me cope with my weight gain from Postpartum depression and anxiety. I was still eating horribly, with cheat weekends and lots of pizza. 😂 I still thought exercising was enough to help me reach my goals. Working out 7 days a week with my trainer and a Ketogenic diet have changed my life. Down from a size 18/20 to a Size 0/2, over 130 pounds, and over 115 inches. 🎉🙌🎊
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. 

In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[54]
Anecdotally speaking, people do lose weight on the keto diet. Heather Wharton, a 35-year-old business relationship manager from Tampa, Florida, lost 140 pounds since starting the keto diet in January 2016: “I plan on being on the keto diet for the rest of my life,” says Wharton. “My husband and I consider ourselves to be food addicts, and the keto diet is what we use as a form of abstinence from trigger foods that have sugar and other carbohydrates." A typical day of eating for Wharton includes coffee with a protein supplement, a cup of unsweetened cashew milk, cauliflower rice with ground turkey and liquid aminos (a carb-free substitute for soy sauce), spinach, six slices of turkey bacon, six eggs, and a little salsa.
Everyone has to find their nutritional sweet spot for producing enough ketones and staying in ketosis, but “the core principle of the diet is to keep carbohydrate intake low enough, so your body continues producing ketones at elevated levels,” says Volek. “Your body adapts to this alternative fuel and becomes very efficient at breaking down and burning fat.”

Food reward regions in the brain programmed much of this physical dependence on processed foods and refined starches. But the body can reverse it. Acute bouts of aerobic exercise have been shown to significantly suppress appetite and hunger while increasing satiety and fullness.6 Exercise in the form of resistance (weight) training can enhance insulin sensitivity,7 which results in reduced insulin secretion.8 Less insulin helps bodies favor fat burning over fat storage.
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4. Gomez-Arbelaez D., Bellido D., Castro A.I., Ordonez-Mayan L., Carreira J., Galban C., Martinez-Olmos M.A., Crujeiras A.B., Sajoux I., Casanueva F.F. Body composition changes after very-low-calorie ketogenic diet in obesity evaluated by 3 standardized methods. J. Clin. Endocrinol. Metab. 2017;102:488–498. doi: 10.1210/jc.2016-2385. [PubMed] [CrossRef] [Google Scholar]
Around this time, Bernarr Macfadden, an American exponent of physical culture, popularised the use of fasting to restore health. His disciple, the osteopathic physician Dr. Hugh William Conklin of Battle Creek, Michigan, began to treat his epilepsy patients by recommending fasting. Conklin conjectured that epileptic seizures were caused when a toxin, secreted from the Peyer's patches in the intestines, was discharged into the bloodstream. He recommended a fast lasting 18 to 25 days to allow this toxin to dissipate. Conklin probably treated hundreds of epilepsy patients with his "water diet" and boasted of a 90% cure rate in children, falling to 50% in adults. Later analysis of Conklin's case records showed 20% of his patients achieved freedom from seizures and 50% had some improvement.[10]
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.
The keto diet is notorious for delivering a quick initial slim down. That’s because carbs hold on to more water than protein or fat, says Becky Kerkenbush, RD, a clinical dietitian at Watertown Regional Medical Center. So when you stop eating them, all that extra H2O gets released through urination. As a result, the scale might read a few pounds lower, and you may look a bit leaner.
Experts agree more research needs to be done to determine which keto diet has the potential to preserve muscle and help increase the chances of sustained weight loss. But similar studies suggest the keto version analyzed in this study may hold promise. For example, a randomized study published in December 2014 in the journal Endocrine found that a very-low-calorie ketogenic diet was more effective at sustaining weight loss and preserving lean muscle mass in obese people than a standard low-calorie diet after one year.
It seems obvious that the type of food consumed can affect energy expenditure and fat loss. Staying away from processed foods made with refined starches and added sugar is, “the road map to reducing the obesity epidemic in the United States,” said Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University.
In a fantastic online review of the study, Dr. Stephan Guyenet, a nutritional research expert, notes the study's thoroughness and that the results, at face value, support the researchers’ initial hypothesis that a ketogenic diet promoted greater fat loss. Compared with the higher carbohydrate diet, the keto diet coincided with increased energy expenditure, meaning the subjects appeared to burn more calories when their carbohydrate levels were cut, thought they were consuming the same amount of calories as they were on the high carbohydrate diet.
Looking for that hearty crunch that’s packed full of flavor? Look no more. Instead of cracking open a box of Ritz or Cheez-Its, go ahead and make your own! You can make crackers from anything including flaxseed meal (featured in The RULED Book), chia seeds, or even almond flour to make your own homemade crunchy snacks with a delicious flavor of your own.
Gosh I remember the feelings I had before I started keto... feelings of fear, feelings of being discouraged or letting myself down again... what if I fail at this like I have with every other thing I’ve tried the past 12 years. Looking back a year ago on Mother’s Day reflecting where I was then to where I am now not just my weight loss but also my mental state at the time. Things were better but I was no where near where I am now. The weight loss and drastically changing my eating habits have all contributed and I’m so thankful I made myself show up everyday. So what if? What if I never gave myself the chance? I preach believing in yourself a lot because you are the only one who can push yourself to make the change. No one else just you. Don’t let the what’s ifs hold you back. Believe in YOU. Show up for YOU. Tip toe if you must but if it’s something you want soooo bad... everyday wake up and TAKE THAT STEP! It’s worth it💕 Happy #transformationtuesday 🌸
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.
I have ate bacon everyday since starting Keto and have lost 78 pounds in 11 weeks. Most Keto recipes consist of bacon that I see actually. I see so many list of foods to avoid and I certainly find some of them to have some odd foods on them. Packaged sausage is another I have had as a protein and have had no issue. To each their own I guess, some things obviously work differently for others.
“As an interventional pain physician, in addition to cutting-edge techniques I use nutritional strategies to deliver people from a cycle of pain and disability. Chronic pain may result from inflammation and metabolic disarray; it intersects every part of life and is an illness as much as it is a symptom. Obesity and aging are inflammatory processes at the root of many pain-inducing chronic diseases. I suggest anti-inflammatory, low-carb, ketogenic diets and fasting protocols to optimize patients’ health. Diet Doctor is a great resource for patients compliant with this lifestyle.”
Clinical improvement was observed in Alzheimer’s patients fed a ketogenic diet, and this was marked by improved mitochondrial function. (15) In fact, a European Journal of Clinical Nutrition study pointed to emerging data that suggested the therapeutic use of ketogenic diets for multiple neurological disorders beyond epilepsy and Alzheimer’s, including headaches, neurotrauma, Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis. (16)

A recent randomized, double-blind, placebo-controlled trial found that subjects who received 400 mg garlic powder tablets twice a day lost significantly more fat than the control group. Although there are many confounding variables in this trial, animal studies back up the human findings by providing us with evidence that garlic supplementation can have anti-obesogenic effects (i.e., garlic prevents weight gain) in mice.
There is not one “standard” ketogenic diet with a specific ratio of macronutrients (carbohydrates, protein, fat). The ketogenic diet typically reduces total carbohydrate intake to less than 50 grams a day—less than the amount found in a medium plain bagel—and can be as low as 20 grams a day. Generally, popular ketogenic resources suggest an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. For a 2000-calorie diet, this translates to about 165 grams fat, 40 grams carbohydrate, and 75 grams protein. The protein amount on the ketogenic diet is kept moderate in comparison with other low-carb high-protein diets, because eating too much protein can prevent ketosis. The amino acids in protein can be converted to glucose, so a ketogenic diet specifies enough protein to preserve lean body mass including muscle, but that will still cause ketosis.
I also asked a friend to join me as an accountability partner. She had tried the keto diet before with good success, so having a guide for my myriad questions was a big help. It was also nice to have someone to message at 10 p.m. when I really wanted a cookie so she could commiserate with me. (We agreed the cookie would be delicious, and then ate a cheese stick.)
Ariel Warren is a Registered Dietitian, Diabetes Educator, graduate from Brigham Young, and was diagnosed with Type 1 at the age of 4 years old. Ariel understands diabetes and enjoys working with clients to improve their blood sugar management, healthy eating, weight loss, fitness, and pregnancy. For coaching from a T1D Dietitian, you can contact Ariel directly, through her website: arielwarren.com.
This message was posted back in 2017 by Mattie, I do not see a response to it as I have the same question. Basically, why do I have to eat so much fat if I have plenty of fat on me that I want to be used for energy during this weight loss process? How do I know when to limit the amount of fat I’m eating so that the fat I already have will be used for energy? Please email me with an answer as I really do need to know.

You've selected an efficient, well-designed meal substitute system. The technology of meal substitute demands continuous and careful monitoring from experts. It can be unsafe to do this on your own, although it won't be practical to get your own personal doctor either. The best solution is to join a meal substitute program that offers an extensive solution-from providing advised items, to helping your acquire healthier habits, to aiding your persistence for a fit, energetic and healthier lifestyle.
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.

On the ketogenic diet, with carbs low, our bodies need to use glycerol from fatty acids in order to produce glucose (but under normal circumstances it doesn't use the fatty acids themselves).  Producing glucose from glycerol is fairly inefficient, meaning our bodies have to break down a lot of fat to get a little glucose.  Anytime our bodies do something inefficient it uses more calories than doing it the efficient way.
Adding heavy cream or half-and-half to your coffee is one way to get an additional source of fat into your day, says Keatley. Just realize that it is a source of saturated fat — and, given the small serving size, it’s easy to go overboard. According to the USDA, 1 tbsp has 51 calories, 5 g of fat (3.5 g saturated fat), and is just shy of ½ g of carbohydrate.
Getting your macronutrients—fat, protein, carbohydrates—in balance ensures your body has the best sources of energy. “The ketogenic diet for ‘nutritional ketosis’ is 20 percent protein, 5 percent carbs, and 75 percent fat,” says Jake Crandall, a trainer and CEO and founder of Okie Crossfit in Tulsa, OK. “If you go too high in protein, you’re effectively on the Atkins Diet and are low-carb. You’ll achieve weight loss, but not the health benefits of being in ketosis.” But you can still benefit from the 15 best Atkins diet foods for weight loss.
If you can't see any ketones, be patient. It typically takes 2-3 days for your body to deplete glycogen stores, so don't expect to be in ketosis after just a day of low-carb. Remember, ketosis is a favourable condition and an indication that your body uses fat for fuel but you can lose weight even without being in ketosis. A diet high in fat, adequate in protein and low in carbohydrates is naturally sating, making you less hungry and, therefore, helps you lose weight.
Thyroid health and longevity. Along with balancing sex hormones, a ketogenic lifestyle has a positive effect on thyroid hormones as well. A very low-carb diet tends to drive down T3, the main active thyroid hormone. Higher T3 levels make your cells use more energy (hyperthyroidism), which can increase free-radical production. Many scientists believe that lower levels of T3 actually increase lifespan by conserving energy and decreasing free-radical production. A ketogenic lifestyle is positively correlated with improved thyroid health and overall longevity [15].
The keto diet (also known as ketogenic diet, low carb diet and LCHF diet) is a low carbohydrate, high fat diet. Maintaining this diet is a great tool for weight loss. More importantly though, according to an increasing number of studies, it helps reduce risk factors for diabetes, heart diseases, stroke, Alzheimer’s, epilepsy, and more1-6.On the keto diet, your body enters a metabolic state called ketosis. While in ketosis your body is using ketone bodies for energy instead of glucose. Ketone bodies are derived from fat and are a much more stable, steady source of energy than glucose, which is derived from carbohydrates.
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]

When dietary CHO is of sufficient quantity the body has the ability to store small amounts for later use. Stored CHO is referred to as glycogen. Body reserves of glycogen, however, are limited, with relatively small amounts stored in the liver and skeletal muscle. As CHO is the “go to” energy source for the CNS, as well as an important energy source for other tissues, the body must maintain a stable supply of circulating blood glucose. While this is a complex process, the liver is primarily responsible for either breaking down stored glycogen or manufacturing small amounts of glucose in a process known as gluconeogenesis. In this manner the liver is able to maintain circulating blood glucose levels under most conditions. If the liver is unable to supply a sufficient amount of glucose, blood sugar levels will fall and result in hypoglycemia, a condition characterized by hunger, fatigue, headache, nausea and impairments in cognitive ability. In sporting terms hypoglycemia is referred to as “bonking” or “hitting the wall” and significantly affects athletic performance. Therefore, it is easy to understand the perceived need for dietary CHO; in the absence of sufficient blood glucose, physiological function is rapidly compromised.


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.


However, maintaining muscle mass and its functionality (i.e., muscle strength) has an important role in preventing weight regain, maintaining physical functionality, improving cardiometabolic risk factors, and reducing cardiovascular outcomes (5, 7–9, 32, 33). It is commonly assumed, and stated in several textbooks on obesity, that weight loss is associated with an important loss of muscle mass that evolves in parallel with the fat reduction. Some dietary guidelines have even suggested that diets that induce rapid weight loss, such as VLCK diets, create a greater energy deficit and contain lower amounts of protein, and therefore increase the risk of reductions in muscle mass compared with other interventions with more gradual weight loss (34, 35). In this article it was shown that the reductions observed in lean mass were mostly a result of body water loss, both intra- and extracellular. The combined information from the DXA and MF-BIA methods allows for such differentiation (28, 36–38). The loss attributable to muscle mass was minimal (∼1 kg), and an absolute preservation of HG strength was observed, a remarkable fact considering that the patients have experienced a weight reduction of ∼20 kg.

Thanks for this article. I just started a Keto diet so found it appropriate to my current lifestyle. Though I don’t believe your bottom line is strong enough since you simply stating that the diet is “hard to follow” and food is “notoriously unhealthy” without evidence going deeper into why those “notoriously unhealthy” foods are worse than keeping carbohydrate-heavy food that are addictive and give the body a quick sugar high for energy. I believe “hard to follow” is your opinion only, since acceptable Keto foods are found at all restaurants easily and also all grocery stores. All the foods you mention: “rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water” are all Keto-friendly. Many people have been on a Keto-diet for years. A healthy lifestyle is a healthy mindset change and making right choices – it’s not going to be easy.
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%.
Throughout the study, the patients completed a maximum of 10 visits with the research team (every 15 ± 2 days), of which 4 were for a complete physical, anthropometric, and biochemical assessment; the remaining visits were to manage adherence and evaluation of potential side effects. These 4 visits were made according to the evolution of each patient through the steps of ketosis as follows: visit C-1 (baseline), normal level of ketone bodies; visit C-2, maximum ketosis; visit C-3, reduction of ketotic approach because of partial reintroduction of normal nutrition; visit C-4, no ketosis (Supplemental Fig. 1). The total ketosis state lasted for 60 to 90 days only. In all of the visits, patients received dietary instructions, individual supportive counsel, and encouragement to exercise on a regular basis using a formal exercise program. Additionally, a program of telephone reinforcement calls was instituted, and a phone number was provided to all participants to address any concerns. 

The good news, however, is that following a well-formulated ketogenic diet should help increase HDL while lowering triglyceride levels. LDL will likely remain the same or potentially increase in order to efficiently transport triglycerides to cells to metabolize for energy. Again, LDL will likely become more of the pattern A type which is a highly beneficial shift.
“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.”
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