The weight-loss program has five steps and adheres to the most recent guidelines of the 2015 EFSA on total carbohydrate intake [22]. The first three steps consist of a VLCK diet (600–800 kcal/day), low in carbohydrates (<50 g daily from vegetables), and lipids (only 10 g of olive oil per day). The amount of high biological-value proteins ranged between 0.8 and 1.2 g per each kg of ideal body weight to ensure that patients were meeting their minimum body requirements and to prevent the loss of lean mass. In step 1, the patients ate high-biological-value protein preparations five times a day and vegetables with low glycemic indexes. In step 2, one of the protein servings was substituted with a natural protein (e.g., meat or fish) either at lunch or at dinner. In step 3, a second serving of low-fat natural protein was substituted for the second serving of biological protein preparation. Throughout these ketogenic phases, supplements of vitamins and minerals, such as K, Na, Mg, Ca, and omega-3 fatty acids, were provided in accordance with international recommendations [23]. These three steps were maintained until the patient lost the target amount of weight, ideally 80%. Hence, the ketogenic steps were variable in time depending on the individual and the weight-loss target. The total ketosis state lasted for 60–90 days only.
This style of Ketogenic Diet, the temporary reduction in fats, carbohydrates and sugars is the heart of the Ideal Protein Protocol. Ideal Protein a medically developed, step-by-step, personalized Ketogenic Weight Loss Diet available today. By temporarily restricting fat intake, the Ideal Protein dieter burns through fat stores more rapidly, resulting in safe, efficient weight loss. Because the Ideal Protein Protocol is a Keto Diet focused on weight loss and weight maintenance, for most people it will be the safest and most credible entry point into living a low carbohydrate lifestyle. Not only is the Ideal Protein Protocol a supervised Ketogenic weight loss program, we teach our dieters how to develop and maintain a healthier relationship with food after they have graduated from Ketosis. This makes maintaining your new healthier weight easier and safer following your weight loss, because living in a state of Ketosis should only be temporary.
“One of the best meal planning tips I’ve ever received is to structure breakfast and lunch so that you don’t have to think too much about it,” says Emily Bartlett, co-founder of Real Plans. “If you’re OK with repetition, it’s ideal to have a simple selection of recipes for breakfast—including some that can be taken on the go. For lunch, go ahead and use your leftovers with a fresh green salad, and be sure to include a dressing that you really love.” Before you make your keto diet menu, check out the 13 things doctors want you to know about the keto diet.

The VLCK diet was used because of its ability to produce a rapid and well-tolerated weight loss with a ketogenic phase that lasts 60-90 days and a final result of 20 kg of weight reduction at 4 months. The rapid reduction in weight is the probable explanation of the positive effects of this dieting approach, which are evident 1 and 2 years later (12, 13). Four different stages occurred with the VLCK diet used: a basal stage with obese body weight and no ketosis, a second stage with extreme ketosis and marked body weight loss, a third stage with body weight loss and declining ketosis, and a fourth stage with weight loss and no ketosis. Body composition was studied with the 3 techniques at each of these stages.


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.


The ketosis produced by fasting or limiting carbohydrate intake does not have negative effects for most people once the body has adapted to that state. The ketosis caused by diet has been referred to as dietary ketosis, physiological ketosis, benign dietary ketosis (Atkins), and, most recently, nutritional ketosis (Phinney and Volek), in an attempt to clear up possible confusion with diabetic ketoacidosis.
Keto can promote fat loss—in the right person. For people who are sugar burners and can’t kick their sugar cravings, keto can be very helpful, because the increased fat is satisfying and curbs sugar cravings, and people eat less overall compared to their baseline diet. So, I occasionally prescribe it for weight (fat) loss, and for help with specific hormone imbalances involving insulin and stubborn fat gain because it improves insulin sensitivity. This includes patients struggling with: obesity, weight-loss resistance (assuming the thyroid is healthy), and PCOS with insulin resistance and weight gain.
I understand your point, and thanks for the reply. I suppose I'm wondering this because when I go through foods (meats in particular, it seems) in the database on MFP, the keto-friendly foods seem to be high in calories. So, I'm wondering if it will be difficult to keep a calorie ceiling of around 1200-1500 per day. My guess would be I'll have to emphasize vegetables moreso than meat in my diet to maintain that level.
According to one hypothesis, low-carb diets have a distinct “metabolic advantage” over diets with higher carbohydrate content when the amount of calories consumed are the same.3 This metabolic advantage is essentially an increase in the expenditure of energy (calories) on the low-carb diet. Factors that may account for this higher rate of calorie burning include:
Adequate food records were available for analysis in a proportion of participants at each of the 4 timepoints (Table ​(Table2).2). Participants completed food records at a mean of 2.5 and a median of 3 timepoints. In general, comparing baseline to subsequent timepoints, mean carbohydrate intake decreased substantially and energy intake decreased moderately while protein and fat intake remained fairly constant.
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]
Nurse practitioners (NP) are advanced practice registered nurses that manage acute and chronic medical conditions, both physical and mental, through history and physical exam and the ordering of diagnostic tests and medical treatments. NPs are qualified to diagnose medical problems, order treatments, perform advanced procedures, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions within their scope of practice. Their education includes a Bachelor of Science in Nursing (BSN) or other undergraduate degree, and requires a license as a registered nurse (RN) and experience as an RN in a health care setting. They must graduate from an accredited graduate (MSN) or doctoral (DNP) program and achieve a board certification.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[18]

Already in ketosis but not losing as quickly as you’d like, or stuck in a stall?  The wildly popular and effective Keto Egg Fast Diet Meal Plan below has helped thousands of people lose up to 10 pounds in just five days – while eating delicious Fettuccini Alfredo, snickerdoodle crepes, and salted caramel custard!  Be sure to join our IBIH Egg Fast Facebook Group to get support, encouragement, and have your questions answered by seasoned egg fasters!

I can maintain 20g daily carbs and lose weight fast if I remain mostly sedentary. I get weak very fast when I try exercise and even though I get all the electrolytes I get muscle burn. I did this for 5 weeks..went from 248 to 217. Am starting a modified diet tomorrow with 1500 total cals/150 g protein/50 g carb. I hope to tolerate exercise better and the extra carbs will basically be burnt on exercise. If I still feel the carb level impedes my biking and walking will add 10 carbs until I feel comfortable exercising.
While you don’t have to be 100% accurate, you can use calorie counting as a starting point. It’s a way to measure how much energy you are actually taking in, and then adjust it to your needs. Obviously, a faster/slower metabolism, activity levels, endocrine problems, etc. will affect the amount of energy you will be expending, and therefore will affect the number of calories you need to take in.
I’m 50 and have been working out with weights and cardio for over 30 years, 6-7 days per week. I have always had controlled weight in the 180’s for 5′ 9″ due to strength training. I went on a “version” of the Keto diet—per day goals: 35 net carbs/85-95 grams protein/35-40 grams fat. I didn’t want to go all-in with high fats. I weighed 188 at the start and in 6 months dropped 26 lbs to 162, and bodyfat at 9%. My cholesterol levels have mostly been 220 with 50-75 HDL.
We in Broxtowe constituency have to put up with this undemocratic politician daily. To call her duplicitous is a huge understatement. ..... And try getting a reply from her over other issues. All you get is a cut and paste general reply. She's clearly far too busy doing the rounds of radio, TV and other interviews for which she presumably takes fees rather than doing the job she's paid for as an MP.
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But all those studies were very small, and not all research on the keto diet is as promising. One American Society for Clinical Nutrition study of 20 participants found that those on the diet didn’t lose more weight than those on a non-keto diet. But they did have fouler moods and higher levels of inflammation, which has been linked to a variety of conditions, including heart disease and cancer.
The ketogenic diet may seem like the Jekyll to the Hyde-like low-fat craze of the 1990s. The bulk of current research finds that the middle ground between the two extremes is more beneficial for overall health. Make it easy for yourself: Eat at least two servings a week of fatty fish (salmon, sardines, mackerel) and cook with a variety of quality fats (olive oil, canola oil, avocado oil) throughout the week.
Following a very high-fat diet may be challenging to maintain. Possible symptoms of extreme carbohydrate restriction that may last days to weeks include hunger, fatigue, low mood, irritability, constipation, headaches, and brain “fog.” Though these uncomfortable feelings may subside, staying satisfied with the limited variety of foods available and being restricted from otherwise enjoyable foods like a crunchy apple or creamy sweet potato may present new challenges.
“In 2010 I came face-to-face with the compelling, robust evidence for the effectiveness of the low-carb, high-fat diet to prevent and treat serious diseases like diabetes, obesity and heart disease. It contradicted everything I knew as a doctor and scientist about optimal nutrition. I have since aimed to change medical dogma and foster respectful dialogue on evidence-based nutrition, but at a brutal personal and professional cost, even though eventually vindicated. The Noakes Foundation, since 2012, has been promoting unbiased nutritional research into the effects of LCHF on all aspects of human health. The sugar-free train is bound for glory.”
The American Academy of Family Physicians defines low-carbohydrate diets as diets that restrict carbohydrate intake to 20 to 60 grams per day, typically less than 20% of caloric intake.[2] A 2016 review of low-carbohydrate diets classified diets with 50g of carbohydrate per day (less than 10% of total calories) as "very low" and diets with 40% of calories from carbohydrates as "mild" low-carbohydrate diets.[18] In a 2015 review Richard D. Feinman and colleagues proposed that a very low carbohydrate diet had less that 10% caloric intake from carbohydrate, a low carbohydrate diet less than 26%, a medium carbohydrate diet less than 45%, and a high carbohydrate diet more than 45%.[16]
Coconut oil has been denounced “officially” by the American Heart Association and others who parrot “authoritative” nutritional advice condemning saturated fats despite the overwhelming independent science that prove they’re wrong about fats. (See: Coconut Oil is Beneficial for Your Heart: Shining the Truth on Mainstream Media’s Negative Attacks Against Coconut Oil.)
I personally don't follow a very low-carb diet because I have such a preexisting condition which may have been caused by my calorie-restricting dieting many years ago. My "ideal" level is somewhere around 30 grams of net carbs (light ketosis). By "ideal" I mean a level at which I feel great and maintain a healthy weight. I sometimes eat less carbs out of habit, not because I force myself to follow a very low-carb diet. Following a very low-carb diet (less than 20 grams of total carbs) doesn't help in my case: it made no difference to my appetite or energy levels but I felt worse. You simply need to try it yourself and find your "ideal" carb intake.
A lot of people on the keto diet tend to go absolutely overboard with the unhealthy food that they pack into their plan. Sure a bunch of cheese, mayonnaise and bacon will fit into a seventy-five percent fat allowance, however, for your health these foods are not always the best option. Your day to day seventy-five percent fat allowance is meant to be used for healthy sources of fat such as such avocados, coconut oil, whole eggs, nuts and fats found in unprocessed meats such as beef, salmon, chicken thighs, ground pork or turkey.
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.
Julie Hand is a certified holistic health and nutrition counselor (Institute for Integrative Nutrition), personal fitness trainer (National Personal Training Institute), and yoga teacher (Kripalu Center for Yoga & Health). Though she can’t resist trying every science-backed health tip, she also has a penchant for crystals and astrology (don’t judge). You can find her walking the beach (coffee in hand, of course) and practicing the ukulele on weekends.
Now, there’s even evidence that a low-carb, high-fat regimen (as the keto diet is) helps you live longer, compared to a low-fat diet. In a study by the medical journal The Lancet that studied more than 135,000 adults from 18 countries, high carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction or cardiovascular disease mortality.
You’ll need to focus on titrating your insulin. Given the low amount of carbs in the Keto diet, I suggest you take detailed notes on how your blood sugar reacts to protein and fats. That way you can determine how much insulin to take with food. As for your basal, if you consistently go high/low without any bolus on board it might be a good idea to revisit your basal rates

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)?
Mustering the willpower to push aside the bread basket at your favourite restaurant does not make you a keto aficionado. The ketogenic diet is different from other low carb diets in that your glucose levels have to be so low that you have to moderate even the amount of protein that you consume. With 40% of calories coming from protein, protein will convert to glucose once consumed, which is not keto friendly. 
Nurse practitioners (NP) are advanced practice registered nurses that manage acute and chronic medical conditions, both physical and mental, through history and physical exam and the ordering of diagnostic tests and medical treatments. NPs are qualified to diagnose medical problems, order treatments, perform advanced procedures, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions within their scope of practice. Their education includes a Bachelor of Science in Nursing (BSN) or other undergraduate degree, and requires a license as a registered nurse (RN) and experience as an RN in a health care setting. They must graduate from an accredited graduate (MSN) or doctoral (DNP) program and achieve a board certification.
A well-formulated ketogenic diet, besides limiting carbohydrates, also limits protein intake moderately to less than 1g/lb body weight, unless individuals are performing heavy exercise involving weight training when the protein intake can be increased to 1.5g/lb body weight. This is to prevent the endogenous production of glucose in the body via gluconeogenesis. However, it does not restrict fat or overall daily calories. People on a ketogenic diet initially experience rapid weight loss up to 10 lbs in 2 weeks or less. This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by a fat loss. Interestingly with this diet plan, lean body muscle is largely spared. As a nutritional ketosis state sustains, hunger pangs subside, and an overall reduction in caloric intake helps to further weight loss.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
Lunch: pat dry chicken and cut into cubes. Lightly (!) salt and pepper. Heat a skillet over medium heat, once hot add coconut oil and fry chicken cubes until brown from all sides. Remove chicken, and add crushed garlic, curry paste and fish sauce to pan. Stir until fragrant and remaining oil in pan and curry paste are well combined. Then add coconut milk and whisk until well combined. Simmer and reduce sauce until desired consistency (1-3 minutes). Pour sauce over chicken and sprinkle with sesame seeds. Serve with baby spinach.

An interesting effect on sexual function was induced by the nutritional intervention (Table S1; Figure 4). The EMAS-SF questionnaire reported no statistically significant changes for sexual activity in men (Figure 4A). However, the FSFI questionnaire for sexual activity in women evidenced that excitation (p = 0.043) and lubrication (p = 0.013) improved with statistical significance throughout the study. Moreover, from baseline to maximum ketosis, a statistically significant increase was observed in the score for the orgasmic domain (Figure 4B; 0.95; p = 0.034). Based on the FSFI mean total score, women included in this study showed sexual dysfunction (total score = 9.55) at baseline. This total score was improved at maximum of ketosis (total score = 10.48) and at the end of the nutritional intervention (total score = 9.8).

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.
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]
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.

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!
“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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