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]

In most circles, ketosis refers to nutritional ketosis, an optimized state in which you burn fat instead of sugar. Nutritional ketosis has been used to treat epilepsy since the 1920’s and its popularity for mental acuity and weight loss has surged recently. More technically, ketosis refers to a metabolic state in which most of your body’s energy comes from ketones in the blood, as opposed to glycolysis, in which energy supply comes from blood glucose. Ketones are the energy source made by the body (in the liver) when there’s not enough carbohydrates to be burned for energy demand, so the body turns to fat for energy. The body enters ketosis when blood sugar levels are below a certain level, and liver glycogen is no longer available to produce glucose for energy.

Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms. 

In steps 4 or 5, the ketogenic phases were ended by the physician in charge of the patient based on the amount of weight lost, and the patient started a low-calorie diet (800–1500 kcal/day). At this point, the patients underwent a progressive incorporation of different food groups and participated in a program of alimentary re-education to guarantee the long-term maintenance of the weight loss. The maintenance diet consisted of an eating plan balanced in carbohydrates, protein, and fat. Depending on the individual, the calories consumed ranged between 1500 and 2000 kcal/day, and the target was to maintain the weight lost and promote a healthy lifestyle.
The National Academy of Medicine recommends a minimum intake of 130 g of carbohydrate per day.[23] The FAO and WHO similarly recommend that the majority of dietary energy come from carbohydrates.[24][25] Low-carbohydrate diets are not an option recommended in the 2015-2020 edition of Dietary Guidelines for Americans, which instead recommends a low fat diet.
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]

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]


But there is evidence that low-carb diets may increase metabolism, according to a paper published November 14 in BMJ. Researchers found that overweight adults who lowered carbohydrates and added more fat into their diets burned about 250 calories more each day than people on high-carb, low-fat diets. The study is impressive because it's the largest, most expensive, and controlled study of its kind.
Very low calorie diets are designed to bring on a mild form of ketosis, which means your body shifts from using primarily carbohydrates to fat as an energy source. The relative safety of ketosis is a hotly debated topic. In very low calorie diets, which are medically supervised diets, ketosis is supported for a short period of time to produce rapid weight loss in people who are extremely obese. It's not something you try at home simply because you want to lose a few pounds. Very low calorie diets and ketosis in people who are simply overweight can be dangerous.
Your individual fat adaptation period. Remember your body needs time to become fat-adapted and that time depends on your metabolism. For instance, if you’re coming off a Standard American Diet (SAD) and your adult body has never run on ketones before, your adaptation period might take a little longer. You’ll only experience the true weight loss effects of keto when your body is actually running on ketones.
Ketogenesis has existed as long as humans have. If you eat a very low amount of carbohydrates, you starve your brain of glucose, its main fuel source. Your body still needs fuel to function, so it taps into your reserve of ketones, which are compounds the liver creates from fat when blood insulin is low. This process is known as ketosis: It’s like when a hybrid car runs out of gas and reverts to pure electricity.
Hi Danielle, yes, most Keto Recipes I’ve seen on social media don’t look very appealing to me either. I have a Keto Breakfast Casserole and a Green Smoothie on the blog you can use the search bar in the menu, just enter “keto” and they’ll all appear. I am also working on a 21-Day Keto Challenge e-book at the moment. If you’re interested in being notified when it’s ready I recommend signing up for my newsletter, safest way to not miss it.
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.
12. Ferrer-Garcia M., Pla-Sanjuanelo J., Dakanalis A., Vilalta-Abella F., Riva G., Fernandez-Aranda F., Sanchez I., Ribas-Sabate J., Andreu-Gracia A., Escandon-Nagel N., et al. Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls. Appetite. 2017;117:284–293. doi: 10.1016/j.appet.2017.07.007. [PubMed] [CrossRef] [Google Scholar]
“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.”
d) Or does the entire question revert back to a classic calorie counting exercise? In this case, I’ll eat the minimum amount of protein that is needed to prevent my muscles from being cannibalized (for energy) and for the rest, I’ll limit my dietary fat intake per day to a level, where its energy + energy currently obtained from adipose tissue match my total energy need? (I’ll leave gluconeogenesis out of this equation for simplicity.) If this is the case, I’ll lose adipose tissue, i.e. lose weight, but the interesting question still remains: How much energy can my body extract from the adipose tissue at its best? How can I maximize the share of energy coming from adipose tissue instead of dietary fat?
As of 2016 it was unclear whether low-carbohydrate dieting had any beneficial effect on cardiovascular health, though such diets can cause high LDL cholesterol levels, which carry a risk of atherosclerosis in the long term.[9] Potential favorable changes in triglyceride and HDL cholesterol values should be weighed against potential unfavorable changes in LDL and total cholesterol values.[31]
Metabolic flexibility: The ketogenic diet is not metabolically flexible. On the diet, your body adapts to using fats for fuel, which, in turn, means it is no longer adapted to using carbs efficiently. People have the tendency to follow the diet strictly for a few months, get the results they want, and then switch right back to a carb-happy diet.  If you introduce a lot of carbs when your body isn’t adjusted to handling them, you may gain back all of the fat you lost, if not more. It's often the case that many people gain fat after reintroducing carbs because their calories inadvertently go up or they get nutrient timing wrong. When transitioning out of keto, re-introduce carbs carefully to ensure your suffering wasn’t all for nought.
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
Doing a 1:1 substitution would probably change the macros too much but that doesn’t mean that you have to eat dairy to eat a ketogenic diet. If you want to use the meal plan you’d have to adjust it with other sources of fat so that you match the macros. It will require a little work (I recommend using an online diary like MyFitnessPal for support) but you’ll end up with a plan that works for you and your needs

Keto diets are high in healthy fats and protein also tend to be very filling, which can help reduce overeating of empty calories, sweets and junk foods. (4) For most people eating a healthy low-carb diet, it’s easy to consume an appropriate amount of calories, but not too many, since things like sugary drinks, cookies, bread, cereals, ice cream or other desserts and snack bars are off-limits.


In one week my husband lost 1.5 kg because of Keto diet and recipes. Thank you for the insights and tips. I would like to have a complete recipe for meals everyday and hoping by subscribing I will receive try my mail. I will keep u posted. It takes 2 to tango. The one who wants to diet must be cooperative with the plan and execution while the other person who is preparing the food must be patient to the dieting person. Its not easy to change meals so patience is required
Thanks for this inputs. 20 years ago I gain 17 pounds a year for 5 years. I was healthy but my dr told me start diet, any diet just come back in a month I want to see you start loosing… I started Atkins and lost 7 pound in a month. She was checking my progress every six months and checking my condition. I lost 64 pounds in 3 years. Now I started eating out of control. I am eating healthy but too much… I gain 40 pound back after 20 years. Now I will start again my Atkins to take off 30 pounds…
^ St Jeor ST, Howard BV, Prewitt TE, Bovee V, Bazzarre T, Eckel RH (October 2001). "Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association". Circulation. 104 (15): 1869–74. doi:10.1161/circ.104.15.1869 (inactive 15 February 2019). PMID 11591629. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. ... Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. ... High-protein diets may also be associated with increased risk for coronary heart disease due to intakes of saturated fat, cholesterol, and other associated dietary factors.
Hence, the 2 main objectives of this study were to assess the changes in body composition and muscle strength promoted by a VLCK diet in the treatment of obese patients and to compare different methodologies used to evaluate body composition. To achieve this, body composition was evaluated by 3 potent and well-validated techniques: dual-energy X-ray absorptiometry (DXA), multifrequency bioelectrical impedance analysis (MF-BIA), and air displacement plethysmography (ADP) at different stages during the weight reduction process induced by a VLCK diet.
Published studies established the metabolic advantage of low-carb diets.4,3,15 A recent pilot study–though flawed and biased against low-carb eating–showed a significant increase in energy expenditure (100-150 calories/day) associated with a ketogenic diet.16 If sustained, this would lead to ~ 10 to 15 pounds of fat lost, or not gained, over a year.

The popular belief that high-fat diets cause obesity and several other diseases such as coronary heart disease, diabetes, and cancer has not been observed in recent epidemiological studies. Studies carried out in animals that were fed high-fat diets did not show a specific causal relationship between dietary fat and obesity. On the contrary, very-low-carbohydrate and high-fat diets such as the ketogenic diet have shown to beneficial to weight loss.
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