These are all keto related questions that a person looking into the ketogenic diet for the first time will have, and I’ve put together a comprehensive list of answers to these questions and more in my 3 Day Keto Kickstart Plan & Keto frequently asked questions linked to below.  If you’re new to keto I recommend starting there, and if you use that Keto Kickstart meal plan as written, I am confident that you will get into ketosis and be losing weight within 3 days of starting.  I’m excited for you!!!!
Touting their discovery as “a great step forward in weight loss history,” the panel were quick to offer up their hard earned cash to back the entrepreneurial pair. “We were shocked. The most we were hoping for was some advice…we weren’t even sure that we would manage to get any investors,” explained Samantha. After outstanding offers from each panel member, the sisters burst into tears.

What's more, it's especially important to make sure your diet is well-planned when you're eating keto-style, because the foods you can choose from are limited. In addition to checking in with a dietitian if you're able, Stefanski recommends that you "talk to your doctor and make sure she or he is aware that you'll be starting a diet that completely changes how your body metabolizes energy." You might also want to check your most recent bloodwork levels for things such as cholesterol, vitamin D, and other indicators of health because these can change while on keto. That's because for some people, a prolonged keto diet can result in certain nutritional deficiencies or even high cholesterol. But most experts will tell you that the ketogenic diet is not a permanent lifestyle change (as could be the case for something like the 80/20 approach to eating or a Mediterranean eating style).

To maintain ketosis (where you burn fat rather than sugar for energy), you need to keep your carb intake to around 20 to 50 grams daily. Some of my patients have to go to the lower end to get those results. That doesn't mean you can't incorporate some carbs: You can fit plenty of green vegetables and low-sugar fruits like berries and avocado into even a 20-gram carb allotment.
The concept of the glycemic index was developed in 1981 by David Jenkins to account for variances in speed of digestion of different types of carbohydrates. This concept classifies foods according to the rapidity of their effect on blood sugar levels – with fast-digesting simple carbohydrates causing a sharper increase and slower-digesting complex carbohydrates, such as whole grains, a slower one.[58]
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.
When ketone bodies accumulate in the blood, this is called ketosis. Healthy individuals naturally experience mild ketosis during periods of fasting (e.g., sleeping overnight) and very strenuous exercise. Proponents of the ketogenic diet state that if the diet is carefully followed, blood levels of ketones should not reach a harmful level (known as “ketoacidosis”) as the brain will use ketones for fuel, and healthy individuals will typically produce enough insulin to prevent excessive ketones from forming. [2] How soon ketosis happens and the number of ketone bodies that accumulate in the blood is variable from person to person and depends on factors such as body fat percentage and resting metabolic rate. [3]
Nutritional ketosis has been proposed as a mechanism through which hunger may be suppressed. A recent meta-analysis investigated the impact of diet on appetite and shed some light on this possible phenomenon (11). The meta-analysis included 12 studies which investigated the effect of either a very low energy diet (VLED: defined as <800 calories per day) or ketogenic low-carbohydrate diet (KLCD: defined as CHO consumption of <10% of energy or <50 g/day, but ad libitum consumption of total energy, protein and fat). Interventions ranged from 4 – 12 weeks and weight loss was from 5.0 to 12.5 kg. In all studies nutritional ketosis was confirmed in VLED and KLCD via circulating levels of β-hydroxybutyrate. Interestingly, both groups reported decreases in appetite. The results of this meta-analysis are noteworthy in two regards. The VLED groups were clearly and significantly hypocaloric, suggesting a state in which hunger should be increased, not decreased. Similarly, the KLCD groups experienced simultaneous reductions in weight and appetite, while eating an ad libitum diet. The results of this meta-analysis provide support for the theory that nutritional ketosis may exert an appetite suppressing effect.
Lastly, if you're active, you might need to make some adjustments to take that into account. "For the first one to two weeks, temporarily reducing your exercise load can be helpful as your body adjusts to being in ketosis," he says. "Additionally, for those who have an intense workout schedule, carb cycling may be a good option." Carb cycling essentially means you'll increase your carb intake on the days you're doing exercise, ideally just two to three days per week. "While low-carb days may be around 20 to 30 grams of net carbs daily, high-carb days can range all the way up to 100 grams, although it can vary based on your size and activity level," says Dr. Axe. (Related: 8 Things You Need to Know About Exercising on the Keto Diet.) 
To figure out how many fat grams specifically you want, you would take the total number of calories it takes to maintain your body weight (normally around 14-16 calories per pound of body weight). Subtract your protein calories from that number and then divide by 9 (number of calories per gram of fat). This should give you how many total fat grams you need to eat per day.

Still, there are limitations to the keto diet. The first few weeks on the diet can be rough, and cause what’s known as the keto flu. And some people may experience side effects like thyroid or hormone imbalance, adrenal fatigue, poor sleep quality, and extremely dry eyes. It’s also true that permanent ketosis may not suit everyone. However, there is a way to build a sustainable keto diet which utilizes intermittent, cyclical ketosis as opposed to long-term ketosis…
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.”
Hi Gigi, Low carb and keto is about the balance of macronutrients eaten (fat, protein and carbs), not specifically meat or lack thereof. Most people on keto do eat meat, though some people do vegetarian keto. Fat is actually necessary for many body processes. There is no issue for the kidneys with a high fat diet, but if you eat too much protein that isn’t great for the kidneys. It’s a common misconception that keto is high protein (it isn’t). Keto is great for diabetics as it naturally helps stabilize insulin. All of this being said, please know I’m not a doctor and you should consult your doctor on any medical questions or before starting any diet. If you have more questions that aren’t medical questions, I recommend our low carb & keto support group here.
Although studies have shown that the keto diet can reduce seizures for children with epilepsy, there is no evidence indicating that keto helps with other brain disorders or improves mental cognition, according to Harvard Health Publishing. Some studies show that keto may lower blood sugar for people with type 2 diabetes, but there is not enough long-term research to determine whether it’s safe and effective for diabetics.

Participants were recruited from the Durham Veterans Affairs Medical Center (VAMC) outpatient clinics. Inclusion criteria were age 35–75 years; body mass index (BMI) >25 kg/m2; and fasting serum glucose >125 mg/dL or hemoglobin A1c >6.5% without medications, or treatment with oral hypoglycemic agents (OHA) and/or insulin. Exclusion criteria were evidence of renal insufficiency, liver disease, or unstable cardiovascular disease by history, physical examination, and laboratory tests. All participants provided written informed consent approved by the institutional review board. No monetary incentives were provided.
Twenty participants were tasked with following a very-low-calorie keto (VLCK) diet consisting of 600 to 800 calories. They took supplemental docosahexaenoic acid (DHA) omega-3 fats, vitamins, and minerals. DHA is an important structural component of the human brain, which was added to participants’ diets to ensure their body had enough of the component during fat loss. They took vitamins and minerals to make up for the nutrients lost from carb-containing foods. Meanwhile, they also followed a “formal exercise program.” The program was not defined in the study paper, and the study authors were not available for comment by this story’s publication.
Some people on a keto or low carb diet choose to count total carbs instead of net carbs. This makes it more difficult to fit in more leafy greens and low carb vegetables (which are filled with fiber), so you should only try that if you don’t get results with a net carb method. And, start with reducing sugar alcohols and low carb treats before deciding to do a “total carbs” method.
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]
This process of burning fat provides more benefits than simply helping us to shed extra weight — it also helps control the release of hormones like insulin, which plays a role in development of diabetes and other health problems. When we eat carbohydrates, insulin is released as a reaction to elevated blood glucose (an increase in sugar circulating in our blood) and insulin levels rise. Insulin is a “storage hormone” that signals cells to store as much available energy as possible, initially as glycogen (aka stored carbohydrates in our muscles) and then as body fat.
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.
Since this is my full-time job, donations really help me keep afloat and allow me to post as much to the website as I do. I really appreciate any donation you want to give, but you can change the price yourself. I’ve added in $15 as the suggested price. I think that’s a very fair price considering other websites are charging in the hundreds of dollars, and I’ve seen what they are like on the inside.
Hello, following a Keto diet with IF but cholesterol ratios not proper. Diet fats come mainly from olive oil, avocado oil, once a week beef, no butter, bacon etc. Had to go back on statins. Goal is stay away from drugs. Is there a doctor/clinic in the Boston area that you can recommend that understands/tests what you explain in this article? Please advise.
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.
“As a physician, I see daily the tremendous impact that our pandemic of chronic nutritional disease is having on people and the health care system, despite our best conventional efforts over the last 40 years. I now focus my time and energy on counseling, supporting and guiding patients on the power of real food as medicine. Using the core principles of low-carb, high-fat eating and intermittent fasting, we see great improvements in diabetes, obesity, metabolic syndrome, polycystic ovary syndrome, NAFLD and many more chronic diseases. Diet Doctor is a great resource for my patients to help them in their journey.”
This work was supported by grants from the Fondo de Investigacion Sanitaria, (PI14/01012 and PI17/01167) research projects and CIBERobn (CB06/003), from the Instituto de Salud Carlos III (ISCIII), Fondo Europeo de Desarrollo Regional (FEDER) Spanish. DGA is grateful to the Colombian Department of Science, Technology and Innovation—COLCIENCIAS as a recipient of their pre-doctoral scholarship to support his work. Ana B Crujeiras is funded by a research contract “Miguel Servet” (CP17/00088) from the ISCIII.
“I recommend a ketogenic diet as a powerful tool to treat diseases such as type 2 diabetes, hypertension, metabolic syndrome and obesity in general. Oftentimes I am able to wean patients off most of their medications and have seen dramatic improvement in their health as a result of this diet. I recommend Diet Doctor to my patients on a regular basis as a resource to help them eat a ketogenic diet.”
On a second note, some individuals find they like to eat a little fruit along with protein before their final workout on Friday night as this will help restore their liver glycogen levels and give them the energy they need to push through that workout. Plus, by refilling the liver glycogen you will help put your body into a slightly more anabolic state so you don't see as much energy breakdown.
My point here is that the warnings about the ketogenic principles are well taken and well documented. My concern is implications that this is a fad. I don’t use the word diet with my patients and I’m concerned that the principles behind the label and the real results that these readers have commented on might get minimized. I have found it best to encourage patients to read authors like: Stephen Phinney, Jeff Volek, Patricia Daly, and Charles Gant and the be partners with their doctors and check blood work as they move along. I am not for or against the article. If ketogenic principles offer people enduring, satisfying, and cohesive change then why not read about its potential and flexilbity?
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more

“As a Diplomate of the American Board of Clinical Lipidology, I help my patients decrease their risk of diabetes, heart disease, stroke, and Alzheimer’s disease. Intermittent fasting, low-carb, high-fat (LCHF) diets, and ketogenic diets have powerful effects on adiposopathy, arterial inflammation, and endothelial dysfunction. Patients often come to me for a consultation because they have developed an extremely high LDL-P while on a ketogenic diet. We work together to improve their lipid profile by optimizing their nutrition and lifestyle using a personalized, integrative approach.”
It's important to keep in mind that when you are on a low-carb diet of any type, you will lose several pounds in the first few days. That's because your body is dropping water weight. When I returned to typical eating over the wedding weekend, I gained 4 pounds. I didn't overeat that weekend. I had just returned to eating carbs, so the water weight returned.

“As an American board-certified endocrinologist who moved back to Mumbai, I saw India’s diabetes epidemic and dogma through a different lens. Low carb plus intermittent fasting has proven very effective in the reversal of insulin resistance, fatty liver, PCOS, reduced fertility, obesity, metabolic syndrome, hypertension and even early diabetic neuropathy and nephropathy. I conduct Diabetes Self-Management classes every month while looking at the whole lifestyle: stress, sleep, exercise, mindfulness, self-care and nutrition. This works even in India’s predominantly vegetarian culture! I often refer patients to DietDoctor for low-carb recipes and FAQ’s.”
There are plant based healthy oils that have been in the food chain for thousands of years, including high-fat foods such as all nuts and seeds, avocados, extra virgin olive oil, sesame seed oil, black cumin seed oil (popular in the Middle East), palm oil sourced from sustainable producers, and the healthiest plant based fat of them all, coconut oil.
Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.
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.)
Hi Sam, it won’t work. You will be incredibly hungry and you won’t have any energy. The idea of the keto diet is to get your body used to use fat to burn energy not carbs. Since you won’t be eating carbs energy has to come from “something” and it can’t be protein. I can’t recall what happens when you have too much protein when doing Keto but it was something scary. In general, I do not recommend the Keto diet without some sort of supervision by your doctor or nutritionist that can watch your process and progress.
Often caused by lymph node removal or damage due to cancer treatment, lymphedema occurs because there’s a blockage in the lymphatic system and results in the swelling in leg or arm. A 2017 study involved patients who suffered from obesity and lymphedema and who embarked on a 18-week ketogenic diet. Weight and limb volume was significantly reduced. (5)
I did Atkins way back and successfully lost 40 lbs and also my gallbladder. Today, I love being in ketosis. (Down 35 lbs so far). There is a learning curve, for sure, and yes, I “fell off the wagon” for a time (long enough to gain a couple pounds back and feel hungry all the time and lethargic) but I am now back in ketosis & love the mental clarity, the energy, weightloss & best of all, not being hungry all the time!
While body weight decreased significantly (-8.5 kg) in these 21 diabetic participants, the mean weight loss was less compared with what we observed in the LCKD participants of an earlier trial (-12.0 kg) [18]. Given that the diabetic participants had a higher baseline mean weight than the LCKD participants of our previous trial (131 kg vs. 97 kg), this translates into an even more dramatic disparity in percent change in body weight (-6.6% vs. -12.9%). This lesser weight loss might result from several factors. First, in the current study, most of the participants were taking insulin and/or oral hypoglycemic agents that are known to induce weight gain[20,21] Second, these same agents, particularly insulin, inhibit ketosis, which is strived for in the earliest phases of the LCKD; while it remains unclear whether ketones actually play a role in weight loss on the LCKD, previous research in non-diabetic patients has shown a positive correlation between level of ketonuria and weight loss success [22]. Lastly, compared with our previous study the participants in the current study had more comorbid illness, lower socioeconomic status, and a shorter duration of follow-up (16 weeks versus 24 weeks), all of which are associated with reduced success on any weight loss program [23].
Too many "legal" high-calorie foods can sabotage your keto diet. So can lots of other things. One way to pinpoint those potential glitches is through a food journal. One study found people who tracked everything they ate lost twice the amount of weight as those who didn't track what they ate. A food journal also keeps you honest and compliant with your keto plan.
The first signs of ketosis are known as the “keto flu” where headaches, brain fogginess, fatigue, and the like can really rile your body up. Make sure that you’re drinking plenty of waterand eating plenty of salt. The ketogenic diet is a natural diuretic and you’ll be peeing more than normal. Take into account that you’re peeing out electrolytes, and you can guess that you’ll be having a thumping headache in no time. Keeping your salt intake and water intake high enough is very important, allowing your body to re-hydrate and re-supply your electrolytes. Doing this will help with the headaches, if not get rid of them completely.
Dr. Stephen Phinney, who has been doing research on ketogenic diets since the 1980s, has observed that people don't do as well when they are consuming a lot of these oils (mayonnaise and salad dressings are a common source). This could be because omega-6 fats can be inflammatory, especially in large amounts, or some other factor. In his studies, people didn't feel as well or perform as well athletically.

If you're doing everything else right but missing these elements, you'll stall your progress. Getting subpar sleep, not moving enough, and environmental toxins are among the factors that can stall weight loss even when you're vigilantly following a keto diet. What you eat matters, but how you live also dramatically affects weight loss. For many patients, dialing up sleep, reducing environmental and psychological stressors, and incorporating high-intensity burst training can be big needle movers to overcome plateaus.
Aude, Y., A. S, Agatston, F. Lopez-Jimenez, et al. “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat: A Randomized Trial.” JAMA Internal Medicine 164, no. 19 (2004): 2141–46. doi: 10.1001/archinte.164.19.2141. jamanetwork.com/journals/jamainternalmedicine/article-abstract/217514.
Never before had the judging panel unanimously decided to each invest millions of dollars into a potential company. But was a different story. A Low Cost - No Exercise Way to lose weight? The sharks got on board - and did it quickly. Kevin Daryl, a nutrionist, created the product to help the millions of people who have trouble losing weight. "Most people want to lose weight, but don't know how - they have other issues preventing them from losing weight the traditional way. With our product, they don't need to change anything, they can just add the supplement to their diet and start seeing the weight loss. - It's Keto, the easy way!" He launched the product for sale through his company website and it sold out within 5 minutes. “We even made sure we had more product than we thought we could sell, but all of it sold out within five minutes!” exclaimed Daryl said.

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.
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.
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.
You should then transition to a normalized set of macros. While keto dieting can be good for short term fat loss, it’s important that it not brainwash you into thinking that certain foods or macros are “bad”. Eating a balanced diet with an understanding of your total daily energy expenditure (TDEE) is the healthiest way to eat and the most sustainable way to lose weight long term.

Although the exact role of the keto diet in mental and brain disorders is unclear, there has been proof of its efficacy in patients with schizophrenia. And, to boot, it works to reverse many conditions that develop as a side effect of conventional medications for brain disorders, like weight gain, type 2 diabetes and cardiovascular risks. More research is needed to understand the role of the ketogenic diet in treating or improving schizophrenia, as the current available studies are either animal studies or case studies, but the benefits of a low carbohydrate, high-fat diet in neurology is promising.


Some people on a keto or low carb diet choose to count total carbs instead of net carbs. This makes it more difficult to fit in more leafy greens and low carb vegetables (which are filled with fiber), so you should only try that if you don’t get results with a net carb method. And, start with reducing sugar alcohols and low carb treats before deciding to do a “total carbs” method.
The keto diet is known for helping people lose a few pounds very quickly, says Becky Kerkenbush, RD, a clinical dietitian at Watertown Regional Medical Center. Carbs hold on to more water than protein or fat, so when you stop eating them, your body releases all that extra H2O by making you pee more. As a result, the scale might read a few pounds lower, and you may look a bit leaner.

I get many questions about intermittent fasting, the health benefits, the weight loss benefits, and the like. People normally use intermittent fasting for both the energy and mental clarity it can offer. But it’s not just good for that. It can offer breakthroughs of plateaus and even benefits in nutrient uptake in exercise. We go more in depth to intermittent fasting in Week 3 and 4, so keep your eyes peeled!

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