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.
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]
Hi I’m new to Keto. I have been reading about it, and understanding what to eat and what not to eat. My problem is I’m not sure if I’m doing it correctly. I’m constantly hungry whereas information reads that I will never be hungry. I use fats as required along with topping up with vegetables in my meals yet this does not fill me up. I haven’t experienced the Keto flu and I’ve even put on weight! I have been doing this for about 3 weeks now. Any ideas where I am going wrong.
Very happy to have stumbled across your blog site (during a recipe search)  only to realise that I have recently purchased 2 of your books (I'm in Australia). Both of which I like.  I have been doing this way of eating since February, switched from WW which was progressing slowly and I was often hungry. I am never hungry on this plan and I am finding it so much easier. And I am losing weight twice as fast. After about 2 1/2 months doing Keto I realised that the lists I was using for a resource for net carbs in foods was completely wrong. It said mushrooms was 0.3 net carb per 100g and I was happily having 200g thinking it was 0.6g and it wasn't. I ended up checking some lists against the USA Agriculture list and found all were wrong.  So I started to make my own list using that website. This was a bit of a pain but at least I knew it was accurate. Anyway,  I found your site and could stop doing my list. YAY!  🙏 Thank you so much for providing accurate information that you have referenced and for all the other guides and recipes you have shared.  I really wish these guides were in my books though (I have your latest book), so can you please consider for the next book 😁. I had to print them after saving it to MS word for a friend (that has also bought a book)  and it's pages of poorly edited A4 paper.  Many thanks again 🙏
The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.

Something that makes the keto diet different from other low-carb diets is that it does not “protein-load.” Protein is not as big a part of the keto diet as fat is. Reason being: In small amounts, the body can change protein to glucose, which means if you eat too much of it, especially while in the beginning stages, it will slow down your body’s transition into ketosis. 

Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
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)

About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether.[18] Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions.[46] This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.[9]
Which leads us to your personality. You need to be VERY strong willed to follow this diet. It follows very strict rules and you need to be able to commit to this. It makes it hard to eat out with friends or eat with friends in general. It’s hard to find food that fits this diet in common restaurants, but and this takes us to the next point, your health goals might be more important.
Also, consider supplementing with the amino acid leucine, as it can be broken down directly into acetyl-CoA, making it one of the most important ketogenic amino acids in the body. While most other amino acids are converted into glucose, the acetyl-CoA formed from leucine can be used to make ketone bodies. It’s also present in keto friendly foods like eggs and cottage cheese.
A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence was inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]
High-protein ketogenic diet (HPKD): This version of the keto diet is often followed by folks who want to preserve their muscle mass like bodybuilders and older people. Rather than protein making up 20 percent of the diet, here it’s 30 percent. Meanwhile, fat goes down to 65 percent of the diet and carbs stay at 5 percent. (Caution: folks with kidney issues shouldn’t up their protein too much.)

A related clinical diet for drug-resistant epilepsy is called the medium-chain triglyceride ketogenic diet, in which MCT oil is extensively used because it’s more ketogenic than long-chain triglycerides. (13) Another dietary therapy for epilepsy called Low Glycemic Index Treatment (LGIT) was developed in 2002 as an alternative to the keto diet. LGIT monitors the total amount of carbohydrates consumed daily, and focuses on carbohydrates that have a low glycemic index.) (14)
A one-ounce (28-gram) serving of olives contains 2 grams of total carbs and 1 gram of fiber. This works out to a net carb count of 1 gram for 7–10 olives, depending on their size. If you don’t like olives or don’t want the net carbs they contain, then olive oil is a great option as well. Although you won’t get all of the benefits of olives by consuming olive oil, you will still get plenty of healthy fats and health-promoting compounds.
High-protein ketogenic diet (HPKD): This version of the keto diet is often followed by folks who want to preserve their muscle mass like bodybuilders and older people. Rather than protein making up 20 percent of the diet, here it’s 30 percent. Meanwhile, fat goes down to 65 percent of the diet and carbs stay at 5 percent. (Caution: folks with kidney issues shouldn’t up their protein too much.)
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.
The keto diet works by eliminating carbohydrates from the your daily intake and keeping the body’s carbohydrate stores almost empty, therefore preventing too much insulin from being released following food consumption and creating normal blood sugar levels. This can help reverse “insulin resistance,” which is the underlying problem contributing to diabetes symptoms. In studies, low-carb diets have shown benefits for improving blood pressure, postprandial glycemia and insulin secretion. (7)
Hello Myriam, I am a dual certified personal trainer and Sports Nutrition Specialist. I really love how concisely you have put this article together. I did notice that on your macro breakdown for a 1500 calorie diet you actually listed the protein intake at around 31% of the daily calories (117*4=468..468/1500=.31). I was wondering if you did this to bring the protein amount closer to 1 gram per pound of body-weight to preserve lean mass?
The low glycaemic index treatment (LGIT)[49] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[18] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]
Therefore, when you’re following a ketogenic diet plan for beginners, your body is burning fat for energy rather than carbohydrates, so in the process most people lose weight and excess body fat rapidly, even when consuming lots of fat and adequate calories through their daily food intake. Another major benefit of the keto diet is that there’s no need to count calories, feel hungry or attempt to burn loads of calories through hours of intense exercise.
The popular low-carb diets (such as Atkins or Paleo) modify a true keto diet. But they come with the same risks if you overdo it on fats and proteins and lay off the carbs. So why do people follow the diets? "They're everywhere, and people hear anecdotally that they work," McManus says. Theories about short-term low-carb diet success include lower appetite because fat burns slower than carbs. "But again, we don't know about the long term," she says. "And eating a restrictive diet, no matter what the plan, is difficult to sustain. Once you resume a normal diet, the weight will likely return." 

Ready to head out the door and start buying groceries? Slow down there, chief. Go through the pantry, fridge, freezer, and secret stashes under the bed, and get rid of foods with any significant carb content. In the first few days, you could end up craving them—badly. This means fruit, too. Even carrots and onions are too high-glycemic to work with keto, Wittrock says.
Like nuts, seeds are great for a snack on the go. But they're also a fun, crunchy addition to a salad. In addition to being low-carb and high-fat, seeds also offer a good serving of protein, which will help keep you full throughout the day. Listed in order of lowest to highest carb content per 1-ounce serving, the best seeds for the keto diet include:
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture, and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more food energy than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein, and carbohydrate is then evenly divided across the meals.[37]
Sulforaphane is a compound that is created when we crush or chew cruciferous vegetables. Once it is digested, sulforaphane activates a cytoprotective (cell-protecting) pathway that protects the cells from oxidative stress and removes toxins from the body. This is one of the main reasons why cruciferous vegetable consumption is linked to improved cognitive function and decreased cancer and heart disease risk.

A computer program such as KetoCalculator may be used to help generate recipes.[47] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[37]
Keep up electrolytes. The major electrolytes in our bodies are sodium, potassium and magnesium. Because a low carb diet (especially a keto diet!) reduces the amount of water you store, this can flush out electrolytes and make you feel sick (called “keto flu”). This is temporary, but you can avoid or eliminate it by salting your food liberally, drinking broth (especially bone broth), and eating pickled vegetables. Some people also choose to take supplements for electrolytes, but it’s best to first consult a doctor that understands and supports keto/low carb lifestyles.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
Leftovers will be another thing we will take into consideration. Not only is it easier on you, but why put yourself through the hassle to cook the same food more than once? Breakfast is something I normally do leftover style, where I don’t have to worry about it in the morning and I certainly don’t have to stress about it. Grab some food out the fridge, pre-made for me, and head out the door. It doesn’t get much easier than that, does it?
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.
A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures.[2] Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable.[2] In the largest trial of the ketogenic diet with a non-diet control[16], nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.[2]
Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 
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]

Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
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The keto diet also appears to help induce autophagy, which helps clear damaged cells from the body, including senescent cells that serve no functional purpose but still linger inside tissues and organs. In animal studies when rats are put on the ketogenic diet, autophagic pathways are created that reduce brain injury during and after seizures. (21)

By cutting carb intake significantly, we can drastically reduce insulin resistance, the precursor to type 2 diabetes. In addition, low carb diets, along with exercise, can be very effective at helping alleviate the symptoms and progression of type 2 diabetes. Beyond that, ketosis itself is appetite-suppressing, meaning your hunger will naturally check itself, increasing your caloric deficit and making you lose fat even faster. Read more about ketosis: What Is Ketosis, and How Long Does It Take to Get into Ketosis?
In this section you’ll find the original set of 12 weeks of Keto Menu Plans that thousands and thousands of people have used to lose up to 50 pounds or more on the Keto Diet!  Easy and delicious recipes, shopping lists and prep lists to make your transition into keto foolproof and effective!  You can use an app to input the data if you want to track your macros, but honestly if you’re following these plans closely you shouldn’t need to!
But even if you’re not trying to lose weight, the keto meal plans might appeal to you. By limiting sugars and processed grains, you lower your risk of type 2 diabetes. Eating an array of heart-healthy fats, like nuts, olive oil and fish, can decrease your risk of heart disease. And while some people stick to a super strict keto diet, with 75 percent of their diet coming from fat, 20 percent from protein and just five from carbs, even a less intense, modified version can help you reap the keto diet’s benefits.
The easiest macro to calculate in the ketogenic diet is fat. Once you've got your carbs and protein set, simply fill the rest of your daily calorie needs with fat sources. If you find yourself wanting to gain a bit of weight, add approximately 500 calories, or 55 grams. If you want to lose weight, cut down on your fat intake by 200-500 calories, or 22-55 grams.
There are so many tricks, shortcuts, and gimmicks out there on achieving optimal ketosis – I’d suggest you don’t bother with any of that. Optimal ketosis can be accomplished through dietary nutrition alone (aka just eating food). You shouldn’t need a magic pill to do it. Just stay strict, remain vigilant, and be focused on recording what you eat (to make sure your carb and protein intake are correct).
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. 

High-protein ketogenic diet (HPKD): This version of the keto diet is often followed by folks who want to preserve their muscle mass like bodybuilders and older people. Rather than protein making up 20 percent of the diet, here it’s 30 percent. Meanwhile, fat goes down to 65 percent of the diet and carbs stay at 5 percent. (Caution: folks with kidney issues shouldn’t up their protein too much.)
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][31][32] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.[9][33]
Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 
Take a 2 – 3 cups of lettuce, crumble in some bacon and dice a medium tomato. Mix that with two or three tablespoons of mayo, and toss after adding some splashes of hot sauce. Delicious, filling, full of fiber and healthy fats, and absolutely easy. I know the mayo sounds weird as a dressing, but trust us; it’s amazing! Add in some avocado chunks to boost potassium too! 

Also, consider supplementing with the amino acid leucine, as it can be broken down directly into acetyl-CoA, making it one of the most important ketogenic amino acids in the body. While most other amino acids are converted into glucose, the acetyl-CoA formed from leucine can be used to make ketone bodies. It’s also present in keto friendly foods like eggs and cottage cheese.
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