More and more studies show that low-carb diets are an effective way to lose weight: A 2018 report out of Framingham State University found that after five months on a low-carb, high-fat diet, overweight adults burned about 250 more calories daily than people who ate a high-carb, low-fat diet. The keto diet in particular has a number of famous adherents, including Halle Berry, Katie Couric and Gwyneth Paltrow. Kourtney Kardashian blogged about doing keto, calling it “a really positive experience.” And keto-friendly recipes, snacks and meal plans have proliferated in the past few years.

Katie Wells, CTNC, MCHC, Founder and CEO of Wellness Mama, has a background in research, journalism, and nutrition. As a mom of six, she turned to research and took health into her own hands to find answers to her health problems. WellnessMama.com is the culmination of her thousands of hours of research and all posts are medically reviewed and verified by the Wellness Mama research team. Katie is also the author of the bestselling books The Wellness Mama Cookbook and The Wellness Mama 5-Step Lifestyle Detox.


The Keto diet versus Plate Method study triggered some challenges and a bit of criticism. In an editorial, Andrew Reynolds, PhD, a postdoctoral research fellow at the University of Otago, New Zealand, suggests that the much better results in those on the ketogenic diet may be due not to the diet itself but to the lifestyle changes and ongoing support that keto diet group received.5
One notable clinical trial of the ketogenic diet for schizophrenia occurred in 1965. Back then, one of the authors noted that in some of his schizophrenic patients a carbohydrate binge preceded eruption of their hallucinations and paranoia. The study put 10 women with schizophrenia on a ketogenic diet for two weeks. The diet was added to their standard treatment of medication and ECT (electroconvulsive therapy) and resulted in a significant decrease in symptoms. A week after the women resumed a standard diet, symptoms returned. Despite this preliminary, positive outcome, few researchers in the intervening 50 years have investigated the promising potential of the ketogenic diet in schizophrenia.
“Keto diets should only be used under clinical supervision and only for brief periods,” Francine Blinten, R.D., a certified clinical nutritionist and public health consultant in Old Greenwich, Connecticut, told Healthline. “They have worked successfully on some cancer patients in conjunction with chemotherapy to shrink tumors and to reduce seizures among people suffering from epilepsy.”
And that’s the kicker -- most people “going keto,” may not actually be following a true ketogenic diet since it’s hard to know for sure if your body’s in ketosis. Mancella explains that the only formal and valid method of determining if your body is in ketosis is if there are ketone bodies being excreted in your urine. “There are strips for purchase at local drug stores that are available to determine this,” she says. “Otherwise, we’re not actually sure if we’re in ketosis, and we’re just following a ‘low carbohydrate’ diet.”
There is quite a bit of research that has been done on the effects of a ketogenic diet, and the findings show a general reduction in blood pressure. This could be due to a higher concentration of potassium and a lower amount of sugar in the foods common to this diet. It may also be due to the weight loss benefits, as obesity is a causative factor in hypertension.
There are various ways to practice intermittent fasting on keto, including some that are less likely to trigger side effects like fatigue or cravings. Crescendo fasting gives you a break from fasting throughout your week, but is still very helpful for achieving the benefits of IMF. Dr. Cabeca and other experts, such as Amy Shah, M.D., advise their patients to check their urinary ketone levels (using ketone strips) and to aim for testing positively for ketones about three days per week.
Look for natural sources of electrolytes or take an over-the-counter supplement. “Avocados, leafy greens, asparagus, and cruciferous veggies are great for providing important electrolytes, says Josh Axe, DNM, DC, CNS, a certified doctor of natural medicine and clinical nutritionist. Dr. Axe also suggests a magnesium supplement to help you sleep and avoid cramps or constipation.
Despite its explosive popularity, there’s a lot of confusion about what the ketogenic (keto) diet really is. “Many people think they’re following a keto diet when they’re really just consuming a low-carbohydrate diet,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “So one person’s ‘keto diet’ may look very different than another’s.”
I’m sorry…no we don’t. Sure, more studies will happen, and more information is always good. But, we KNOW that keto works. You can argue that all you want…but in truth, facts don’t care about your feelings. There are plenty of studies, both in groups and in individuals, that prove beyond any reasonable doubt that going on a proper keto diet WILL improve your life as a diabetic, and will often allow the person to reverse diabetes completely (type 2, obviously). Not to mention the weight loss and the myriad of other health benefits it provides.
Dehydration. With fewer water-binding carbohydrates in the diet, the body is less able to hold onto fluids, which can lead to dehydration. Eating more salt can help offset this, but it can also raise blood pressure, creating a whole new set of issues. If you plan to follow a keto diet, hydration is key. To know how many ounces of fluid you need each day, Yancy recommends dividing your body weight in half. Then think of the resulting number as your daily fluid goal in ounces. So if you weigh 200 pounds, strive for 100 ounces of water a day.

But Jini’s doctor — intelligent though I’m sure he was — fell victim to the common confusion between nutritional ketosis and diabetic ketoacidosis, the latter of which being a life-threatening complication of Type 1 diabetes, where ketones are produced rapidly, overwhelming the body’s acid-base buffering system. This is a common misconception or myth about keto diets that I seek to dispel. 
It’s no secret that carbs—especially refined ones like sugary cereals, white bread and pasta, or sweet drinks—cause your blood sugar to spike and dip. So it makes sense that eating less of them can help keep things nice and even. For healthy people, this can translate to more steady energy, less brain fog, and fewer sugary cravings, Mancinelli explains.
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)
One way to find out if the keto diet is not be ideal for your cardiovascular health is by checking if your total-to-HDL cholesterol ratio is above 4 and/or your LDL-P remains high or increases after starting the keto diet. If this is the case for you, then you may fare better with a low to moderate fat diet with plenty of whole foods, fiber, monounsaturated fats, polyunsaturated fats (especially omega 3s), and limited saturated fats.
The researchers hypothesized that the positive effects that the ketogenic diet has on migraines are due to how ketone bodies inhibit neural inflammation and enhance brain mitochondrial metabolism. The ketone bodies do this by blocking high concentrations of glutamate (commonly found in both migraine and epilepsy sufferers) and reducing oxidative stress.
I am a 7 year stroke survivor that is partially paralyzed from the stroke. I work part time and while working I walk at least 2 miles at work three to five times per week, but I can only walk 1 mph if even that speed. Which I know average speed is 3 mph when walking. I am 40 pounds overweight due to not being to do cardio workouts. I take aspirin daily as a blood thinner. I have considered getting on the keto diet. I drink sweet tea and one dr pepper per day along with coffee and water. I talked to my dr about this diet all he could tell me was he hasn’t researched it enough but knew of someone that lost weight on it. For my health I need to maintain a healthy weight and not be overweight. I have a b12 deficiency along with folic acid. I have not been taking any supplements for either.

Because slimming down is the main reason most people consider altering their diet in the first place, it’s a good place to start. Because the ketogenic diet has been studied for so long, there’s actually a fair amount of research in this department. One 2013 meta-analysis compiled results from 13 different studies to determine how a diet featuring no more than 50 grams of carbohydrates per day stacked up against a low-fat diet. According to the researchers, those on the ketogenic diet lost more weight. It’s also important to note these studies occurred over a pretty lengthy amount of time, with a minimum follow-up of 12 months.
Ben Tzeel is a Registered Dietitian and Certified Strength and Conditioning Specialist (CSCS), holding a Masters in Nutrition from the University of North Carolina at Chapel Hill.Ben has lived with Type 1 Diabetes since 1999 and has never allowed it to hold him back from achieving his goals. He is a published fitness model and author who writes about exercise, nutrition, and diabetes.
Another one of my concerns long-term is that many people are being persuaded to remain on a ketogenic diet over a long period. In 3, 5, or 10 years, we are going to see a sharp rise in colon cancer cases. People in conventional dietary circles will then point fingers at all of us engaged in unconventional dietary advice and we will be lumped together and labeled as dangerous fads. The key is to be smarter and to view ketogenic dieting as the short-term tool/response it is, not as a solution to all health struggles.
Appetite regulation: One of the first things people notice when they’re in ketosis is that they’re no longer hungry all the time. In fact, research has shown that being in ketosis suppresses appetite. One study looked at people who lost weight by following a ketogenic diet for eight weeks and then reintroduced small amounts of carbs. The researchers reported that the levels of ghrelin (the “hunger hormone”) were suppressed in those who remained in ketosis, whereas those who were no longer in ketosis had higher ghrelin levels.

Here’s what we do know: The keto diet may be useful in treating symptoms of epilepsy, a seizure disorder. “The use of keto in treating epilepsy has the most evidence,” Angelone says. One study conducted by Johns Hopkins Medicine, for example, followed epileptic patients on the keto diet and found that 36 percent of them had a 50 percent reduction in seizures after three months on the diet, and 16 percent were seizure-free. However, experts aren't entirely sure why the keto diet has this affect, she adds.
The relation between a high fat diet and cancer is not conclusive. Recent epidemiological studies (17,58–60) could not explain a specific causal relationship between dietary fat and cancer. It has been found that altered energy metabolism and substrate requirements of tumour cells provide a target for selective antineoplastic therapy. The supply of substrates for tumour energy metabolism can be reduced by dietary manipulation (eg, ketogenic diet) or by pharmacological means at the cellular level (eg, inhibitors of glycolysis or oxidative phosphorylation). Both of these techniques are nontoxic methods for controlling tumour growth in vivo (61). Sugar consumption is positively associated with cancer in humans and test animals (58–61). This observation is quite logical because tumours are known to be enormous sugar absorbers. It has also been found that the risk of breast cancer decreases with increases in total fat intake (16). Further studies on the role of a ketogenic diet in antineoplastic therapy are in progress in our laboratory.
The low-carb, high-fat approach to the keto diet limits the types of foods you can have, and entire food groups are eliminated entirely. Beans, legumes, and whole grains are out, as are many fruits and vegetables. Many of these foods carry vitamins, minerals, and other nutrients you can’t get from any other source, and without them, you may start to experience nutritional deficiencies.
Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.
Truly Dr. Colbert is also a reputable source for more thorough science and modification of previous Keto extremes. The statements about Keto diets with dairy everyday are not true…I am a 66 year old professional (University trained) and have found medical people often very unknowledgable or partially knowledgeable which may be worse. I ask you Abbey to dig deeper…meet Dr. Colbert-not a quack and more in depth than your overview. Personally I am finding switch to more green’s and low glycemic vegetables and fruits with healthy fats, occasional dairy and healthy protein; a way of life that is helping our whole family. Please watch The Magic Pill…the help for family’s caught in old thinking from poor science (ie. Alex Keys) and with autism etc. and so much modern disease is in itself, motivation to search out more truth.

Registered dietitian Julie Stefanski is based in York and has specialized in the ketogenic diet for more than a decade. She also advocates for anyone starting keto, especially individuals who have not seen a doctor in more than a year, to first see a physician and/or registered dietitian to have their lab work checked and monitored. She also notes there are certain medications that cannot be used while on a ketogenic diet.  


Weight loss isn't the only benefit of this way of eating. Here is a piece from my friend Sybille Bellamy. We each have a child with Angelman Syndrome, which can lead to seizures. Our children not only have a better life on Ketogenic foods, but their brain function has also improved. Studies show similar benefits for people with epilepsy. Ketogenic diets may also help children on the autism spectrum.

ME: It is not essential. You can be fully ketogenic without any intermittent fasting. However, most people find it natural to do intermittent fasting as their hunger is reduced to where they don’t need a third meal. Keeping feeding time reduced to a smaller window during the day enables the body to use stored body fat for fuel longer, which benefits weight loss. My husband Craig and I still do intermittent fasting every day as maintenance. It just makes life easier only having to make two meals a day instead of three.
It’s not totally clear whether weight loss achieved on the keto diet can be maintained by most adults once the diet ends, both because the diet can be hard to follow and due to the body adapting metabolically. Long-term studies conducted on animals show that weight loss tends to level off after about six months on the diet, and sometimes may start to creep back up.
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.

thank you Dr. Jockers for the informative article. I have hypothyroidism from 3 parathyroid cysts being removed along with 80% of my thyroid. It is under control with Levothyroxine and liathyronine. I have been on the keto diet for almost 4 weeks and am still experiencing heart palpatations, dizzyness and low energy. I have been quite strict and feel disappointed. I have Chronic Lymphocytic Leukemia and my oncologist was ok with me going on it. I feel like this diet would help me have more energy and help my overall health. Any advise would be appreciated. thank you, Inika
Ok. I have MCT oil. It’s day six. I got a metallic taste in my mouth last night (day 5), and have had 2 hypoglycemia attacks over night (took small amount of OJ and some 2 tbsp of flaxseed meal with half & half). Slowly felt better throughout the day. Bought just about all the adrenal support products you recommend this a.m. My main issue since last night: my heart has been pounding, non stop. I read it might be cortisol induced reflexive hypoglycemia or something? I’ve never been diagnosed with adrenal exhaustion, but I am noticing tiredness and weight gain (I’m 47). So, the adrenal exhaustion perhaps is self diagnosed (I’m know, so annoying for a physician to hear! I hate saying it myself). But, I’m wondering, if I’m just perimenopausal instead, should I continue on keto? If so, will the heart pounding resolve after a certain time? (Days? Weeks?) Plesse excuse how long this is. Just trying to anticipate questions.
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)

This effect can also be demonstrated by researchers at Kraft Foods, published in the American Journal of Clinical Nutrition. For 12 weeks one group ate a low fat, calorie restricted date, and the other ate a low-carb, high-fat diet without restriction… other than low carb of course. After 12 weeks, the low-fat group lost 5.5 pounds and the low-carb group lost 10.8 pounds.

The ketogenic diet is a high-fat, very-low-carb diet plan. The goal of the diet is to reach a “ketosis” state. The more restrictive you are on your carbohydrates (less than 15g per day), the faster you will enter ketosis. Once in this state, rapid weight loss begins. Research does indicate that the ketogenic diet is most effective in weight loss by reducing visceral (body) fat.
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