The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up?
In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week.
Make sure you’re eating whole, unprocessed foods when on keto. There are different types of keto diets, and some, like dirty keto, may be low-carb but they’re still full of inflammatory foods. Learn more about how dirty keto works. Your best anti-inflammatory game plan is to emphasize good fats, grass-fed proteins, and fresh, organic vegetables, like on the Bulletproof Diet. Learn more with this Bulletproof Diet Roadmap.
Thank you so much for this article! My husband and I have been following keto for a little over a month now and we love it! I did a lot of research before starting, and am still doing lots of research because I like to be armed with the best information I can have when friends question my choices. Just yesterday I had a friend tell me that our brains need carbs to function (more than what we get from veggies). I hadn’t heard that before so I didn’t know what to answer. Thanks to your article now I know, and I have lots more answers in case more points come up. 😉

In Europe and in North America the impact of mental illness on the individual and society is enormous. Each year, one in five people will be impacted by a mental health condition and over the course of a lifetime, almost one in three (29%). Since 2005 the rate of depression alone has increased 18%, now impacting 322 million people globally and the number one cause of disability in the world. 


Keto changes the way your body fuels itself. When you limit carbs, your body starts to burn fat, rather than glucose, for energy. You go into ketosis — when your liver converts fatty acids into molecules called ketones, an alternative source of fuel. Learn more about keto and how it works with this beginner’s guide. Burning ketones carries all kind of benefits: 


Roxy, I started at 283 in February 2018. I am now 212 with the hope to make 100lbs lost by Feb 2019. KETO is a life choice and comes with changes that have to be made! My mantra at difficult times in the beginning was to be different i must do different! Also most modern foods pizza and tacos can be adapted to keto way of eating. Just takes research and a little planning. I have tacos weekly!
Studies are emerging that ketogenic diets (in conjunction with other treatments) can either reverse progressive brain disorders or help repair the damage. These include traumatic brain injuries and neurodegenerative diseases like Alzheimer’s and Parkinson’s. The Wahl’s Protocol also utilizes this benefit of the ketogenic diet to help repair neurological damage from multiple sclerosis.
The good news is, if you’re a generally healthy adult, you can probably tolerate the keto diet. “It’s likely appropriate and safe for almost everyone,” says Robert Santos-Prowse, a Clinical Dietitian and the author of The Ketogenic Mediterranean Diet and The Cyclical Ketogenic Diet. “Ketosis is a natural metabolic state that everyone has spent some time in at some point in their lives. It has been proven to be most useful for weight loss and diabetes management, but it could provide benefit for some athletes and also might prove to be useful for many disease states including some cancers and forms of neurodegeneration.”
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)
The word “keto” often has negative associations for people living with diabetes, especially Type 1. DKA, diabetic ketoacidosis, is a life-threatening condition arising when the body produces too many ketones. So how does entering ketosis deliberately through a conscientious diet differ from entering it accidentally? The answer has to do with the level of ketones, the former causing “regulated and controlled production” and the latter causing an overabundance.

At any given intensity, a keto-adapted athlete burns more fat and less glycogen than a sugar-burning athlete. Long-term elite keto athletes can burn up to 2.3 times more fat at peak oxidation and 59% more fat overall than non-keto athletes, and they do it at higher intensities. They remain in the predominantly fat-burning zone at 70% of VO2max, whereas non-keto athletes switch over from predominantly fat burning to a spike in sugar-burning at 54.9% VO2max.
Another way to test the body’s response to nutritional ketosis is through breath acetone levels. This essentially shows how much of the ketones are being utilized by the body. I used a Levl meter (use the code wellnessmama at this link for $25 off) to test breath acetone levels. This device is more pricey but does not require strips so it can be used more often. I used it to test my response to certain foods or exercises and to see if they pulled me out of ketosis.
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.

The average person's diet contain about 55% carbohydrates, 30% fat, and 15% protein. On the keto diet, you eat a whole lot more fat, and a lot less carbs: 80% of the diet is comprised of fat, 15% is protein, and a mere 5% of calories come from carbohydrates. For someone on a 1,500-calorie diet, that translates to 19 grams of carbohydrates per day, which is less than what you find in one medium-sized apple.
If you’re wondering why iron is at risk on a meat-based diet, hear me out. Many grain foods provide a considerable amount of iron, because wholegrains naturally contain iron in their inner layer called the ‘germ’. Another reason is that some grain products can have iron added to them during manufacturing. So, once you cut grains out, your iron status could suffer, which can lead to unpleasant symptoms like tiredness and lethargy. It can even compromise your immune system.
Use Exogenous Ketones: Exogenous ketones are a fantastic way to train the body to use ketones for fuel before our body is good at creating ketones.  They also buffer hypoglycemic responses by providing ketones the body can use for energy rather than having a significant stress response when blood sugar drops.  A great exogenous ketone product that also has adaptogens and electrolytes is Keto Edge
You are so biased against Keto, this can be noticed very quickly because almost every positive thing you say about Keto, you immediately follow with a “but…” negative statement. And most of your negatives are simply saying it’s hard to maintain. You completely exaggerate the negatives “If you have one bad day and your body is kicked out of Ketosis, you immediately gain all of your weight back”. That is simply not true; if someone is on a Keto diet for 3 months, they will not gain that weight back in a day. Also, their body will be back into Ketosis the next morning. You say that the ADA doesn’t recommend 60-70 grams per meal, but it does (coincidentally I just left their website before coming here). I don’t claim to be a Diabetes expert; I admit that. But your bias is leaning heavily against Keto. “Moderation” is not your goal if you have diabetes. When you compare HbA1C levels, for example, you compare them with someone in Keto at less than 20 g of Carbs per day as compared to someone at a 70-90 gram of carbs per day diet. You should be fair and compare them with someone on a 200 g of Carbs diet. If you want to get rid of the effects of Diabetes, get on a Keto Diet, period. It MAY get rid of the effects completely, but in the very least it WILL reduce your Insulin needs to very low and you’ll have little-to-no side effects other than a relatively restrictive diet (most diets are WAY more restrictive than Keto). You back up everything with “science” and misleading numbers/arguments without providing any real evidence.
Test ketones in the late morning or afternoon. Blood and urine ketones are usually lowest right after waking up. Try testing later on, preferably a few hours after eating. Even if you’re only in ketosis for a portion of the day, you’re still getting some benefits, as discussed in this talk by Dr. Steve Phinney: Achieving and maintaining nutritional ketosis.
Often these children who have trouble gaining *don’t feel good* when eating, so they aren’t interested in eating much.  In the case of underweight children who crave refined carbs, the dopamine hit they get from eating the simple sugars may override enough of the discomfort of eating, making these nutrient-void foods the only ones they accept.  In addition, if their gut flora is off balance, the gut flora may be sending signals to the brain to keep consuming simple starches and sugars.
The main limitations of our study are its small sample size, short duration, and lack of control group. That the main outcome, hemoglobin A1c, improved significantly despite the small sample size and short duration of follow-up speaks to the dramatic and consistent effect of the LCKD on glycemia. For other effects, however, such as the rises in serum LDL and HDL cholesterol, the small sample size might be the reason statistical significance was not reached. Future studies of larger samples and containing a control group are needed to better address questions about the effect of the LCKD on serum lipids in patients with type 2 diabetes.
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.”
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)?
While sugar may be a great quick form of energy, it doesn’t keep your brain at its best. “There is a lot of evidence coming out which suggests that the brain operates more efficiently on ketones than it does on blood sugar, but the research is all fairly new,” Olin says. “Ketones are made to fuel the brain in the absence of glucose,” says Kristen Mancinelli, a registered dietitian and author of The Ketogenic Diet. “On a normal diet, the brain gets 100 percent of its energy from glucose. On a ketogenic diet, up to two-thirds of the brain’s energy comes from ketones. It’s understandable that brain function would change drastically on a ketogenic diet.” Here are 13 things doctors want you to know about the keto diet.
The same goes for people with type 2 diabetes. While some preliminary research suggests the keto diet may be safe and effective for certain people with type 2 diabetes, there’s still the risk for low blood sugar, especially for those on insulin, and the keto diet omits certain food groups known to benefit those with this disease. For example, a study published in September 2016 in the journal Nutrients highlights the importance of whole grains for helping to control weight as well as episodes of high blood sugar. Whole grains are off-limits on the ketogenic diet.

Thank you Dr Jockers! I recently came across your website and i absolutely love what you do. I am an advanced practice nurse and just started a part time keto coaching practice.I am already amazed by the changes i see in my clients. Do you have by chance a training program for keto coaches. If not, is there one out there that you recommend? Thank you in advance.
To minimize the risk of hypoglycemia, Yancy and his team decrease medication as soon as a patient starts the diet. While drugs like metformin and liraglutide (Victoza) are less of a concern, there are others that pose a substantial hypoglycemia threat. In addition to insulin, the sulfonylurea drugs glipizide and glyburide require a watchful eye, as they work by stimulating the pancreas to make more insulin, increasing the risk of dangerous lows in the face of insufficient carbohydrate intake. “People on this diet need to be prepared to check their blood glucose any time they feel like it could be getting too low,” says Urbanski. “I would say a minimum of twice a day, but ideally three to four times a day, at least in the beginning in order to see the effect of the diet on their blood glucose readings.”

In addition, as the Harvard School of Public Health points out, “Carbohydrate metabolism plays a huge role in the development of type 2 diabetes, which occurs when the body can’t make enough insulin or can’t properly use the insulin it makes.” When a food containing carbohydrates is eaten, the digestive system has to process these carbs and turns them into sugar which then goes into the bloodstream. The ketogenic diet majorly minimizes carbohydrate intake so prediabetics, as well as type 1 and type 2 diabetics, aren’t challenging their bodies with carbohydrate breakdown that can raise blood sugar levels and create problematic insulin demands for the body.
To avoid the overload of stress, I find my relief by being the person at the origin of my son’s quality of life. I am not a doctor, a pharmacist, or a research person. I am just Max’s mother. For almost 15 years I have been using food to treat the adverse side effects of his syndrome. Angelman Syndrome (AS) is one of many neurological disorders that can be treated with therapeutic diets.
In part, keto diet weight loss is a real thing because high-fat, low-carb diets can both help diminish hunger and boost weight loss through their hormonal effects. As described above, when we eat very little foods that supply us with carbohydrates, we release less insulin. With lower insulin levels, the body doesn’t store extra energy in the form of fat for later use, and instead is able to reach into existing fat stores for energy. 

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. 

Hi, I’m Bhuboy. Nutrition became my biggest passion after getting my blood chemical result showing my LDL cholesterol level over 481. I wanted to create a site where I could help you, my readers live a healthy and nutritious life. I believe we control our destiny, and we can choose to live a long and healthy life by eating right and treating our bodies with respect.
The good news here is no! All the evidence points to the fact that a low carbohydrate diet actually does lower blood glucose and A1c levels and does contribute to weight loss. The problem is we do not yet have enough large studies, over enough sustained years to support evidence that people with diabetes can remain on a highly restrictive Ketogenic Diet for the rest of their life and also not have other consequences to their health.

Keto flu is a real thing. Cutting your carbs to the bone and going into a state of ketosis (where your body burns fat for energy) can bring on a cluster of uncomfortable symptoms, such as headaches, fatigue, muscle aches, nausea, and diarrhea. The side effects are the result of your body transitioning to using fat as its primary source of energy instead of carbs, explains Kristen Mancinelli, MS, RDN, author of The Ketogenic Diet. Once it adapts to the new fuel source (usually within a week or two), you’ll start to feel better.

You’re a diabetic counselor and are talking about being worried about not being able to eat birthday cake? Hell I’ve been on keto since July 2016 and haven’t felt any urge to go back, simply because I feel so much better. Also the diet is really not all that restrictive, you can make desserts using stevia/erythritrol, coconut/almond flour, etc. I had ketogenic pizza the other night and it turned out great. Lots of great resources out there for food options. I’m not diabetic myself, but I used to be prone to hypoglycemia and keto has eliminated the issue since I’m not dependent on glucose. There are a lot of wrong ways to do keto though, and doing the diet correctly has a moderate learning curve.


In summary, the LCKD had positive effects on body weight, waist measurement, serum triglycerides, and glycemic control in a cohort of 21 participants with type 2 diabetes. Most impressive is that improvement in hemoglobin A1c was observed despite a small sample size and short duration of follow-up, and this improvement in glycemic control occurred while diabetes medications were reduced substantially in many participants. Future research must further examine the optimal medication adjustments, particularly for diabetes and diuretic agents, in order to avoid possible complications of hypoglycemia and dehydration. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
Bingo!! It’s all about the $. The info graphic at the very beginning is labeled Keto-Paleo. And is misleading. Contrary to popular belief the Paleo diet is plant based. It restricts carbohydrate and dairy consumption based on foods that cause an inflammatory response in the body. Keto restricts foods that cause a blood sugar spike two very different purposes. American nutrition is very obviously broken and any recommendation tied to a money making association should be taken with a grain of salt because you can bet there are $$ strings attached. Usually big Pharma funding.
Restricting carbohydrates.  Studies show that after three or four days without carbohydrate consumption, your body starts tapping its fat storage also known as ketosis. You’ll want to stay between 25–35 grams of carbs to get into ketosis, and that requires bucking mainstream, carb-heavy, and supposedly nutrient-rich foods like fruit and grains. There are good carbs you can eat that will help you stay in ketosis. Be sure to look over these more keto diet friendly fruit options.
Ketoacidosis occurs mainly in people with type 1 diabetes if they do not take insulin. In diabetic ketoacidosis (DKA), blood sugar and ketones rise to dangerous levels, which disrupts the blood’s delicate acid-base balance. People in ketoacidosis feel extremely ill and experience profound dehydration, vomiting, abdominal pain, and weakness. DKA requires hospitalization so that IV fluids and insulin can be given to gradually and safely lower blood sugar.
That's certainly the case with the ketogenic diet—a very low-carb meal plan—based on the findings of two recently published studies.1,2  Dr. Saslow and her team report that the individuals with type 2 diabetes who followed the keto diet lost significantly more weight than those on the low-fat diet espoused by the American Diabetic Association.1 These dieters also were able to get their hemoglobin A1c (HbA1c) below 6.5%, suggesting that some may have reversed their type 2 diabetes.1
It’s best to approach this change in eating as a way to feel better and become healthier, rather than as a “fad diet” or weight loss quick-fix. Dr. Cabeca recommends giving it six months to test the effects, keeping in mind that some trial and error is expected along the way. The diet should ideally be approached in step-wise fashion, focusing on alkaline first before adding in fasting and the keto aspect.
As ketosis begins, your body will start dumping its stores of glycogen, a substance in your fat and muscles that carries excess weight. This will increase how often you urinate and can lead to an inevitable loss of electrolytes, Dr. Rahnama says. Electrolytes are essential to cardiac function and normal heart beating. “The loss of electrolytes, such as sodium, magnesium, and potassium will put the dieter at risk of a cardiac arrhythmia,” Dr. Rahnama adds.
Hello Dr. Jockers, in the past few months I have been working on cleaning up my diet. Eating gluten & dairy free as much as possible. I started taking exogenous ketones at the same time. I got a juicer for Christmas and about 3 weeks ago I added celery juice ( 1st thing in the AM) and a carrot, apple, turmeric juice in the afternoon. Some days I am fine and other days I have sudden diarrhea within an hour of drinking the celery juice. I’ve read so much about the benefits of drinking it but am wondering if the ketones are reacting to it adversely? Please let me know your thoughts on this.

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The keto diet has a massive fan base that has grown at least in part due to the popular Netflix documentary The Magic Pill, which touts a trove of promising keto health benefits. But the fact of the matter is that most of the studies on the keto diet are premature. Meaning: They’re in small populations of humans, or they’re in rats. (And you are very different from a rat.)
Finally, a feasibility study was done on 10 cancer patients in 2012. All patients followed a ketogenic diet for 28 days after exhausting every other cancer treatment option. The results of the study found that 1 had a partial remission of their cancer, 5 stabilized and 4 continued progressing. It’s important to remember that these individuals had tried all other forms of cancer treatment. 60% of these individuals then stalled or improved their cancer rates by following a ketogenic diet for 4 weeks.

If you’re wondering why iron is at risk on a meat-based diet, hear me out. Many grain foods provide a considerable amount of iron, because wholegrains naturally contain iron in their inner layer called the ‘germ’. Another reason is that some grain products can have iron added to them during manufacturing. So, once you cut grains out, your iron status could suffer, which can lead to unpleasant symptoms like tiredness and lethargy. It can even compromise your immune system.

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