The only difficulty with some of these studies is that they tend to have small sample sizes, like this one that only has five cyclist participants and the data was largely skewed by the fact that only ONE cyclist experienced a large enhancement of exercise capacity after the keto diet. Their studies also tend to be short term. Back in 2014, Phinney and scientist Tim Noakes wrote an editorial that stated that in the past 31 years, there have only been a handful of studies measuring sports performance and low carb diets. Out of a total of 11, only 3 found exercise improvements.
Let’s also get one thing cleared up, there’s a difference between not pooping and constipation.  Constipation is obvious blockage and discomfort–there’s something there but it ain’t movin’.  Not pooping is well, not pooping.  There’s nothing there to come out.  When you  produce less waste, you poop less often–and on Keto, you’re going to poop less often.  The body is very efficient at extracting nutrients from meats and fatty foods.  The result is less waste.  So don’t mistake fewer bowel movements with constipation.
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.
More recently, a meta-analysis was published in the Journal of Neurology that assessed the impact of the ketogenic diet in treating epilepsy. It included a total of 19 studies with a total of 1084 patients. After analyzing the data, the researchers noted that the patients who stayed on the diet had a 2.25 times greater probability of treatment success (at least a 50% reduction in seizures).

So one study looked at the long-term effects of a keto diet in obese patients and after 24 weeks, patients lost weight, reduced their total cholesterol, LDL, triglycerides and increased their HDL. Another study conducted on 132 obese patients found that the low carb (keto) group lost more weight than the low fat group while improving biomarkers like decreased triglycerides, improved insulin sensitivity, and decreased fasting glucose. This all was confirmed in a 2013 meta-analysis, 13 RCTs (1,569 participants) found that patients assigned to a very low carbohydrate diet resulted in greater weight loss compared to those assigned to a low-fat diet.
What about fruits and vegetables? All fruits are rich in carbs, but you can have certain fruits (usually berries) in small portions. Vegetables (also rich in carbs) are restricted to leafy greens (such as kale, Swiss chard, spinach), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber, celery, and summer squashes. A cup of chopped broccoli has about six carbs.
Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920's, the mainstay of therapy was dietary modification. Diet recommendations in that era were aimed at controlling glycemia (actually, glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes [1,2]. For example, the Dr. Elliot Joslin Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat [3]. A similar diet was advocated by Dr. Frederick Allen of the same era [4].
When Steve contacted TheDiabetesCouncil, he wanted to know where to find information on meal plans for the Ketogenic Diet. There are many resources online where you can search for meal plans for the Ketogenic Diet. There are also many books you can purchase at your local bookstore. The Atkins Diet is the most well- known Ketogenic Diet in its Induction Phase which is the first 2 weeks in this diet.
A great long-term benefit of the ketogenic diet is reduced cravings for sugar and other unhealthy foods. However, you might initially have stronger cravings for carbs during the transition period. This can last anywhere from one to two days to around three weeks. But stick it out! At the end, you’ll be pleased with the reduced, and often eliminated, cravings.

Regarding keto diets specifically, studies have proven this method to be more effective than moderate protein diets in lowering blood glucose, promoting weight loss and lowering HbA1c in patients with Type 2 diabetes. A growing number of clinicians now agree that low-carb diets can effectively treat this disease. The fact remains: these diets remain controversial and contradict dietary guidelines, so they are not very often discussed or recommended in the clinical setting.
Most people already know about the keto flu, which can happen when you start the diet. It’s a result of the body adapting to the low-carb state. Lowering carb intake forces the body to burn ketones for energy instead of glucose. Once the body is in ketosis — burning fat instead of glucose — the keto diet is working. But you may not feel so great at first, hence the term keto flu.
In a March 2018 blog post, Dr. Ede provides a range of very helpful tips for anyone already on mood-altering or psychiatric medications who want to try a ketogenic diet, such as how to talk with your psychiatrist or mental-health provider and what laboratory metabolic tests the doctor should order to help monitor your response to the diet. Most importantly, she provides details about some specific medications — notably specific antipsychotic medications, anticonvulsant medications, and lithium — that should be carefully monitored.
From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A1c.

I have serious doubts that eliminating an entire food group is healthy. What’s not being considered is that perhaps there is something in the type of carbohydrates that many people consume in the U.S. that is unhealthy, and not necessarily that all carbohydrates are bad for you. Eliminating these bad carbohydrates might work because you’re actually eliminated a huge source of heavy metal poisoning. Research done by Renee Dufault of the Food Ingredient and Health Research institute strongly suggest that foods laden with preservatives and mercury-laced processed food additives have a strong causal effect on health conditions ranging from ADHD to diabetes. If you are eating processed foods in the U.S., you’re getting a steady diet of heavy metal poisoning from the preservatives, pesticides, and concentrations of mercury in the U.S. food supply. If “food” can sit on a shelf for long periods of time without spoiling, there’s some kind of preservative in it that just might eventually kill you by triggering whatever dis-ease you are genetically predisposed to acquiring. You can read more about her research in her book _Unsafe At Any Meal:What the FDA Does Not Want You To Know About the Foods You Eat_. There is a free tutorial to help you apply what you’ll learn in the book on this web site: http://www.foodingredient.info I wish someone with the money to do more research would find out if its the carbohydrates that are not good for you, or the chemically-laden carbohydrates and beverages that U.S. Americans ingest that are the real culprit.
It’s only dangerous to not get enough carbs at each meal if one is taking too much meds or insulin for the amount of carbs they are eating! Restricting carbohydrates doesn’t lead to hypoglycemia unawareness, but having lots of lows and lots of highs will (and decreasing insulin and carbs leads to way fewer highs and fewer lows, or at least it can). On the other hand, being in ketosis does make low blood sugars less negative as an experience. I still feel my lows just fine, but they are less of an emergency because my brain still works (feeding on ketones) and by body doesn’t freak out and release tons of adrenaline that then makes me want to eat a house. Mind you, I still wake up and know immediately if I’m low, I know from experience and how it feels in my head and body but without the crazy shakes. This is not unawareness but it is less reactive.
As both study groups acknowledge, additional research is needed to tease out any and all of the factors that may be producing the weight loss and decrease in HbA1c, says Dr. Gonzalez-Campoy, for example  there may be other mechanisms of action that are helping these individuals to achieve weight loss, including changes in the gut microbiome, increased insulin sensitivity, enhanced leptin response, and decreased ghrelin levels, each of which contribute to weight loss.
"We recommend against 'dieting', which is invariably a short-term solution," Dr. Gonzalez-Campoy, tells EndocrineWeb, "and since weight loss may be accomplished by a reduction in calories by any means, a ketogenic diet that restricts carbs is simply shifting the calories away from foods that typically demand insulin as in both of these studies.1,2  
It’s important to note, however, that most of the research is being done on diseases and disorders, not specifically weight loss. That doesn’t mean there hasn’t been evidence of weight loss as a benefit of the eating pattern, just that the studies performed specifically for the benefits for long-term weight loss are limited. There’s anecdotal evidence out there, of course, but there was evidence of weight loss associated with a low-fat diet in the '90s… until that farce came falling down around our collective shoulders as the long-term evidence came rolling in to the contrary.

These findings were backed up in a 2012 study which had obese diabetics follow a ketogenic diet for 12 months. The researchers found lower fasting glucose levels, improved cholesterol markers and improved HA1c readings. Remember, carbs and glucose are not required when on a ketogenic diet, as stable, clean burning energy is sourced from fat. This makes controlling blood sugar levels near foolproof.
Try to be patient. Although some people get into ketosis relatively quickly, it can take others a while. Unfortunately, people who are insulin resistant often have a longer journey. Put in a solid month of consistent keto eating, and try to ramp up your physical activity, if possible. Within four weeks, you should definitely be in ketosis and experiencing its benefits.
That might be part of the reason the keto diet is thought to be a better fit for endurance athletes. But even for them, evidence is mixed. "The keto diet has been popular with athletes that engage in long endurance events, because it requires them to rely on less frequent carbohydrate feedings to fuel their exercise (think gummies, drinks, and goos) and more on their body fat stores," Brown explains. "This can decrease uncomfortable gastrointestinal symptoms (fewer stops at the porta-potties!), but a keto diet can be as challenging to maintain for an athlete as it is for a layperson."
It’s a fairly common scene for new keto dieters. Aubrey Marcus recently referenced a highly-disturbing stat that 25% of physicians still equate consuming dietary cholesterol with increased blood cholesterol, an association that has been unequivocally refuted by recent science. But before you accept AHA-sanctioned diet advice, determine if there’s actually a problem.
Plagued by pimples? You may start to notice a difference in your skin on the keto diet, especially if you were a former sugar addict. Consuming lots of empty carbs is linked to worse acne—in part because these foods trigger inflammation and signal the release of hormones that up the production of pore-clogging oils, according to a review published in the Journal of the Academy of Nutrition and Dietetics. Some findings suggest that curbing your carb intake could help solve these problems, improving your skin as a result.
Reduced hunger. Many people experience a marked reduction in hunger on a keto diet. This may be caused by an increased ability of the body to be fueled by its fat stores. Many people feel great when they eat just once or twice a day, and may automatically end up doing a form of intermittent fasting. This saves time and money, while also speeding up weight loss.
Oh yes global warming is real and so is global cooling. About 3 years ago it was officially recognized that the earths axis has tilted a 10nth of a degree. the north pole is now pointed more towards the sun than before making the northern hemisphere warmer. It has nothing to do with mankind at all! it’s called natural and is somewhere between the last ice age and the next.
Thanks Dr. Jockers…very informative article. Im into pure keto diet almost a week now but started illiminating sugar and carbs 3weeks ago and the side effects that i’ve encountered are frequently urinating and light headache only. Is it good or not? I’ve never consult a specialist before doing keto diet but i do my research, is it okay? As of now i’ve loose almost 11lbs. Im just curious how can i get the percentage of fats, protein etc in my meals? Do i need to measure it all? How can i measure the percentage of foods that i need to eat?is there any ways?
Work towards cycling fasting days so you’re fasting on 2–3 nonconsecutive days per week (e.g. Tuesday, Thursday and Saturday). Stick to only light exercise or yoga on fasting days to reduce feeling exhausted or hungry, keeping higher intensity activities for your non-fasting days. This approach allows for more dietary and lifestyle “moderation” because the goal isn’t to eat 100 percent “perfectly” all the time.
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