A Ketogenic Diet for Beginners

A Ketogenic Diet for Beginners

A ketogenic diet (keto) is a very low-carb diet, which turns the body into a fat-burning machine. It has many potential benefits for weight loss, health and performance, but also some potential initial side effects.

A ketogenic diet is similar to other strict low-carb diets, like the Atkins diet or LCHF (low carb, high fat). These diets often end up being ketogenic more or less by accident. The main difference between strict LCHF and keto is that protein is restricted in the latter.

A keto diet is designed specifically to result in ketosis. It’s possible to measure and adapt to reach optimal ketone levels for health, weight loss, or for physical and mental performance. Below you can learn how to use keto to achieve your personal goals.

Make keto even simpler by signing up for our free two-week keto challenge. Get unlimited meal plans, shopping lists and much else with a free membership trial.

 





 

What is Ketosis?

KetosisThe “keto” in a ketogenic diet comes from the fact that it makes the body produce small fuel molecules called “ketones”.1 This is an alternative fuel for the body, used when blood sugar (glucose) is in short supply.

Ketones are produced if you eat very few carbs (that are quickly broken down into blood sugar) and only moderate amounts of protein (excess protein can also be converted to blood sugar).

Ketones are produced in the liver, from fat. They are then used as fuel throughout the body, including the brain. The brain is a hungry organ that consumes lots of energy every day,2 and it can’t run on fat directly. It can only run on glucose… or ketones.

On a ketogenic diet your entire body switches its fuel supply to run almost entirely on fat. Insulin levels become very low and fat burning increases dramatically. It becomes easy to access your fat stores to burn them off. This is obviously great if you’re trying to lose weight, but there are also other less obvious benefits, like for example less hunger and a steady supply of energy.

When the body produces ketones it’s said to be in ketosis. The fastest way to get there is by fasting – not eating anything – but obviously it’s not possible to fast forever.

A ketogenic diet, on the other hand, can be eaten indefinitely and also results in ketosis. It has many of the benefits of fasting – including weight loss – without having to fast.

Learn more about ketosis

 

checklistWho should NOT do a ketogenic diet?

Most people can safely do a ketogenic diet. But in these three situations you may need extra preparation or adaptation:



 

The Benefits of a Ketogenic Diet

The benefits that come from a ketogenic diet are similar to those of any strict low-carb diet. However, the effect might be even greater since protein is more restricted. This raises ketones more, and lowers insulin (the fat-storing hormone) more.

 

 


 

Weight loss

Weight-lossTurning your body into a fat-burning machine has obvious benefits for weight loss. Fat burning is vastly increased while insulin – the fat storing hormone – levels drop greatly. This creates ideal circumstances in which fat loss can occur, without hunger.

Around 20 scientific studies of the highest class (RCTs) show that, compared to other diets, low-carb and ketogenic diets result in more effective weight loss.3

How to Lose Weight Using Optimal Ketosis

Learn more about losing weight on low-carb diets


 

Diabetes type 2 reversal

reverse-t2-diabetes-1200A ketogenic diet is excellent for reversing type 2 diabetes,4 since it lowers blood sugar levels and the negative impact of high insulin levels.

Learn more about reversing type 2 diabetes using a low-carb diet


 

Improved mental focus

Ketosis results in a steady flow of fuel (ketones) to the brain. And on a ketogenic diet you avoid big swings in blood sugar. This often results in the experience of increased focus and improved concentration.

A lot of people specifically use keto diets specifically for increased mental performance.

Interestingly, there’s a common misperception that eating lots of carbs5 is needed for proper brain function. But this is only true when ketones are not available.

After a few days (up to a week) of keto-adaptation – during which people may experience some difficulty concentrating, have headaches and become easily irritated – the body and brain can run effortlessly on ketones.

In this state many people experience more energy and improved mental focus.


 

Increased physical endurance

Ketogenic diets can vastly increase your physical endurance, by giving you constant access to all the energy of your fat stores.

The body’s supply of stored carbohydrates (glycogen) only lasts for a couple of hours of intense exercise, or less. But your fat stores carry enough energy to easily last for weeks or even months.

When you’re adapted to burning primarily carbohydrates – like most people are today – your fat stores are not easily available, and they can’t fuel your brain. This results in constantly having to fill up by eating before, during and after longer exercise sessions. Or even just to fuel your daily activities and avoid “hanger” (hungry and irritable).

On a ketogenic diet this problem is solved. As the body and brain can easily be fueled 24/7 by your powerful fat stores, you can keep going forever like the Energizer Bunny.

Whether you are competing in a physical endurance event, or just trying to stay focused on reaching some other goal, your body has the fuel it needs to keep you going and going.

Two problems

So how is it possible that most people believe that carbs are necessary to perform exercise? There are two reasons. To unlock the power of ketogenic diets for physical endurance, and not instead suffer reduced performance, you need:

  1. Enough fluid and salt
  2. Two weeks of adaptation to burning fat – it does not happen instantly

Learn more about maximizing physical endurance on low-carb ketogenic diets

Metabolic syndrome

There are many studies showing that low-carb diets improve markers of metabolic syndrome6 such as blood lipids, insulin levels, HDL-cholesterol, LDL particle size and fasting blood sugar levels. Improvements have been shown to be even greater when carbs and protein are restricted to a the point of being steadily in nutritional ketosis.


 

Epilepsy

The ketogenic diet is a proven medical therapy for epilepsy that has been used since the 1920s. Traditionally it has mainly been used in children with uncontrolled epilepsy despite medication.

More recently it has also been tested successfully by adults with epilepsy, with similar good results. There are many randomized controlled trials that demonstrate the effectiveness of the ketogenic diet in decreasing seizures in patients with epilepsy.7

Using a ketogenic diet in epilepsy is that usually allows people to take less anti-epileptic drugs, while remaining seizure-free. It’s not unusual to even be able to completely stop taking these drugs while staying seizure-free.

As all anti-seizure medications have side effects – like drowsiness, reduced concentration, personality changes or even reduced IQ – being able to take less or no drugs can be hugely beneficial.

More about controlling epilepsy on a ketogenic diet

Other possible benefits

Acne,8 Alzheimer’s,9 Cancer,10 Migraine,11 Parkinson’s disease.12

 



 
 

What Do You Eat on a Ketogenic Diet?

Here are typical foods to enjoy on a ketogenic diet. The numbers are net carbs per 100 grams. To remain in ketosis, lower is generally better:

 
Low Carb Keto Foods
 

The most important thing to reach ketosis is to avoid eating most carbohydrates. You’ll probably need to keep carb intake to under 50 grams per day of net carbs,13 ideally below 20 grams. The fewer carbs the more effective.

This means you’ll need to completely avoid sweet sugary foods, plus starchy foods like bread, pasta, rice and potatoes. Basically follow the guidelines for a strict low-carb diet, and remember it’s supposed to be high in fat, not high in protein.

A rough guideline is below 10% energy from carbohydrates (the fewer carbs, the more effective), 15-25% protein (the lower end is more effective), and 70% or more from fat.

More specific advice on what to eat – and what not to eat
 

Examples

Here are examples of keto recipes:

All keto recipes

Diet plans

Here are two weeks worth of recipes for breakfast, lunch and dinner on a ketogenic diet:

14-Day Ketogenic Diet Plan

Get lots of weekly keto meal plans, complete with shopping lists and everything, with our premium meal planner tool (free trial):

 

Video course

How to Eat Low-Carb, High-Fat Video Course

Do you want to watch an 11-minute video course on how to eat a ketogenic LCHF (low carb, high fat) diet? And about the most important things to think about? Sign up for our free newsletter and you’ll get instant access to it:

The newsletter arrives once a week with low-carb news, recipes and tips free from ads or industry influence. Your email address is kept 100% private. To unsubscribe just press “unsubscribe” at the bottom of any newsletter.

 

Visual keto guides

For more on specific areas – like what fruits or nuts to eat on a ketogenic diet – check out our visual guides:

 

Get started

For everything you need to get started – meal plans, shopping lists, daily tips and troubleshooting – just sign up for our free 2-week keto low-carb challenge:

challenge_pic2

More

Low Carb for Beginners

Low Carb Foods
 
 




 

How to Know You’re in Ketosis

How do you know you’re in ketosis? It’s possible to measure it by testing urine, blood or breath samples. But there are also telltale symptoms, that require no testing:

Symptoms of ketosis: dry mouth, thirst, frequent urination

  • Dry mouth and increased thirst. Unless you drink enough and get enough electrolytes, like salt, you may feel a dry mouth. Try a cup of bouillon or two daily, plus as much water as you need.
  • Increased urination – another ketone body, acetoacetate, can end up in the urine. This makes it possible to test for ketosis using urine strips. It also – at least when starting out – can result in having to go to the bathroom more often. This is the main cause of the increased thirst (above).
  • Keto breath – this is due to a ketone body called acetone escaping via our breath.14 It can make a person’s breath smell “fruity”, or similar to nail polish remover. This smell can sometimes also be felt from sweat, when working out. It’s often temporary. Learn more

 
Other, less specific but more positive signs include:

  • Reduced hunger – many people experience a marked reduction in hunger.15 This may possibly be caused by an increased ability of the body to be fueled by its fat stores. Many people feel great while eating just once or twice a day, automatically ending up doing a form of intermittent fasting. This saves both time and money, while also speeding up weight loss.
  • Increased energy – perhaps after a few days of feeling tired (the “keto flu“) many people experience a clear increase in energy levels. This can also be experienced as clear thinking, a lack of “brain fog” or even as a sense of euphoria.


 

How Do You Measure Ketosis?

ketone meters
There are three ways to measure for ketones, which all come with pros and cons:

  1. Urine strips
  2. Breath ketone analyzers
  3. Blood ketone meter


 

1. Urine stripsketostix

Urine strips is the most simple and cheap way to measure ketosis. It is the first option for most beginners.

You dip the stick in your urine, and 15 seconds later the color change will tell you the presence of ketones.16 If you get a high reading (a dark purple color) you’ll know that you’re in ketosis.

Pro: Ketone strips are available in regular pharmacies or via Amazon and they’re very cheap. A strongly positive test reliably proves that you’re in ketosis.

Con: Results can vary depending on how much fluid you drink.17 The strips don’t show a precise ketone level. Finally and most importantly, as you become increasingly keto-adapted and your body reabsorbs ketones from the urine, urine strips may become unreliable even if you’re in ketosis.18 Thus the test may sometimes stop working – always showing a negative result – when you’re been in ketosis for several weeks.

Order urine strips at Amazon


 

2. Breath ketone analyzers

ketonixBreath ketone analyzers is a simple way to measure ketones19 in your breath. At around $150 they are more expensive than urine strips. But they are cheaper than blood ketone meters in the long run, since they are reusable any number of times.

These analyzers do not give you a precise ketone level, but rather a color code for the general level. Research shows that there is decent correlation with blood ketones in most situations.

Pro: Reusable, simple test.

Con: Does not always correlate well with blood ketones. Not accurate, and can sometimes show entirely misleading values. More expensive than urine strips upfront than blood meter. Not portable, needs computer hookup to read..

Order Ketonix

Video

Using Breath Ketone Analyzers


 

3. Blood ketone metersprecision xtra

Blood ketone meters show an exact and current level of ketones in your blood.20 They are currently the gold standard and the most exact way to measure your ketosis level. The major disadvantage, however, is that they are quite expensive: A meter with 10 test strips included costs about $100 and then an additional $3 per test after that.

GOOD: Exact, reliable.

BAD: Expensive. Requires pricking your finger for a drop of blood.

Order the blood ketone meter Precision Xtra with everything included, at Amazon


 

 

 

How to Reach Optimal Ketosis

Getting into ketosis is not a black or white thing. It’s not like you’re either in ketosis, or out of ketosis. Instead, you can be in different degrees of ketosis, as this chart demonstrates.21 The numbers below refer to values when testing blood ketone levels.

 
The Ketone Zone

  • Below 0.5 mmol/l is not considered “ketosis”. Although a value of, say, 0.2 demonstrates that you’re getting close. At this level you’re still far away from maximum fat-burning.
  • Between 0.5–1.5 mmol/l is light nutritional ketosis. You’ll be getting a good effect on your weight, but perhaps not optimal.
  • Around 1.5–3 mmol/l is called optimal ketosis and is recommended for maximum mental and physical performance gains. It also maximizes fat burning, which can increase weight loss.
  • Values of over 3 mmol/l aren’t necessary. That is, they will achieve neither better nor worse results than being at the 1.5–3 level. Higher values can also sometimes mean that you’re not getting enough food (“starvation ketosis”). For type 1 diabetics, it can be caused by a severe lack of insulin that requires urgent attention.22
  • Values of over 8–10 mmol/l are usually impossible to get to just by eating a ketogenic diet. It means that something is wrong. The most common cause by far is type 1 diabetes with severe lack of insulin.23 Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The end result can be a state called ketoacidosis, that may be fatal. Needless to say abnormally high ketones requires immediate medical care. Learn more

 

How to achieve ketosis

There are many things that increase your level of ketosis. Here they are, from most to least important:

  1. Restrict carbohydrates to 20 digestible grams per day or less – a strict low-carb diet. Fiber does not have to be restricted, it might even be beneficial.24
  2. Restrict protein to moderate levels. If possible stay at or below 1 gram of protein per day, per kg of body weight. So about 70 grams of protein per day if you weigh 70 kilos (154 pounds). It might be beneficial to lower protein intake even more, especially when overweight, and then aim for 1 gram of protein per kg of desired weight. The most common mistake that stops people from reaching optimal ketosis is too much protein.
  3. Eat enough fat to feel satisfied. This is the big difference between a ketogenic diet and starvation, that also results in ketosis. A ketogenic diet is sustainable, starvation is not.
  4. Avoid snacking when not hungry. Unnecessary snacking slows weight loss and reduces ketosis.
  5. If necessary add intermittent fasting, like 16:8. This is very effective at boosting ketone levels, as well as accelerating weight loss and type 2 diabetes reversal.
  6. Usually not necessary: Supplement MCT oil and/or Bulletproof coffee.
  7. Usually not necessary: Supplement exogenous ketones.25

Two stories about achieving long-term ketosis

Optimal ketosis experimentHere are the three reports from a 2-month experiment in reaching optimal ketosis:

  1. Experiment: Optimal ketosis for weight loss and increased performance
  2. Four weeks of strict LCHF and ketone monitoring
  3. Final report: Two months of strict LCHF and ketone monitoring

 
Here’s a great ten-minute presentation about self-tracking one year in nutritional ketosis:

A Year of Self-Tracking in Nutritional Ketosis – Dr. Jim McCarter4.5 out of 5 stars5 stars70%4 stars19%3 stars4%2 stars5%1 star0%119 ratings11910:20

Do I have to reach optimal ketosis to experience the benefits?

In short, no. Many of the benefits, such as weight loss, are experienced at lower levels of ketosis (at least above 0.5). There are indications that you might need to reach higher levels of ketosis for high-level physical performance.

A master class in ketosis

Here’s a great presentation by Professor Jeff Volek, about the benefits of adapting your body to run on fat and ketones for fuel:

Keto-Adaptation and Performance – Prof Volek4.7 out of 5 stars5 stars84%4 stars7%3 stars3%2 stars0%1 star3%117 ratings11758:58

Long-term ketosis

Do you want to understand what it takes to successfully and enjoyably reach and maintain long-term ketosis? Then there’s no better teacher than Professor Stephen Phinney. Get inspired here:

Low-Carb Living – Dr. Stephen Phinney4.8 out of 5 stars5 stars91%4 stars3%3 stars3%2 stars1%1 star1%94 ratings941:00:21

 


 

 

Potential Side Effects of Ketosis

Can ketones get too high, dangerously high? Not under normal circumstances.

For most people it’s quite a challenge to even get to optimal ketosis. Getting into dangerously high ketone levels (more than 8 – 10 mmol/l) is most often simply impossible. The main exception is type 1 diabetes, where the pancreas does not produce enough insulin. In type 1, it’s very possible to get dangerously high ketone levels – just by forgetting to take your insulin injection. There are also other situations like breastfeeding and taking type 2 diabetes medications called SGLT-2 inhibitors26 that in rare situations can result in too high ketone levels.

This will result in feeling sick, nauseous and very weak. It can develop into a life-threatening condition called ketoacidosis. There’s a simple treatment if you suspect this may be happening: eat some carbohydrates right away (e.g. a couple of fruits or a sandwich or a glass of juice). If you have type 1 diabetes take more insulin. Then contact emergency medical services if you do not immediately start feeling better.

The Keto Flu

While ketosis is normally safe, it is common to experience some time-limited side effects.

People transitioning from sugar-burning to fat-burning mode often initially experience side effects. This is referred to as the keto flu, since symptoms are similar to those of the flu: fatigue, nausea, headaches, cramps, etc. There are two main things that one can do to prevent or alleviate these symptoms:
 

  • Drink water with salt and lemon – alternatively have a daily cup of bouillon.
  • Gradually reduce carbohydrate intake – stopping suddenly results in more temporary symptoms

When starting on a ketogenic diet, you lose water and consequently electrolytes. This is happening since carbs retain water and salts in the body, so when you stop eating carbs your body loses this water. If the keto flu is happening due to too little hydration, it might help to drink a glass of salt water with a little bit of squeezed lemon (for taste).

When carbohydrates are suddenly removed from the diet, the brain can run slightly low on energy before it learns to use ketone bodies for fuel instead of sugar. This means that if you drastically reduce carbs from one day to another, you may get symptoms of such as tiredness, nausea and headaches. Replacing fluids and electrolytes as described above can alleviate the symptoms. Or by instead gradually lowering carb intake over a period of a week or more, the body gets used to burning fat and ketones instead of glucose and there will usually be no symptoms.

If you do not wish to gradually reduce carbs, make sure to get enough fluid and salt (like 1-2 cups of bouillon per day) to minimize symptoms. After a week or so the body is usually adapted to a ketogenic diet.

Dangers, Myths and Side Effects of the Ketogenic Diet

The side effects, potential dangers and myths around the ketogenic diet are virtually identical to other strict low-carb diets. Learn more about them here:

Low-Carb Side Effects & How to Cure Them

Alternatively choose a specific topic below.

The 6 most common problems when starting


Less common issues on keto / low carb



Low-carb & keto myths


 

 

Q&A, Fine-tuning and Troubleshooting

What’s the difference between low-carb and keto diets?

Keto is a very strict low-carb diet, that also puts even more emphasis on moderating the protein intake, and relying primarily on fat to supply energy needs.

A regular strict low-carb diet will likely put most people in ketosis anyway. But a keto diet tweaks things even further to make sure it’s working and, if desired, to get even deeper into ketosis.

Keto could be called an extra strict low-carb diet.

Should you aim for high ketone levels to speed up weight loss?

Yes and no. Eating less carbs, less protein and intermittent fasting certainly promotes weight loss, while lowering insulin and raising ketones.

However, adding extra fat to raise ketone levels does not promote weight loss. Neither does supplementing with MCT oil to raise ketone levels, or drinking “exogenous” ketone supplements. These methods actually slow down weight loss, by providing alternative fuel to be used instead of burning body fat.

If you want to lose weight only use these methods – MCT oil or exogenous ketones – when you are hungry, or for performance reasons (unrelated to weight loss).

Learn more: The Benefits of Ketones… Endogenous Ketones

At what time of day should you test ketone levels?

For comparison purposes it’s good to do it about the same time every day. Doing it in the morning before eating makes it most easy to compare the result from day to day.

However, morning values are usually among the lowest in the day, while evening values are higher. So if for some reason you want impressively high values, do it in the evenings instead. Be aware that your ketone levels don’t distinguish between the burning of dietary fat and stored fat.
 
More Low-Carb Questions & Answers
 



 

Resources to Learn More

Updates

Get free video courses, keto recipes and news updates like over 250,000 people:

 

Top ketosis videos

More (for members) >

Websites

Ketogenic Diet Resource (very thorough, but not simple)

Books

The Art and Science of Low-Carbohydrate Performance by Stephen Phinney and Jeff Volek.

Podcasts

Excellent two-part podcast where the top ketogenic diet researcher Dominic D’Agostino is interviewed by Tim Ferriss:

  1. The Tim Ferriss Show: Dom D’Agostino on Fasting, Ketosis, and the End of Cancer (November 2015, interview)
  2. The Tim Ferriss Show: Dom D’Agostino — The Power of the Ketogenic Diet (July 2016, D’Agostino answers reader questions)

D’Agostino is also quite active on Twitter @DominicDAgosti2.


Comments

Do you have any suggestions on how to improve this page about ketogenic diets? Anything that is unclear or wrong? Any important information missing? Please let us know in the comments below.

  1. There are three different ketones, or “ketone bodies” used as fuel by the body. They are:

    1. Acetone
    2. Acetoacetate
    3. Beta-hydroxybutyrate

    Ketones

    Learn far more than you’ll ever need about ketones here:

    Dr. Peter Attia: Ketosis – advantaged or misunderstood state? (Part I)

  2. and can run perfectly well on ketones. The brain consumes about 20% of the body’s required energy every day, despite only representing 2% of the body’s mass.

    A good bonus for weight loss, if you can get your hungry brain to burn fat for you, 24-7.

  3. For example Shai 2008 or Bazzano 2014.

    Full list of studies with the most important findings explained

  4. The superiority of a low-carb diet has for example been shown in these 3 studies: Daly 2005, Westman 2008 and Tay 2014.

    Full list of low-carb studies

  5. 120 grams per day or more

  6. Volek, Jeff S. et al. Carbohydrate Restriction Improves the Features of Metabolic Syndrome. Journal of Nutrition and Metabolism, 2005.

  7. These two articles show how the ketogenic diet can be used to treat children with epilepsy:

  8. Here’s a recent review article summarizing the science on the topic:

    Skin Pharmacology and Physiology: Nutrition and Acne: Therapeutic Potential of Ketogenic Diets (2012)

  9. One small study has found improvement in memory in people with mild cognitive impairment, using a ketogenic diet:

    There are studies linking high, or even “normal”, non-diabetic blood sugar levels to dementia and Alzheimer’s. Since a ketogenic diet lowers blood glucose it could conceivably cut the risk of developing these diseases. Take a look at this study for instance:

    Crane, Paul K. et al. Glucose Levels and Risk of Dementia. The New England Journal of Medicine, 2013.

  10. Here are a couple of pilot studies where a ketogenic diet was used in cancer patients. The conclusions are that an insulin-inhibiting diet is safe and feasible in selected patients with advanced cancer.

    In brain cancer in particular the ketogenic diet looks like a promising addition to other treatments:

    NOTE: This is only an experimental additional treatment of selected cancers, with highly limited evidence. Many conventional cancer treatments (surgery, chemo etc.) are highly effective and they often offer excellent chances of a cure when used in early stages of the disease. To turn down such treatment would be a mistake that could easily be fatal.

  11. Two studies:

    Euroupean Journal of Neurology 2015: Migraine improvement during short lasting ketogenesis: a proof-of-concept study.

    Journal of Headache and Pain 2016: Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study.

  12. A small pilot study of five people with Parkinson’s disease showed clear improvement of symptoms on a ketogenic diet. There was no control group, so a placebo effect can’t be ruled out.
    Vanitallie, TB et al. Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study. Neurology, 2005.

  13. Net carbs (or “digestible carbs”) are total carbs minus fiber. Fiber is OK to eat since it doesn’t affect blood sugar levels.

  14. This can sometimes be measured as early as during the first day on a ketogenic diet:

    AJCN: Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. (2002)

  15. This has been clearly demonstrated in several scientific studies:

    Obesity Reviews: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis (2014)

  16. The strips measure for the ketone type acetoacetate. The presence of this in your urine indicates that you’re been in ketosis during the hours before testing.

  17. By drinking more water, you dilute the concentration of ketones in the urine and thus a lower level of ketones will be detected on the strips.

  18. This happens when the body becomes more adapted to using ketones, meaning that they increasingly stay in the blood to be used as energy instead of being lost through the urine.

  19. Breath analyzers measure the ketone acetone.

  20. Blood ketone meters measure the ketone beta-hydroxybyturate (BHB).

  21. The chart is from the excellent book The Art and Science of Low-Carbohydrate Performance by Professor Stephen Phinney and Jeff Volek. Highly recommended.

    perf

  22. Take insulin, eat carbs (if your blood glucose isn’t already high), and contact medical services immediately.

  23. Other possibilities include doing a strict keto diet while breastfeeding or on a class of diabetes medications called SGLT-2 inhibitors (e.g. Farxiga, Jardiance, Invokana).

  24. Fiber is digested by bacteria in the colon, and some of it is transformed into a fat called medium-chain triglycerides. This fat can be absorbed by the body and is very effective at turning into ketones. Thus eating more fiber (but still very low carb) could result in higher ketone levels in the blood.

  25. The company Prüvit sells drinkable ketones, called KETO//OS. This drink raises blood levels of ketones and may possibly improve physical and mental performance under certain circumstances.

    However, it does not lower insulin or blood sugar, and it does not increase fat burning. Thus it hardly helps with weight loss or type 2 diabetes reversal.

    Also note that they are selling through a multi-level marketing scheme, meaning their affiliates are paid on commission. So take all endorsements with a grain of salt.

     

    Pruvitnow.com

  26. E.g. Farxiga, Jardiance, Invokana

1 2

83 Comments

  1. Josephine
    Hello, if adding fat is simply a means of adding extra calories (which I guess it is with the exception of essential omega 3s etc) does a ketogenic diet circumvent the need for meeting BMR requirements or worrying about metabolic adaptation to less calories? I am not hungry whilst meeting my protein requirements and getting lots of leafy greens (and cheese, nuts, butter etc) but I can do this well under 1200 calories per day. Any suggestions would be greatly appreciated!
    Reply: #4
  2. Afiq
    Hi, i am on type 2 diabetes. i have been on LCHF for about a week. My ketone level when i had my urine tested was 4+. How do i get it down or rather to an optimal level. Any recommendations are much appreciated. And another question, how much of fat is required or recommended for each meal. Thank you.
    Reply: #5
  3. Prachi Garg
    It looks like diet doctor has changed its stance on ketogenic diets that it was promoting originally. The article above dies not line list positives and negatives clearly.and the authors it promoted earlier are treated differently now. Any particular reason behind this.

    Best regards

    Reply: #8
  4. Jane
    Hi Josephine, not sure if you have had a reply... No you have to replace the calories you would get from carbohydrates with good fat sources such as oily fish, avocado, olives, olive oil, coconut oil, nuts and seeds etc. Stick to your BMR guidelines, over eating is over eating and will usually result in weight gain. The bonus of the keto diet, LCHF + moderate protein, is that you feel fuller for longer and should not have cravings like you may on other calories resticted diets.
  5. Jane
    Hi Afiq, firstly have you been adn discussed this with your doctor. If not please do so prior to changing your diet. Dietary changes may affect any medications may be taking which must be monitored by your doctor. Once cleared to go ahead the ratios have been detailed in the script above. There is alot of information and I suggest you read it. Not easy to summarise in to two sentences...
  6. Maureen
    Is there a difference between the "Low Carb" and the "Keto" diets as explained on this site? It is my understanding that the Low Carb diet would put you into ketosis, so then is the "Keto" diet even MORE low carb? Could you please provide a comparison between the two if they are different? Thanks!
    Reply: #7
  7. Keto is a very strict low-carb diet, that also puts even more emphasis on moderating the protein intake, and a few other things.

    A regular strict low-carb diet will likely put most people in ketosis anyway. But a keto diet tweaks things even further to make sure it's working and to get even deeper into ketosis.

    I've added this to the Q&A section above.

    Reply: #22
  8. I don't feel we've made any substantial changes in how we view ketogenic diets, except of course learning more and tweaking our approach based on new knowledge. I'd be interested in finding out what in particular you feel is different?

    Regarding listing positives and negatives clearly, this page is relatively new and we'll rapidly iterate and improve it during the upcoming months. Thanks for the suggestions.

  9. Kim
    Hello,
    I think your site is great, explains great! Thank you!
    I am wondering about salt intake, what kind do you suggest or does it matter? I normally use Himalayan salt.

    Also 9 yrs ago I had emergency surgery which I was in hospital nine days and was only on IV fluids and P.O fluids, I lost weight..related to the constant nausea caused by ill effect from anesthetic, (I think). The unplanned benefit..." I had lost the love handles.." What did I unintentionally actually do? Was I in ketosis?

    For easy calculation of counting carbs and protein, what do you suggest? Any apps?

  10. Eloise
    Hi. Today I bought a urine ketone test for the first time and I am overjoyed to be sitting between the 1 and 2. This is great motivation to continue with IF and try and get to the deep purple. My question is this: I remember a while back reading somewhere something about how urine ketone testing is a delayed form of testing and the results are representative of a few hours ago. Now I can't find the full proper details on this topic. Can you perhaps guide me better in this regard? Blood and breath tests are outside my budget at this point.
    Reply: #11
  11. Hi Eloise!

    I believe it's a good idea to take the test in the morning before you eat your first meal. In that way your tests are made under the same conditions every day.

    Hi. Today I bought a urine ketone test for the first time and I am overjoyed to be sitting between the 1 and 2. This is great motivation to continue with IF and try and get to the deep purple. My question is this: I remember a while back reading somewhere something about how urine ketone testing is a delayed form of testing and the results are representative of a few hours ago. Now I can't find the full proper details on this topic. Can you perhaps guide me better in this regard? Blood and breath tests are outside my budget at this point.

  12. Andrike
    Good day.
    I have been on a prescribed diet that basically kept me in a keto state for 11 weeks. This came with weekly shots to 'help weight loss'. The diet forces me to eat 3 meals a day, plus 2 - 3 snacks (chicken vienna, cheese or just something) in between. I got all of my recipes from your website and followed the diet vigorously; including cutting out of all caffeine initially (I am quite a coffee head). In the first 4 weeks I managed to lose 3 kilograms, but have since picked all of that up again, plus some more. The lady at the diet clinic insists that I am eating too little, but I have never suffered from a big appetite, so now I'm forcing myself to eat.
    Can it be that I am doing something wrong? Should I maybe stop with this for a while and then pick it up again? I am desperately trying to lose the baby weight, but feels like an endless battle right now.
    Any advice would be greatly appreciated!
    Regards
    Reply: #13
  13. Hi Andrike!

    If you are following the diet to lose weight then it sounds odd that you are forcing yourself to eat?
    What we are saying is eat only when hungry.

    If you have other health related problems then you should follow the advice given from your physician.

    Good day.
    I have been on a prescribed diet that basically kept me in a keto state for 11 weeks. This came with weekly shots to 'help weight loss'. The diet forces me to eat 3 meals a day, plus 2 - 3 snacks (chicken vienna, cheese or just something) in between. I got all of my recipes from your website and followed the diet vigorously; including cutting out of all caffeine initially (I am quite a coffee head). In the first 4 weeks I managed to lose 3 kilograms, but have since picked all of that up again, plus some more. The lady at the diet clinic insists that I am eating too little, but I have never suffered from a big appetite, so now I'm forcing myself to eat.
    Can it be that I am doing something wrong? Should I maybe stop with this for a while and then pick it up again? I am desperately trying to lose the baby weight, but feels like an endless battle right now.
    Any advice would be greatly appreciated!
    Regards

    Reply: #14
  14. Andrike
    Dear Peter
    Thanks for your speedy response!
    I do have hypothyroidism (had my thyroid removed because of aggressive cancer) have been on hormone replacement since. I get my TSH, T3 and T4 done regularly, because it does influence my weight loss. But all is well there.
    If I should only eat when I'm hungry, but I don't have much of an appetite, isn't it bad for the metabolism to skip regular meals?
    What about drinking coffee with unsweetened cream and honey? I do overindulge a bit and that might have an influence on my appetite I suppose.
    Regards
    Reply: #15
  15. Hi again Andrike!

    I'm not a physican so try to avoid giving any detailed advice, sorry.

    If you are a member you can direct questions here:
    http://www.dietdoctor.com/member/ask-the-experts

    For healthy persons we think it's a good idea to eat 2-3 times a day with no snacking in between.

    Drinking coffee with unsweetened cream is a good idea, but avoid the honey. :)

    Dear Peter
    Thanks for your speedy response!
    I do have hypothyroidism (had my thyroid removed because of aggressive cancer) have been on hormone replacement since. I get my TSH, T3 and T4 done regularly, because it does influence my weight loss. But all is well there.
    If I should only eat when I'm hungry, but I don't have much of an appetite, isn't it bad for the metabolism to skip regular meals?
    What about drinking coffee with unsweetened cream and honey? I do overindulge a bit and that might have an influence on my appetite I suppose.
    Regards

  16. Tina Gonsalves
    I would like to know more about "net carbs" and whether or not it is good to use that as a guide. (Carbs-fiber=net carbs.) Thanks!
    Reply: #17
  17. Hi Tina!

    We don't count fibers in our recipes. Fiber has a very low impact on insulin and ketone production in the body.

    I would like to know more about "net carbs" and whether or not it is good to use that as a guide. (Carbs-fiber=net carbs.) Thanks!

  18. Carol
    I'm can't do dairy products or whey products. They bother me. So just using coconut and olive oils ok for fat. Just didn't know how to get the fat into diet
  19. Gabriele
    Hello, I’ve started my keto diet nine days ago and I transitioned to ketosis 6 days ago. I have no doubt that I’m in ketosis now, as I present all the symptoms (the smell of my urine, that strange taste in my mouth, increased thirst). Despite this, I still don’t see any of the positive effects of ketosis in terms of increased mental energy, which was the reason that prompted me to start it in the first place: I just feel normal, in no way more focused or clear headed than I usually am. Do I just need to wait a few more days or, maybe, my body’s response just doesn’t include those positive effects on brain activity?
    Thanks!
  20. Martin
    I really enjoyed Dr.Wilson's video on resistance training and ketosis. Having reached the body fat percentage I was targeting I started eating carbs more than during my fat reduction phase. After seeing his presentation on cycling in and out of ketosis I think I'd like to remain more in than out. Strength training to failure is my primary form of exercise.

    After having cheated significantly this weekend to the tune of ice cream on Friday and four pints of craft beer on Saturday. I'd like to know if a fast on the day after a cheat of that magnitude is appropriate or harmful.

    I completed a fasting full body workout by mid afternoon. Is an intermittent fast allowable on the same day as such a workout?

    Is there risk of muscle loss if one fasts the entire day of a strength training workout?

  21. Gina Panagiotou
    DEAR TEAM LCHF DOCTORS

    My name is Gina and I'm writing from South Africa and YES I do think there is SOMETHING MISSING FROM the diet Doctor site that is VERY IMPORTANT ..

    I have scoured the internet and there are hundreds of KETO and LCHF sites , (yours being one of the best I must add,) but I haven't found ONE site where a MEDICAL DOCTOR addresses the problem of doing KETO or LCHF without a gallbladder in any detail .So many doctors talk about how High FAT reduces chances of getting gallstones and how to save your gallbladder but nothing is written about following a High FAT diet without gallbladder !

    WHY ?

    There must be thousands of people like me out there who do not have a gallbladder and want desperately to stop their addiction to sugar and carbs and try the LCHF but when they try have constant diarrhea , or see an oil slick in the toilet after bowel movement and many other problems ...related to having no gallbladder, they get worried and wonder if they need to stop.

    I am fully aware that it is not simple to talk about doing LCHF without gallbladder because everyone is different and handles FAT differently -- But surely there must be a doctor somewhere who has studied this area, and has treated patients without gallbladders ?
    We need a doctor who will help us by teaching us :

    1) What could possibly happen when the 70 % fat enters a body without gallbladder
    MENTION the various scenario's that could occur .
    2) Is it True that no gallbladder always means that a 70% FAT meal will not be digested properly by the body leading to fat soluble vitamins like A , D, K being flushed out of the body with the waste , thus leading to Vitamin defiency ?
    3_ Is it true that our liver will not be able to break down the fats efficiently so we will not be able to get into the state of KETOSIS like those with gallbladder ?
    4- Is it true that because of this fat digestion problem our bodies will not be able to use Ketones as alternative fuel ?
    5) Is it true that because it will be much harder for us to enter KETOSIS we will be much much slower than normal people to lose weight or that we might not lose weight at all?
    7) What are the markers to look for that your liver is not digesting the fat, and when you see this what can you do about it ?
    6) How does a person without a gallbladder go about beginning the LCHF lifestyle ?
    8) Do we need to take bile salts ?
    9) Are bile salts a solution -and after we take them will we be digesting fats normally again and enter KETOSIS like normal people. ?

    Tell us about different types of bile salts - .
    a) how they work ?
    b) and if must WHEN and HOW must we take them ?

    10) Is it true that you need to increase the fat slowly to see your tolerance level and that the will eventually adapt to high levels of fat ? If this is so can we be given an example as to what level we must start with and by how much to increase?

    I would like to CHALLENGE all of the ground breaking and pioneer doctors believing in the LCHF lifestyle to address the issue of NO GALLBLADDER and LCHF

    After all , it is YOU more than any other doctors , that tell us that overeating sugars and carbs is one of the main reasons we LOST our gallbladders in the first place !

    I am a 53 year old post menopausal woman ,30 kg overweight, who has high insulin and is on the way to becoming a Type 2 diabetic and I am unable to control my appetite for chocolate and cakes and biscuits -- LCHF has given me HOPE
    I really believe LCHF will help me but am so afraid I will be harming my body and having endless diarrhea .

    Please help me and all the others without gallbladders

    Thank you for your time
    Best regards
    Gina

  22. Irfan

    Keto is a very strict low-carb diet, that also puts even more emphasis on moderating the protein intake, and a few other things.
    A regular strict low-carb diet will likely put most people in ketosis anyway. But a keto diet tweaks things even further to make sure it's working and to get even deeper into ketosis.
    I've added this to the Q&A section above.

    Thanks for the clarification. Does it mean that someone who is on a moderately low carb e.g. 50-70 gm will be using both carbs/glucose as well as Ketones? Please advise.

    Reply: #24
  23. tonya
    I was 200 lbs in march i started a supplement called keto/os to help add ketones to my body i choose to add a supplemental form of ketones because being a nurse i know getting to ketosis is difficult and I wanted to see results faster. I was not able to excersie due to 3 pelvic fractures due to a MVA in November but was fixing to go back to work so i needed to feel better soon in order to take care of my patients this was my driving point to look into the keto life style and supplementation. I have to say that not only have i lost weight (38 lbs in 5 months) but my joints don't hurt as bad, my skin looks so much better i have to say all around i feel better, I think we have been taught wrong on how to eat healthy I think that more people will start eating keto diet as word spreads that ketosis is different than DKA
    tonyachadwell31@gmail.com
  24. Hi Irfan!

    I think it depends...but for most people who are not very physical active a moderate LCHF diet is not ketogenic. That means mainly glucose is used.

    Thanks for the clarification. Does it mean that someone who is on a moderately low carb e.g. 50-70 gm will be using both carbs/glucose as well as Ketones? Please advise.

  25. deborah
    I understand that keto includes limiting protein which I ant to do. However how do we calculate this as I also understand that older women (62) need to increase their protein as they age?
  26. Matjaz
    Dear Sirs,
    I'm on LCHF (netto beetwen 40 - 50 gr carbs) for 10 months. Everything is fine (as 61 years old man I got the best body of my life, exercising 5 days in a week, after loosing belly fat I got 3 kg on the right places). But.
    Whenever I talk with some nutrition practioner in my country which know keto and LCHF, they warns me about diet on a long term. Main problem they've founded is loosing a good gut bacteria because of not enought prebiotics and probiotics in food intake. Although I eat a lot of vegetables (at least 0,8 kg or more daily) those statments bodered me somehow and decrease my happines.
    And there is another one. Some of them told me, that cancida (which was guilty for begining my LCHF diet) can eat ketones just fine and I just don't feel candidas present in my body now. Have you any statement on this?
    best regards,
    Matjaz
  27. Steve
    Matjaz, trust your gut feeling. How do you know you're ill in the stomach? It tells you! Loud!

    So how do you know your stomach is fine! Same thing! If it's fine it tells you by feeling fine.

    Trust your gut feeling.

    There is a reason that expression exists!
    Steve

  28. LAURIE ANDERSON
    Help!

    I have seen that you discredit Julian Bakery for low carb bread.

    What about THINSLIM? Ar they also dishonest about the carb content?

    Say it ain't so! The plain bagel is such a nice way to start my day.

  29. Feebee
    Hi all○
    This is what i get from this article & more ☆

    ☆ Information overload 4 me but thank you ° yr all so amazing ☆

    ☆ fast 12 or 16 hours in between 8pm to 12pm to get the body into Ketosis zone ☆
    2 days a week or more.
    Gives yr body a break from working so much
    Also gets you into the Ketosis zone ☆
    Drink lots of water ☆
    Eat natural foods ☆
    1 Glass water with a tbl spoonof apple cider V every moning ☆
    ☆ eat protein with good low carb for energy
    ☆enjoy moving around in yr day ☆
    Keep low impact but moving every hour ☆

    NO high intense training if yr over 30 too hard on yr joints u suffer later.

    YOGA.....Thai Chee or Meditaion always ☆
    YES..........its great for the body.
    Treat yrself one day a week, enjoy it ☆

    Life was made to LIVE....so enjoy ♡
    Be kind to everyone you meet &
    You will attract these type of people ☆

    Manuia ☆ Feebee ♢

  30. Kim Sprout
    Hello! I am interested in following this diet. A couple questions.....I'm lactose intolerant so dairy is out. The other biggie.....I don't like eggs unless they are cooked "in" something. Is it going to be impossible for me to follow this?
  31. Karen Henell
    Hi Kim,
    Not at all impossible! Plenty of great non-dairy choices for you. And are you perhaps able to eat butter, since it is lactose-free? Otherwise, olive oil, avocado oil, and coconut oil as well as animal fat are all fine fat choices. I make a lot of frittatas (beaten eggs binding meats and vegetables, an easy skillet dish with plenty of butter, olive oil or coconut oil) which takes the emphasis off the eggs. Also easy to store the leftovers for a portable lunch or easy next meal.
    Browse the recipe section for ideas.
    Good luck!
    -Karen
  32. Jenna
    I tried low carb before...I joined a group and they were all about FAT FAT FAT! I can't just eat a spoon full of butter or oil...and I can't have heavy cream at all or I am running to the potty. (I got very sick because of this last time, sparing the details it ended my low carb attempt). Is it possible for this to be effective for me if I'm not guzzling copious amounts of fat?

    I have gained 20lbs two yeas ago and I seem to be unable to get rid of it. I got a fitbit. I track my water intake. I have counted calories. I have tried low carb. I have less motivation with every failed attempt. I need to know this will work. (also what if grain fed meats are not always an option?)

    Sorry for the story thank you.

  33. sherrill
    Which low calorie sweetener do you recommend, thanks!
    Reply: #37
  34. Brooke
    Hi, grateful for the questions raised above in the feedback on behalf of the
    "gallbladderless"---which includes me. Would LOVE to see the answers.
    Such content merits it's own listings on google! Until then, how do we
    not miss the reply (since we don't see one yet-understandably-and don't know what day it will appear?
    Reply: #36
  35. Jenny
    I have been eating a LCHF diet for four months. I had my gallbladder removed two years ago and was nervous about eating a high fat diet. However, after about a week on the LCHF diet, my system adjusted and now I have no symptoms of gastrointestinal distress whatsoever. As a caveat, I did take a couple of capsules of oxbile that first week which seemed to help. I have not had any problems since and don't even worry about eating fat anymore.
  36. Hi Brooke!

    If you are a member direct questions like this here:
    https://www.dietdoctor.com/member/ask-the-experts

    Dr Fung and Dr Andreas do unfortunately not have the possibility to answer all comments given.

    Hi, grateful for the questions raised above in the feedback on behalf of the
    "gallbladderless"---which includes me. Would LOVE to see the answers.
    Such content merits it's own listings on google! Until then, how do we
    not miss the reply (since we don't see one yet-understandably-and don't know what day it will appear?

  37. Hi Sherrill!

    We don't recommend sweeteners on daily basis. If you use sweeteners occasionally I don't think it matters so much what you are using. :)

    Which low calorie sweetener do you recommend, thanks!

  38. Debra
    I just started the strict keto diet on Monday and by Wednesday I started having loose diarrhea. Is this one of the side effects?
  39. 1 comment removed
  40. P ierre K erchner
    are there any proven or supposed disadvantages / cons for ketogen nutrition ?

    e.g. fat concretion ?

    or known "do NOT do this" things .. e.g. use the wrong fat ?

    why do many people recommend coconut fat ? it is quite saturated ... there are much better fats like coconut oil .. how about olive and linseed oil ?

  41. AJe Esther
    Thanks for the information. Please can someone who is on hypertensive drugs start keto diet
  42. Christine
    Hi doc. Have been on the low carb diet for a month now but still not into ketosis please I need help is to where am going wrong have also been taken notes of my me doing my test just doesn't seem to go above .3
    Reply: #44
  43. 1 comment removed
  44. Hi Christine!

    Normally what you can do is eat more fat and less of the other stuff or do fasting for a prolonged period.

    Hi doc. Have been on the low carb diet for a month now but still not into ketosis please I need help is to where am going wrong have also been taken notes of my me doing my test just doesn't seem to go above .3

  45. Christine
    Thank u doc this site has been awesome and very helpful. It has helped a great deal for my family receipes have been delicious. Will go ahead and do what you have suggested thank u again.
  46. 1 comment removed
  47. Ian Smith
    I tried a very low carbohydrate diet with mixed results. It started out brilliantly. I lost weight all over, but especially around my belly. I also seemed to have phenomenal amounts of energy. I am a keen trekker and there were days once I got started when I felt like I could walk forever. Nothing was ever a problem. Once I remember I walked six-hours non-stop, then performed a hundred squats when I arrived home, on just a Greek salad with plenty of feta and olives and a double espresso. It was like I was flying. In general, it seemed that I could literally feel myself burning fat every time I went out the door. I was totally sold. It felt like such a revelation.

    Unfortunately I had no sooner hit my stride than the heart palpitations kicked in. At first I would get them when I was asleep, waking in the middle of the night feeling like I'd been run over by a truck. My heart would be flopping about in my chest like a dying fish. If I got up to use the bathroom I would feel so weak and dizzy that I would have to hold onto something in order to stand up. They didn't happen every night, but tough walks or exercise sessions seemed to bring them on. Still at that stage they occurred seldom enough that they didn't feel like a problem.

    Gradually however the palpitations began happening more frequently and not only at night. They often struck while I was exercising. Suddenly I would experience the telltale 'heart in the mouth' sensation and would suddenly feel like a wreck and, if I was going hard, would often have to stop and catch my breath. Often I was able to walk them off, only to have them come back again at night when I lay down in bed. In fact, there were times when lying down seemed to trigger them as reliably as exercise.

    I stuck at this for six months. At times I stopped exercising, thinking I would give myself time to adapt. And there were times I added in some starchy carbohydrate, specifically sweet potato and black beans, which immediately fixed the palpitations. But as soon as I went back to low carb, fifty or sixty grams a day, they immediately returned. At first I probably didn't eat enough food as I was often not hungry and also amazed at how well I felt and keen to push the boundaries. But later on when the palpitations became a problem I began eating an avocado a day and eight or nine cups of vegetables, plus nuts such as almonds and walnuts and heaps of butter and olive oil. I also added plenty of salt. All to no avail. It was uncanny and frustrating. I was eating healthier than I ever had in my life, but unless I upped the carbs the palpitations persisted.

    In the end I became fed up with not being able to work out hard and added back the starch. I am not finished with low carb and will certainly try it again, but for the time being I'm going to back off while I do a bit more research and analyse my experiences in search of what's been going wrong.

    I don't know if there's any lessons to be drawn from this. I am fifty-two years old and before going low carb I used to fuel myself on rice and pasta and bread and legumes. There must be some insulin resistance there. Yet funnily enough I didn't seem to take long to adapt to fat-burning once I cut all that stuff out. Nor did I experience any cravings. I just felt good. It was so disappointing therefore when the palpitations upset the cart.

    All the best,

    Ian

    Reply: #59
  48. Ron
    Great website. I've been using this diet plan to lose weight and I've already dropped 45 lbs. The best part is I really love the food more than I did the other junk I was eating. I also found this really cool iPhone app called "Ketotitian" that shows you the relative contents of carbs, proteins, fats, etc. in a bunch of different foods. I use it all the time now to help plan meals so I can stay within my diet plan and still find lots of good things to eat.

    Thanks for a great website!

    Ron

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