A ketogenic diet for beginners

Have you heard that a keto diet magically helps you lose weight and reverse your diabetes? Although it isn’t magic, under the right circumstances, it can lead to some pretty impressive results.

In this guide, we’ll share everything you need to know about a keto diet and provide helpful guidance for achieving a healthy, successful keto lifestyle.

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500+ keto recipes
14-day keto diet plan

 

What is a keto diet?

A ketogenic diet — more commonly known as a keto diet — minimizes carbohydrates while allowing generous amounts of protein and fat.

Carbohydrates, or carbs, are found in starches, sweets, and other foods that provide your body with glucose, which your muscles and other organs use for fuel.

When on a keto diet, you reduce carbs to the point where your body mostly stops using glucose for energy, and instead uses fat — either the fat you eat or your stored body fat.

Additionally, your liver produces molecules called ketones. These ketones can be used by your brain as an alternative source of energy, and they also provide other potential benefits.123

Learn more about ketosis in the guide below.

What is ketosis?

Eating a keto diet lowers insulin levels, often dramatically, which can help you access your body fat stores for energy. This might make weight loss easier and is a big reason for this diet’s popularity.4

A keto diet has also been shown to reduce hunger and improve body composition.5 And there are many other potential benefits, as you’ll soon learn.


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Cautions before starting keto

Interested in getting started right away? Let’s take a quick pause first.

Although most people can safely follow a keto diet, some of us need to take precautions before beginning:

Are you concerned that a keto lifestyle may not be a great fit? Check out our guide, “Is a low-carb or keto diet right for you?” You can also read our discussion of a recent paper about the potential contraindications to a keto diet.

Disclaimer: While the ketogenic diet has many proven benefits, it’s still controversial. The main potential danger involves medications for diabetes or blood pressure, where doses may need to be adjusted (see above). Discuss any changes in medication and relevant lifestyle changes with your doctor.

Full disclaimer: This guide is written for adults with health issues, including obesity, that could benefit from a ketogenic diet. Controversial topics related to a keto diet, and our take on them, include saturated fats, cholesterol, whole grains, red meat, whether the brain needs carbohydrates and restricting calories for weight loss.

Summary

On a keto diet, you eat very few carbs, which causes your body to shift from burning mainly glucose to burning mainly fat for fuel. Although keto eating has many potential health benefits and is safe for most people, it’s not right for everyone. You’ll need to work with your healthcare provider if you take certain medications.


 

How do you eat a keto diet?

When following a keto diet, the idea is to eat very few carbs, a moderate amount of protein, and as much fat as you need to feel satisfied, rather than stuffed.

Carbs can provide your body with energy, but there’s no minimum amount your body actually needs.6 On a keto diet, the fewer the carbs, the more effective the diet seems to be for reaching ketosis, losing weight, and improving type 2 diabetes.7

How many carbs can you eat to get into ketosis and remain there? While this varies from person to person, aim for a maximum of 20 grams of net carbs per day, especially at the beginning of your keto journey.89 All of our keto visual guides provide net carb counts for whole foods like fruits, vegetables, and nuts.

Getting a moderate amount of protein on a consistent basis is important.10 Excellent sources of protein include meat, fish, eggs, and soy.

Fat provides flavor, helps you feel full, and is your main energy source when following a keto lifestyle. We recommend choosing minimally processed fats and oils most of the time, and adding as much to your diet as you need to feel satisfied. You can learn more in our guide to healthy fats on a keto diet.

What to eat on a keto diet

Is a keto diet restrictive? We don’t think so!

You can enjoy a wide variety of delicious, filling foods on a keto lifestyle, such as:

Check out our detailed list of foods to eat on a keto diet and our keto grocery list, which you can print out and take to the supermarket.

Foods to avoid on keto

On a keto diet, avoid higher-carb foods and beverages. Essentially, you want to exclude anything that isn’t included on the keto foods list above. These no-go foods include:

  • Cakes, pies, cookies, ice cream, or other sweets
  • Sugar-sweetened beverages
  • Bread, pasta, rice, cereal, corn, and other starchy foods — including those made from whole grains
  • Potatoes, sweet potatoes, and other below-ground vegetables
  • Legumes (beans, lentils)
  • Fruit juice and most fruits
  • Milk (other than small amounts in coffee or tea)
  • Beer and sweet alcoholic beverages

What to drink

What is the best keto beverage? Plain still or sparkling water is the clear winner, although unsweetened coffee and tea are good choices as well. We recommend learning to enjoy beverages plain or with just a splash of milk or cream.

If you must sweeten your coffee or tea when first starting out, make sure to choose a keto-friendly sweetener.

What about alcohol? An occasional glass of dry wine or standard drink of pure liquor can be part of a keto lifestyle.

Learn more in our keto drinks and keto alcohol guides.

Summary

A healthy keto diet is low in carbs, moderate in protein, and unrestricted but variable in fat. Keto-friendly foods include meat, eggs, below-ground vegetables, and natural fats. Avoid high-carb foods and beverages, including “whole grains,” most fruit, and juice.


 

Keto meal planning

Now you know what foods to eat on a keto diet. But how do you put them together to create keto meals?

Keto meal planning can be pretty simple:

  • Start with a serving of meat, seafood, eggs, cheese, or tofu. Aim for a portion that’s about the size of a smartphone, or larger if you have higher protein needs. (Use our target protein ranges chart to see how much protein you need per day.)
  • Add below-ground vegetables (raw or cooked). Top with salad dressing, butter, or sauce as needed for flavor and fullness.
  • Season food with salt, herbs, and spices.
  • Drink water, coffee, or tea.

It’s that easy, and it can be absolutely delicious!

Keto recipes

Would you like to make keto-friendly versions of some of your favorite high-carb foods? We have recipes for bread, pizza, pancakes, and more. The best part? All of these recipes are keto-approved and made from healthy, minimally processed ingredients.

For more low-carb meal ideas, we have over 500 keto recipes you can try anytime you like. These tasty, easy-to-follow recipes will help you to stay on track.

Our most popular keto recipes

Keto meal plans

Following weekly meal plans can make keto eating even simpler.

Check out our free 14-day keto meal plan, which provides recipes for breakfast, lunch, and dinner for two weeks.

Using our premium meal planner tool, you also gain access to 60+ keto meal plans — complete with recipes, customized shopping lists, and more.

Meal planner for the keto diet

Time-saving planner tool

Meal plans include practical shopping lists. You can also tailor your own meal plans, using any of our 900+ low-carb recipes, and save them for later.

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Our meal plan themes include budget, family-friendly, keto vegetarian, dairy-free, and more — all of which provide 20 or fewer grams of net carbs per day.

Our customizable meal planner allows you to swap out recipes, skip meals, or even construct your own keto meal plans from scratch, using our recipes.

Summary

Planning keto meals is simple. Include protein, keto vegetables, healthy fat, and season as desired. For variety and inspiration, try out our keto recipes and meal plans.


 

Why might you want to do a keto diet?

What benefits might you experience by switching to a keto diet? Quite a few, possibly.

In recent years, keto diets have become increasingly popular because they often deliver impressive results for weight loss, type 2 diabetes, and other conditions.

Lose weight

Science shows keto and low-carb diets are often effective for losing weight.12

In fact, more than 30 high-quality scientific studies show that, when compared to other diets, low-carb and keto diets lead to greater weight loss.

Why do keto diets work so well for losing weight? As discussed earlier, being in ketosis lowers insulin levels, which can help you access your body fat stores more easily.13

Another reason may be that keto diets help people naturally eat less, as a result of feeling more satisfied.14

It’s also possible that following a low-carb diet might help you burn more calories — although this hasn’t been widely studied.15

At this time, keto diets haven’t been tested against more moderate low-carb diets for weight loss in formal studies. Yet, it seems keto diets may possibly have the edge.16

More than 250 people have shared their stories of losing weight — and achieving other health improvements — by following a keto lifestyle.

Check out our full guides to learn more about keto and weight loss:

How to lose weight
Why low carb can help you lose weight
How to lose weight with a low-carb diet
Top 10 tips to lose weight on low carb or keto for women 40+

 

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Control or reverse type 2 diabetes

Keto and low-carb diets can provide powerful blood sugar control for people with type 2 diabetes.17 In an encouraging move in the right direction, the American Diabetes Association recently acknowledged this.18

This makes perfect sense, since carbohydrates raise blood sugar much more than either protein or fat.19 To lower blood sugar, eat fewer carbs. It can be that simple.

In fact, low-carb diets can lower blood sugar so much that insulin and other diabetes medications often need to be reduced — or, in some cases, discontinued altogether.20

In the past, type 2 diabetes was considered a progressive disease that worsened with time, requiring more and more medication. However, we now know that ketogenic eating can actually reverse type 2 diabetes or put it into remission, meaning you may be able to stop all medications while still normalizing your blood sugar.

You can read more than 200 success stories about people who improved or reversed their type 2 diabetes with keto.

Also, check out our complete guide to reversing type 2 diabetes.

How to reverse your type 2 diabetes

Improve metabolic health

Ketogenic diets may play a strong role in improving several markers of metabolic health, including blood pressure, blood sugar, HDL cholesterol, and triglyceride levels.21

This way of eating seems to be particularly beneficial for those with metabolic syndrome, a condition marked by insulin resistance that increases heart disease risk.22

In studies, when people with metabolic syndrome follow a keto diet, they typically lose weight and many of their health markers improve — often significantly.23

Learn more about insulin resistance in our guides below.

What you need to know about insulin resistance
How to treat insulin resistance

Reduce hunger and achieve success with intermittent fasting

Why is it so tough to stick to most diets? It could be because they can often lead to hunger.24

This isn’t the case with keto diets, which tend to have the opposite effect. They’ve been shown to reduce appetite in multiple studies.25

Although the reason keto diets tend to decrease hunger isn’t fully understood, being in ketosis has been linked to lower levels of “hunger” hormones and higher levels of “fullness” hormones.26

Also, when you cut back on carbs but are allowed enough protein and fat to feel satisfied, you’re likely to eat less overall.27

On a keto diet, you may end up not only eating less but also less often, because you stay full longer. For some, intermittent fasting or time-restricted eating naturally becomes part of their keto lifestyle.28 Eating within a narrow time window can promote weight loss and possibly provide other health benefits.29

Read our complete guides to managing hunger, intermittent fasting, and eating OMAD (one meal a day).

How to manage hunger when trying to lose weight
Intermittent fasting for beginners
What you need to know about OMAD

Other potential benefits

Although there’s less high-quality research about the benefits of a keto diet for other conditions, emerging evidence suggests that it might be helpful for some people — and for many, it’s certainly worth trying:

Keep in mind that although keto diets often lead to dramatic health improvements, results will likely vary from person to person. Don’t compare yourself to anyone else. Just stay on track, celebrate personal victories, and be proud of your progress.

Summary

A keto diet has been shown to provide several benefits, such as weight loss, reversal of type 2 diabetes, and improved metabolic health. However, results may vary from person to person. Focus on your own keto journey.


 

Side effects and how to manage them

Ask someone on a keto diet how they feel, and there’s a good chance they’ll report feeling great and having lots of energy — if they’ve been on keto for a few weeks or more.31

However, the first few days to weeks can be tough, as your body switches from burning mostly glucose to burning mostly fat for fuel.

This shift can lead to what’s commonly known as the “keto flu.” It happens as a result of changes to your body’s balance of fluid and minerals when you begin eating a diet very low in carbs.

Symptoms of keto flu

Symptoms of keto flu include:

  • Fatigue
  • Headache
  • Irritability
  • Lack of motivation
  • Difficulty focusing (“brain fog”)
  • Dizziness
  • Muscle cramps

Fortunately, it’s very easy to cure keto flu — or minimize symptoms before they start — by replenishing fluids and electrolytes.32It’s often as easy as drinking a cup or two of salty broth or being liberal with the salt shaker. Learn more in our complete guide: The keto flu, other side effects, and how to cure them.

Even after you’ve conquered the keto flu and have adapted to your new way of eating, you may need additional fluids or electrolytes, especially if you’re active or live in a hot climate.

Do you need more salt? Are you drinking enough water? Should you supplement with magnesium or potassium, or can you just eat foods rich in these minerals? Read our electrolyte supplementation guide to find out.

Or are you concerned about salt intake? You can learn more in our comprehensive guide on salt.

A comprehensive guide to salt

Summary

The keto flu is caused by fluid and mineral changes that happen when your body switches from using mostly glucose to mostly fat for fuel. Symptoms include weakness, fatigue, headaches, and muscle cramps. Keto flu symptoms can be cured or minimized by upping your intake of water and electrolytes, especially sodium. Occasionally you may need to increase water and electrolytes for other reasons as well.


 

Keto FAQ

Before getting started, you may have a few — or perhaps even several — questions about keto diets.

Here are a few of the more commonly asked questions about keto:

Is keto safe?

For most people, eating a keto diet is safe. However, as mentioned earlier, if you take medications for diabetes or high blood pressure, you should speak with your doctor about adjusting your medications.

Those who should avoid being in ketosis include breastfeeding women and people with rare metabolic conditions that are typically diagnosed in childhood.33

For others, being in ketosis is perfectly safe and healthy. However, ketosis is sometimes confused with another condition called ketoacidosis. Although they sound the same, they’re entirely different.34

Learn more about ketosis and ketoacidosis.

Keto diets aren’t harmful to your heart, kidneys, or bones either.

Read more about why keto diets are overwhelmingly safe in our guide, Top 17 keto and low-carb controversies.

Top 18 low-carb & keto controversies

How much weight can I expect to lose on keto?35

Unfortunately, there isn’t a one-size-fits-all answer to this question.

Most people lose about 2 to 4 pounds (1 to 2 kilos) during the first week. Some people lose even more.

Keep in mind that a good portion of this is water weight, though. After the first couple of weeks, weight loss often slows down quite a bit. While a lot of people continue losing about 1 pound (0.5 kilo) of weight a week, many others lose more or less than this.

For instance, younger men tend to drop weight quickly and steadily. By contrast, women over 40 often lose weight more gradually and may go for a few weeks without losing any weight at all.

Weight loss typically slows down as you approach your goal weight. If your weight loss hasn’t budged for several weeks or months, check out our Top 10 tips to break a weight loss stall.

And remember that a “normal” body weight varies depending on the individual. This is based on your genes, health history, and other factors you have little control over. As long as you eat nourishing keto food when you are hungry and stop when you are full, you’ll eventually stabilize at the weight that’s right for you.

Read more in our guide, Weight, health & happiness: striking the right balance.

Weight, health and happiness: striking the right balance

How will I know whether I’m in ketosis?

Sometimes, you’ll have a pretty good idea when you’re in ketosis.36 Among the most common signs are:

  • Dry mouth or a metallic taste in the mouth
  • Increased thirst and more frequent urination
  • “Keto breath” or “fruity breath,” which may be more apparent to others
  • Initial fatigue, followed by an increase in energy
  • Decreased appetite and food intake (one of the more welcome side effects!)

If you have one or more of these signs and you’re experiencing good results on your keto diet, you may not need to do any testing.

However, the only objective way to verify that you’re in ketosis is by checking your ketone levels.

Learn more in our guide, The best way to test ketones in blood, breath, or urine

The best way to test ketones in blood, breath or urine

What is the difference between keto and low carb?

Keto and low-carb diets differ by how many carbs they contain, and sometimes by which foods are included.

At Diet Doctor, we define a keto and low-carb diets by the following:

  • Keto: Less than 20 grams of net carbs per day
  • Moderate low-carb: Between 20 and 50 grams of net carbs per day
  • Liberal low-carb: Between 50 and 100 grams of net carbs per day

On a keto diet, carbohydrates are minimized to achieve ketosis. On a low-carb diet, ketosis may occur, but it isn’t a goal.

More questions and answers

 

Check out our full Keto FAQ page.


 

Winning at keto

A keto diet can help you take charge of your health and quite possibly improve your quality of life.

Key takeaways

Here are some key takeaways for keto success:

  • Keep carbs low, get adequate protein, and eat enough fat to feel satisfied, not stuffed.
  • Eat when you are hungry and stop as soon as you are full.
  • Focus on the many delicious, nourishing foods you can enjoy instead of carb-heavy favorites from your pre-keto life.
  • Manage or minimize side effects so you can begin to feel great as soon as possible.

Also, make sure to take advantage of the many resources on our site. We have several guides that you may find very helpful — not only at the start but throughout your keto journey:

Dining out on keto
Living low carb in a high-carb world
How to make a low-carb or keto diet cheaper

 

See all of our keto guides here.

Support can also be key when you’re starting a new lifestyle. Our 2-week Get Started Keto Challenge provides everything you need, including encouraging emails, meal plans, and shopping lists. It’s completely free, and you can start right away.

Interested in longer-term support? Our popular 5 Weeks of Keto with Kristie and 10-week Weight Loss for Good programs are available to Diet Doctor members.

As a member, you’ll be able to join our private Facebook group, which provides a supportive community, where you can learn and share experiences with others.

And remember, although this journey is your own, we’re here whenever you need us. We want to help you achieve your goals, and our goal is to help make that happen.

Did you enjoy this guide?

We hope so. We want to take this opportunity to mention that Diet Doctor takes no money from ads, industry or product sales. Our revenues come solely from members who want to support our purpose of empowering people everywhere to dramatically improve their health.

Will you consider joining us as a member as we pursue our mission to make low carb simple?

Jill Wallentin in the kitchen

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  1. Unlike most other parts of the body, the brain can’t use fat for energy. It can only run on glucose or ketones. Studies have shown that during fasting or very low-carb intake, the brain can use ketones to meet a portion of its energy needs:

    Journal of Cerebral Blood Flow & Metabolism 2017: Inverse relationship between brain glucose and ketone metabolism in adults during short-term moderate dietary ketosis: A dual tracer quantitative positron emission tomography study [weak evidence]

    Journal of Clinical Investigation 1967: Brain metabolism during fasting [non-controlled study; weak evidence]

  2. Although the brain can use ketones for a portion of its energy needs, this vital organ requires glucose as well. Fortunately, even if you don’t eat any carbs at all, your liver can create all the glucose your brain needs via a process called gluconeogenesis.

    Learn more: Food for thought: Does the brain need carbs?

  3. Although most organs can use ketones, it’s a common misconception that the body only runs on ketones when you eat a ketogenic diet. The truth is, most of the body – including the muscles – can burn fat directly. A steady ketone supply is primarily necessary for the brain.

  4. Several studies have shown that when overweight people follow a ketogenic diet and their insulin levels decline, in most cases they lose weight very effectively:

    Journal of Medical Internet Research 2017: An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial [randomized trial; moderate evidence]

    Diabetes & Metabolic Syndrome 2017: Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies [randomized trial; moderate evidence]

    Nutrients 2020: The effects of a low calorie ketogenic diet on glycaemic control variables in hyperinsulinemic overweight/obese females [non-controlled study; weak evidence]

  5. Obesity Reviews 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

    Obesity Reviews 2016: Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies [strong evidence]

  6. While noting that the optimal amount of carbohydrate intake for humans isn’t known, the US Food and Nutrition Board’s 2005 textbook on dietary reference intakes states: “The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed.”:

    Institute of Medicine of the National Academies 2005: Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids,[textbook chapter; ungraded]

  7. This is mainly based on the consistent experience of experienced practitioners, and stories from people trying different levels of carb restriction [weak evidence]

  8. “Net carbs” are total carbs minus all fiber. The fiber portion of carbs isn’t digested and absorbed by your digestive tract:

    Nutrients 2010: Effects of dietary fiber and its components on metabolic health [overview article; ungraded]

  9. Subtracting fiber from total carbs to calculate net carbs works well for natural foods, such as vegetables, fruits and nuts. However, it may be less helpful for processed or packaged foods.

    Since we recommend eating mostly natural, minimally processed foods, we focus on net carbs. However, if you find yourself eating low-carb packaged foods, then we suggest using total carbs rather than net carbs as your guide.

  10. We define “moderate” protein as 1.2 to 1.7 grams per kg of reference body weight per day.

  11. Read ingredients on packaged or processed meats, which often contain sugar, flour, and other carby fillers.

  12. Several meta-analyses of randomized controlled trials (RCTs), considered the highest level of scientific evidence, have concluded that low-carb diets are often more effective than low-fat diets for losing weight: The British Journal of Nutrition 2013: Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials [strong evidence]

    PLoS One 2015: Dietary intervention for overweight and obese adults: Comparison of low-carbohydrate and low-fat diets. A meta-analysis [strong evidence] Learn more

    The British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials [strong evidence] Learn more

  13. Journal of Medical Internet Research 2017: An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial [randomized trial; moderate evidence]

    Diabetes & Metabolic Syndrome 2017: Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies [randomized trial; moderate evidence]

    Nutrients 2020: The effects of a low calorie ketogenic diet on glycaemic control variables in hyperinsulinemic overweight/obese females [non-controlled study; weak evidence]

  14. For example, in a small study, 10 overweight adults who followed a non-calorie-restricted, very low-carb diet ended up reducing their usual intake by 1,000 calories, on average — even though they were allowed to eat all the fat and protein they wanted:

    Annals of Internal Medicine 2005: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-randomized trial; weak evidence]

  15. This finding has been referred to as the “metabolic advantage” of low carb. In two studies, people who had previously lost weight were found to burn between 200 to nearly 500 more calories per day on a low-carb maintenance diet compared to a higher-carb maintenance diet:

    Journal of the American Medical Association 2012: Effects of dietary composition during weight loss maintenance: a controlled feeding study [randomized trial; moderate evidence]

    British Medical Journal 2018: Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial [randomized trial; moderate evidence]

  16. This is mainly based on the consistent experience of experienced practitioners, and stories from people trying different levels of carb restriction [weak evidence].

    In addition, one meta-analysis of RCTs found that very-low-carb diets resulted in greater fat loss than more moderate low-carb diets:

    Obesity Reviews 2016: Impact of low‐carbohydrate diet on body composition: meta‐analysis of randomized controlled studies [strong evidence for fat mass loss on very low-carb diets in particular]

  17. Meta-analyses of RCTs have shown that low-carb diets consistently outperform other diets for blood sugar control:

    Diabetes Research and Clinical Practice 2018: Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis [strong evidence]

    The American Journal of Clinical Nutrition 2018: Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments [strong evidence]

    BMJ Open Diabetes Research and Care 2017: Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes [strong evidence]

    Diabetes, Obesity & Metabolism 2019: An evidence‐based approach to developing low‐carbohydrate diets for type 2 diabetes management: a systematic review of interventions and methods [strong evidence]

  18. In a 2019 position statement, the American Diabetes Association stated: “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences:”

    Diabetes Care 2019: Nutrition therapy for adults with diabetes or prediabetes: a consensus report [report; ungraded]

  19. Diabetes Care 2004: Dietary carbohydrate (amount and type) in the prevention and management of diabetes [overview article; ungraded]

  20. This has been shown in several RCTs, as well as longer-term, real-world studies:

    European Journal of Clinical Nutrition 2017: The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials [strong evidence]

    Journal of Medical Internet Research 2017: An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial [randomized trial; moderate evidence]

    BMJ Open Diabetes Research & Care 2020: Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: experience from a community-based cohort [non-randomized study; weak evidence]

    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2019: Diet, diabetes status, and personal experiences of individuals with type 2 diabetes who self-selected and followed a low carbohydrate high fat diet [non-randomized study; weak evidence]

  21. In reviews of RCTs of low-carb and low-fat diets, metabolic health markers improved the most in those who ate very low-carbohydrate or ketogenic diets:

    Nutrition Reviews 2019: Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis [strong evidence]

    British Journal of Nutrition 2013: Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials [strong evidence]

  22. The metabolic syndrome consists of hypertension, abdominal obesity, low HDL (below 40 mg/dl in men or 50 mg/dl in women), triglycerides above 150 mg/dL, and elevated fasting glucose

  23. In one trial, all 22 participants had such impressive results after eating a ketogenic diet for 12 weeks that they no longer met the criteria for metabolic syndrome:

    Journal of Medicinal Food 2011: A pilot study of the Spanish Ketogenic Mediterranean Diet: an effective therapy for the metabolic syndrome [non-randomized trial; weak evidence]

    Lipids 2009 (Volek): Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet [RCT; moderate evidence]

    Experimental & Clinical Cardiology 2004: Long-term effects of a ketogenic diet in obese patients [non-randomized trial; weak evidence]]

  24. This is mainly based on clinical experience [weak evidence]

  25. Obesity Reviews 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis [strong evidence]

  26. In studies, ketosis has been associated with lower levels of ghrelin and higher levels of GLP-1 and CCK:
    Obesity 2018: A ketone ester drink lowers human ghrelin and appetite [randomized trial; moderate evidence]

    The American Journal of Clinical Nutrition 2019: Investigating the effect of sex and ketosis on weight-loss-induced changes in appetite [non-controlled study; weak evidence]

    Frontiers in Psychology 2015: Ketosis, ketogenic diet and food intake control: a complex relationship [overview article; ungraded]

  27. This is supported by studies testing people’s responses to very-low-carb diets:
    Annals of Internal Medicine 2014: Effects of low-carbohydrate and low-fat diets; a randomized trial [moderate evidence]

    Annals of Internal Medicine 2005: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-randomized trial; weak evidence]

    Nutrition & Metabolism 2005: A low-carbohydrate, ketogenic diet to treat type 2 diabetes [non-controlled trial; weak evidence]

  28. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here [weak evidence].

  29. JBI Database of Systematic Reviews and Implementation Reports 2018: Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis [strong evidence]

    Obesity reviews 2017: Short‐term intermittent energy restriction interventions for weight management: a systematic review and meta‐analysis [strong evidence]

    There is also strong clinical experience that keto diets make it easier to implement intermittent fasting. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here [weak evidence].

  30. If you take medication for a mental health condition, speak with your doctor before starting a keto diet

  31. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here. [weak evidence]

  32. The main electrolytes are sodium, potassium, and magnesium.

  33. These include enzyme deficiencies, which interfere with the body’s ability to make and use ketones or to properly digest fats:

    Department of Neurology 2012: Chapter 45 – Ketogenic diet [textbook chapter; ungraded]

  34. Nutrition Bulletin 2011: Ketosis, ketoacidosis and very-low-calorie diets: Putting the record straight [overview article; ungraded]

  35. This answer is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here [weak evidence].

  36. Nutritional ketosis is defined as having a beta-hydroxybutyrate level of 0.5 to 3.0 mmol/L in the blood. Learn more: What is optimal ketosis?