Ketogenic Diet 101: A Complete Scientific Guide to Keto

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KETOGENIC DIET

Ketogenic Diet 101: A Complete Scientific Guide to Keto

By Erin Palinski-Wade, RD, CDCES and Jessica Migala

Medically Reviewed by Kelly Kennedy, RD

Reviewed: July 23, 2021

Ketosis

Bene ts and Risks

FAQ

Keto and Diabetes

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One enduring buzzword to hit the diet world seems to be “keto” — referring to the highfat, low-carb ketogenic diet. With claims that you can eat all the fat you want, never feel hungry again, and even boost your athletic performance, the diet promises something for everyone.

But what exactly is the ketogenic diet, and is the weight loss program right for you? Let’s take a closer look before you attempt to make over your eating habits and lifestyle.

M OS T H E L P F U L

What Is the Ketogenic Diet?

Low-FODMAP Diet Guide: How It

The ketogenic diet is based on the principle that by depleting the body

Sample Menu, and More

of carbohydrates, which are its primary source of energy, you can force the body to

Works for IBS, Food List, 7-Day

burn fat for fuel, thereby maximizing weight loss. When you consume foods that contain

The Weight Loss Plans to Try

carbohydrates, the body converts those carbohydrates into glucose, or blood sugar,

and the Fad Diets to Skip for

which it then uses for energy.

Results Because glucose is the simplest form of

M ORE ON F OL L OW IN G T H E KE T OG E N IC

energy for the body to use, it’s always used

How BMI Came to Define

D IE T

for energy before your body turns to stored

Obesity, and Why This Measure

fat for fuel.

Is Flawed

On a ketogenic diet, the goal is to restrict carbohydrate intake so that the body must break down fat for energy. When this occurs, fat is broken down in the liver,

12 Keto Diet Blogs to Watch in 2021

producing ketones, which are by-products of your metabolism. These ketones are then used to fuel the body in the absence of glucose.

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What Is the Keto Diet?

How to Follow the Ketogenic Diet There are several types of keto, but essentially, to achieve a state of ketosis, you have to severely reduce the amount of carbs you eat. (You can use a ketogenic calculator to create a custom food plan.) Data suggest the average American man age 20 or older consumes 46.4 percent of his daily calories from carbs, and the average American woman older than 20 consumes 48.2 percent of her daily calories from carbs.

But in

the classic ketogenic diet, which was originally used to manage seizure disorders, 80 to 90 percent of calories come from fat, 5 to 15 percent come from protein, and 5 to 10 percent come from carbohydrates.

A modi ed version of the ketogenic diet, which allows you to eat protein more liberally — at 20 to 30 percent of your total calories — with the same carbohydrate restriction, is the more commonly used version of the diet today. Some of the aims of the latest version of the ketogenic diet are weight loss, weight management, and improved athletic performance.

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What Is Ketosis?

The ketogenic diet for weight loss is based on the idea that driving the body into ketosis will maximize fat loss. Ketosis is a normal metabolic process that occurs when the body does not have enough glucose stores for energy. When these stores are depleted, the body resorts to burning stored fat for energy instead of carbs. This process produces acids called ketones, which build up in the body and can be used for energy.

How Do You Know if You’re in Ketosis?

To gure out whether you’re in a state of ketosis, check your urine for ketones. You can purchase ketone strips online or from a retail pharmacy. A strip that tests positive for ketones will indicate you have reached a state of ketosis.

Many people associate elevated ketones with a diabetic medical emergency known as ketoacidosis, but nutritional ketosis associated with a ketogenic diet and diabetic ketoacidosis are very di erent conditions.

Ketosis vs. Diabetic KetoacidosisKetoacidosis (DKA) Ketosis vs. Diabetic MENU

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M ORE ON KE T OS IS A N D D IA B E T IC KE T OA C ID OS IS

(DKA)

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For people with diabetes, rapidly rising Wellness

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For people with diabetes, rising that ketone levels can signal a rapidly health crisis

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ketone levels can signal a health crisis that

requires immediate medical attention. When there is an absence or not enough of the hormone insulin (or the body is too resistant to insulin to allow it to drive glucose into the cells for energy), the body cannot use glucose for fuel. Insulin helps ferry glucose to our cells and muscles for

What’s the Difference Between Ketosis and Diabetic Ketoacidosis?

energy. Instead, in this case, the body resorts to burning stored fat for energy through the process of ketosis, leading to a buildup of ketones in the body.

As ketones accumulate in the bloodstream

of a person with diabetes, they cause the blood to become more acidic, which can lead to the condition known as ketoacidosis. This condition can be fatal and should be treated immediately, as an article published in May 2021 in Endotext points out.

Learn More About Ketosis and How the Keto Diet Works

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Between Keto and Atkins?

Diet

the Ketogenic Diet

About Fat and Weight Loss

Potential Health Benefits and Risks of the Keto Diet If you search online for the term “keto diet,” you'll nd a lot of health claims associated with the ketogenic diet. But before you give this approach a try, it’s important to know what the science suggests about how it may a ect your health. Namely, you'll want to know about potential keto diet dangers.

Risk: You May Suffer Fatigue and Other Symptoms as a Result of the Keto Flu One of the most common side e ects of starting the ketogenic diet is “keto u.” This term describes the often unpleasant, fatigue-inducing symptoms that occur as the body adjusts from a high-carbohydrate to a low-carbohydrate diet. During keto u, the body’s stored glucose begins depleting, and the body starts adapting to producing and utilizing ketones as energy.

Symptoms of the keto u include headache, fatigue, dizziness, sleep problems, heart palpitations, cramps, and diarrhea. These side e ects usually diminish and resolve in about two weeks.

But to lessen the e ects of any discomfort, simply consider slowly

transitioning onto a ketogenic diet rather than rushing to change your eating habits. By gradually lowering your carbohydrate intake and gradually increasing your intake of dietary fat, you can transition with less negative impact and potentially prevent the keto u altogether.

Risk: You May Experience Constipation if You Don’t Eat Enough Fruits and Veggies

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The removal of many grains and fruits with such a large emphasis on fats can bring MENU

about its own set of gastrointestinal side e ects. Keto constipation and diarrhea aren't

6 Best Keto Diet Podcasts for NEWSLETTERS

The removal of many grains and fruits with such a large emphasis on fats can 2021 uncommon.

“If own not done with most of yourKeto carbohydrates coming from& Alerts bring about its set ofproperly gastrointestinal sideWellness effects. constipation and diarrhea aren't uncommon.

Health — Topics Food & Eating News Coronavirus / COVID-19 “If not done properly — with most of your carbohydrates coming from fiber-rich vegetables — you may not be ber-rich vegetables you can maylead not to be getting enough ber, which can lead getting enough fiber, — which

to constipation,” says Chris Mohr, RD, PhD, a sports dietitian based in Louisville, Kentucky, and the co-owner of MohrResults.com.

Eliminating food groups can be problematic. “Ketogenic diets are often low in calcium, vitamin D, magnesium, and folic acid, which over time can lead to nutrient de ciencies if the diet is not planned carefully,” adds Marie Spano, RD, a sports performance nutritionist in Atlanta.

Risk: You May Harm Your Heart With the Diet’s Emphasis on Animal Fat and Protein Reliance on a diet rich in animal fats and proteins may also have a negative impact on “This diet is not for anyone who is at risk of developing

cardiovascular disease or who has already been diagnosed with it,” Spano cautions.

This means that if you have risk factors for heart disease — such as elevated cholesterol, high blood pressure (hypertension), or a strong family history of the disease — you should use caution when following this diet. The diet's heavy reliance on fat, especially saturated fat, can raise cholesterol levels, further increasing your chances of developing heart disease in the future.

A 2019 position statement from the

National Lipid Association Nutrition and Lifestyle Task Force noted that research has found low-carb and very low carb plans (which keto ts into) have mixed e ects on blood cholesterol levels, with some studies nding that these diets raise cholesterol.

RELATED: Is the Paleo Diet Good for Heart Health?

Risk: You May Experience Dangerous Low Blood Sugar if You Have Diabetes For any individual with diabetes, discussing dietary changes — especially those as dramatic as the ones the ketogenic diet requires — with your healthcare team is essential. Because carbohydrates are broken down into glucose in the blood, cutting carbohydrates from your diet could cause levels to crash rapidly depending on your current medication regimen. Such a change may require signi cant adjustments to medication and insulin to prevent dangerous side e ects such as low blood sugar, called hypoglycemia.

Risk: You May Experience Weight Cycling and Negative Effects on Your Metabolism Outside of physical health changes, one of the biggest concerns of the ketogenic diet may be in long-term adherence. “It’s a very di cult diet to stick to and maintain.

Compliance is a challenge because it is so restrictive,” explains Dr. Mohr.

Following a strict diet for weight loss and then quickly reverting to old habits when the dietary changes are too restrictive can lead to what is known as weight cycling, or yo-yo dieting. Gaining and losing the same weight over and over is associated with poorer cardiovascular health, especially among premenopausal women, according to a study in Preventive Medicine Reports published in December 2019.

Benefit: You May See Improvements in Your Athletic Performance For athletes, research on the keto diet highlights potential improvements in athletic performance, especially when it comes to endurance activities. An article in the British Journal of Sports Medicine found that ketogenic-type diets allowed endurance athletes to rely mostly on stored fat for energy rather than having to refuel with simple carbohydrates during endurance training and competition, and saw improved recovery times.

Cholesterol When You Go on a Keto Diet?

Risk: You Could Develop Dangerous Nutrient Deficiencies

heart health, research shows.

What Happens to Your

That said, a review published in October 2020 in Sports concluded that while the

keto diet may help athletes reduce their weight and body fat, there is no conclusive evidence that the method of eating improves or harms health and performance.

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Than You’d Lose on Other Diets

If you’re looking to lose weight, one bene t the ketogenic diet may o er is appetite suppression. A review of this form of eating suggests it may help decrease appetite, but how this actually happens needs to be studied further.

Very low calorie ketogenic

diets may help people who are overweight or have obesity reduce their BMI, decrease the circumference of their waist, and lower levels of A1C, total cholesterol, triglycerides, and blood pressure, notes a review and meta-analysis published in March 2020 in Reviews in Endocrine and Metabolic Disorders.

But when it comes to weight loss — one of the biggest keto selling points for many individuals — the bene ts of the ketogenic diet may not be much di erent from any other diet plan. “There is no magical weight loss bene t that can be achieved from this diet,” says Spano. “The ketogenic diet may help weight loss in the same way other diets help — by restricting food choices so you eat fewer calories.”

Mohr agrees. “Cutting so many carbohydrates is a big reduction in calories,” he says, adding that this e ect will lead to a loss of water weight up front, “which is why people like the immediate response of weight loss that comes from this type of diet.” That said, the calorie reduction isn’t always the case, as it can be easy to consume more calories overall if you’re eating more calorie-dense foods (namely fat). One small study published in February 2021 in Nature Medicine found that people ate almost 700 fewer calories per day on a plant-based low-fat diet compared with a low-carb one consisting of mostly animal fats.

M OS T H E L P F U L

Keto Diet: A Complete List of Benefit: You May See Better Blood Glucose Control if You Have Type 2 Diabetes For individuals with diabetes, adapting a very low carbohydrate diet, such as

What to Eat and Avoid, Plus a 7Day Sample Menu

the ketogenic diet, may o er some bene ts when it comes to glucose management. For

Mangoes 101: Nutrition,

instance, a previous review found that dietary restriction of carbohydrates may reduce

Benefits, Types, and More

or eliminate the need for medication in individuals with type 2 diabetes.

Learn More About the Possible Bene ts and Risks of the Keto Diet

How BMI Came to Define Obesity, and Why This Measure Is Flawed

Common Questions & Answers What can I eat on keto?

In short, a whole lot of fat, a moderate amount of protein, and very few carbs.

Some of the best foods to eat on keto include avocado, olive oil, eggs, asparagus, green peppers, and cauli ower. On the ip side, you should avoid foods high in carbs — such as bread, pasta, many fruits, chips, crackers, candy, and cake.

Is it safe to do the keto diet?

Why is ketosis bad?

How do I get started on keto?

What are the side e ects of a ketogenic diet?

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Is the Keto Diet Right for People With Diabetes?

Because the main tenet of the keto diet is counting and cutting carbs — a commonly used way to control blood sugar — this eating approach has become increasingly popular among people with type 2 diabetes who are looking to lower their A1C, which is the two- to three-month average measurement of blood sugar levels. Indeed, research suggests this diet may lead to fast weight loss and potentially lower blood sugar for people with the disease.

But dietitians warn the keto diet also comes with risks that are speci c to people managing diabetes, including possible drug interactions and potentially dangerous low blood sugar if you're on medication, as well as kidney damage in people whose kidneys are dysfunctional because of elevated ketones in the blood.

Plus, because keto hasn't been studied long term, researchers don't know if the diet will result in nutrient de ciencies for those with or without diabetes.

If you're considering trying the keto diet and you have diabetes, it's crucial to consult your diabetes-care team before doing so to make sure it's a safe and e ective eating approach for you.

Learn More About How the Keto Diet May Bene t People With Type 2 Diabetes

Which Low-Carb Diet Is Best for Type 2 Diabetes?

There's no perfect diabetes diet, but going lowcarb is a popular way to manage your blood sugar. But is keto the absolute best t for you?

Here are some other low-carb options.

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How to Get Started on the Ketogenic Diet Here are some other things to know before you try this restrictive eating plan.

Can You Stick With the Carb Restrictions?

What Are the Signs and Symptoms of Type 2 Diabetes?

Following a diet that drastically restricts carbohydrates requires carefully monitoring MENU

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your food choices to ensure you are

Following a diet that drastically restricts carbohydrates requires meeting your nutritional needs.

Work a you are Wellness Foodyour & Eating News & Alerts Coronavirus carefully monitoring food choices to with ensure meeting / COVID-19 your nutritional needs. Work with a registered dietitian to make sure registered dietitian to make sure you follow you follow

this diet in a healthy manner without increasing your risk for complications or negative side e ects. You can nd a registered dietitian at EatRight.org.

It’s important to remember that the goal of

All About Keto Cycling: What It Is, How to Do It, and If It’ll Help You Meet Your Weight Loss Goals With the Ketogenic Diet

any dietary change is to promote a healthy lifestyle, so make sure to select a meal plan you can envision yourself following long term. If you know you will not be able to comply with such stringent carbohydrate restrictions for years to come, the ketogenic diet is most likely not the right choice for you.

What Are the Different Types of Keto Diets?

There are various modi cations of the ketogenic diet. The majority of individuals following a ketogenic diet follow the so-called standard ketogenic diet plan, which provides about 10 percent of your total calories from carbohydrates.

Other forms of ketogenic diets include cyclic ketogenic diets, also known as carb cycling, and targeted ketogenic diets, which allow for adjustments to carbohydrate intake around exercise. These modi cations are typically implemented by athletes looking to use the ketogenic diet to enhance performance and endurance and not by individuals speci cally focused on weight loss.

Generally speaking, if you plan to follow a ketogenic diet, you should aim to consume less than 10 percent of your total calories from carbohydrates per day. The remaining calories should come from 20 to 30 percent protein and 60 to 80 percent fat. That means if you follow a daily 2,000-calorie diet, no more than 200 of your calories (or 50 grams) should come from carbs, while 400 to 600 calories should come from protein and 1,200 to 1,600 should come from fat. (There’s a reason this plan is also called a highfat, low-carb diet!)

How Much Do You Know About the Ketogenic Diet?

Keto remains one of the hottest buzzwords in the diet world. With claims you can lose weight fast, improve athletic performance, and lower blood sugar in diabetics, the ketogenic diet promises something for everyone. But is the weight loss program the best choice for you? Test your knowledge and find out how much you know about the keto diet.

Is Exercise Involved in the Standard Ketogenic Diet?

Although the ketogenic diet does not explicitly require incorporating fitness into your routine, increasing your physical activity is always important iStock when you want to reduce START Powered by

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Is Exercise Involved in the Standard Ketogenic Diet?

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Although the ketogenic diet does not explicitly require incorporating tness into your Health Topics

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routine, increasing your physical activity is always important when you want to reduce

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to or maintain a healthy body weight, according to an article in Progress in Cardiovascular Diseases.

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For endurance athletes, the transition to a ketogenic diet may cut recovery time after training, but for casual exercisers, the transition to the ketogenic diet may make sticking with your tness routine a challenge at rst, the article notes. If you feel your

12 Popular Low-Carb Diets, and Their Pros and Cons

energy levels drop too much when starting the ketogenic diet, slow down your reduction of carbohydrates, and make sure to do it gradually rather than all at once.

What Side Effects Should You Expect?

To prevent side e ects such as the keto u, begin transitioning your meal plan gradually. Start by understanding how many carbohydrates you consume most days.

Then begin slowly reducing your carbohydrate intake over a period of a few weeks while gradually increasing your intake of dietary fat to keep your calories the same. You should also make sure to seek guidance from a professional to make sure this plan works for you and your health goals. “See a dietitian and adapt the diet to t your longterm needs,” Spano recommends.

Learn More About What Beginners Should Know Before Trying the Keto Diet

The Best and Worst Diet Plans for Weight Loss, Heart Health, and More Whether you’re looking to lose weight or manage symptoms of a chronic disease, dieting isn’t onesize- ts-all. This detailed list will teach you the pros and cons of the most popular plans out there today.

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What to Eat on the Standard Ketogenic Diet The ketogenic diet is not a commercial meal plan, so there are no costs or membership fees associated with starting this diet. But, depending on your current eating habits, this eating approach may increase your food bill.

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Because many processed foods are not considered ketogenic diet friendly, a switch to MENU

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buying more whole, unprocessed foods may seem expensive, especially with the

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Because many processed foods are not considered ketogenic diet emphasis foods. friendly,on a high-fat switchand to protein-rich buying more whole, foodsNews may& seem Health Topics Wellnessunprocessed Food & Eating Alerts Coronavirus / COVID-19 expensive, especially with the emphasis on high-fat and protein-rich foods.

In-season, fresh produce, along with frozen vegetables, which can be just as healthy as their fresh counterparts, will help reduce your costs. Although nuts, seeds, and animal proteins such as beef can drive up the grocery bill, bulk buying can help you save on these items as well.

The ketogenic diet relies heavily on dietary fat. Because high levels of animal fat in the diet have been associated with increased levels of cholesterol, aiming to include a good variety of plant-based fats can be helpful. Plant-based oils such as olive oil and avocado oil provide healthy fat for cooking and dressings.

M ORE ON W H A T T O E A T ON KE T O

Adding fat-rich foods such as avocado, nuts, and seeds can all make for healthful options that will provide you with unsaturated fats along with bene cial ber. Most fruits are restricted on this plan — there are exceptions, including avocado — but nonstarchy vegetables such as leafy

10 Quick and Easy Keto Diet Snacks Already in Your Fridge or Pantry

greens should become a staple of your diet.

Lean proteins such as sh, poultry, and grass-fed beef can be included as a source of protein on this diet.

A List of Acceptable Foods for the Standard Ketogenic Diet Nonstarchy vegetables like leafy greens, broccoli, cauli ower, cabbage, peppers, mushrooms, onions, and rhubarb Dairy, including eggs and cheese Protein like beef, pork, poultry, sh, shell sh, and soybeans Nuts and seeds, including walnuts, almonds, pistachios, sun ower seeds, and pumpkin seeds, coconut (in moderation) Fats like plant-based oils and butter Fruits like avocado, berries (in moderation), and tomatoes

Foods You Should Avoid or Limit on the Ketogenic Diet Processed foods like crackers, corn chips, and potato chips Sweets, including candy, cookies, brownies, and cake Grains of all kinds, including bread, pasta, rice, and quinoa High-carb fruits like melons and tropical fruits Arti cial sweeteners such as Equal and Splenda M OS T H E L P F U L

A Sample 3-Day Menu for the Standard Ketogenic Diet

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Day 1

Works for IBS, Food List, 7-Day

Breakfast: Scrambled eggs with sliced avocado

Sample Menu, and More

Snack: Almond butter on celery

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Lunch: Spinach salad topped with canned tuna, olive oil, and vinegar

Benefits, Types, Side Effects,

Snack: 1 ounce (oz) string cheese and 1 oz pistachios

and More

Dinner: Sirloin steak paired with sautéed mushrooms, onions, and cauli ower rice

Day 2

Breakfast: Mushroom and cheese omelet with sliced bacon Breakfast: Mushroom and cheese omelet with sliced bacon

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Lunch: Chicken stir-fry with peppers, onions, peanuts sautéed in peanut oil Lunch: Chicken stir-fry with peppers, onions, and peanuts and sautéed in peanut oil Snack: 1 oz Brie cheese with 1 oz walnuts Dinner: Salmon llet with oven-roasted Brussels sprouts

Day 3 Breakfast: Keto smoothie made with avocado, full-fat coconut milk, chia seeds, and nut butter Snack: Hard-boiled egg Lunch: Cheeseburger (without bun) over a bed of lettuce paired with string beans Snack: 1 oz almonds Dinner: Chicken breast paired with sautéed broccoli Learn More About What You Can and Can’t Eat on the Keto Diet

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What to Expect if You Try the Keto Diet While the keto diet can lead to rapid weight loss through ketosis, the plan carries some health risks, including: Nutritional de ciencies Heart harms Gastrointestinal issues like constipation, and more.

Because of the health risks involved, experts advise some individuals, such as those with heart disease or individuals who are at a higher risk for it, against trying the keto diet.

People with type 2 diabetes should consult their doctor before attempting the keto (or any new) diet.

Because of the severe carb restrictions and M ORE ON W H A T T O E A T ON KE T O

elimination of food groups such as grains, the plan may also be challenging to adhere to in the long run. Trying the diet, giving it up, then trying it again may lead to weight cycling, or yo-yo dieting, which will make it harder to lose weight permanently.

The 10 Best Low-Carb Ketogenic-Diet-Friendly Instant-Pot Recipes

If you are planning to try the keto diet, be sure to consult your healthcare team and, if possible, a registered dietitian to make sure you meet your nutritional needs on the plan.

Working with a professional can help you determine whether you should make adjustments or if you’d be better o

avoiding the diet entirely.

Learn More About What to Expect on the Keto Diet

For the first time EVER, we're bundling the Simply Tasty Ketogenic Cookbook -- AND -- the InstaKeto Cookbook as a free plus shipping offer. That's 200 FREE keto recipes!

Yes, that's right -- customers will receive TWO BOOKS for the cost of shipping, which is just $9.95. click here...