Ketogenic diets

 

The ketogenic diet (or keto diet, for short) is a low-carb, high-fat diet that offers many health benefits.

In fact, many studies show that this type of diet can help you lose weight and improve your health (1Trusted Source).

Ketogenic diets may even have benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease (2Trusted Source, 3Trusted Source, 4Trusted Source, 5Trusted Source).




Here is a detailed beginner’s guide to the keto diet.

What is a ketogenic diet?
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Keto basics

The ketogenic diet is a very low carb, high fat diet that shares many similarities with the Atkins and low carb diets.

It involves drastically reducing carbohydrate intake and replacing it with fat. This reduction in carbs puts your body into a metabolic state called ketosis.



 

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When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain (6Trusted Source).




Ketogenic diets can cause significant reductions in blood sugar and insulin levels. This, along with the increased ketones, has some health benefits (6Trusted Source7Trusted Source8Trusted Source).

SUMMARYThe keto diet is a low carb, high fat diet. It lowers blood sugar and insulin levels and shifts the body’s metabolism away from carbs and toward fat and ketones.

Different types of ketogenic diets

There are several versions of the ketogenic diet, including:

  • Standard ketogenic diet (SKD): This is a very low carb, moderate protein and high fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs (9Trusted Source).
  • Cyclical ketogenic diet (CKD): This diet involves periods of higher carb refeeds, such as 5 ketogenic days followed by 2 high carb days.
  • Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
  • High protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.

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However, only the standard and high protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.




The information in this article mostly applies to the standard ketogenic diet (SKD), although many of the same principles also apply to the other versions.

SUMMARYThere are several versions of the keto diet. The standard (SKD) version is the most researched and most recommended.

What is ketosis?

Ketosis is a metabolic state in which your body uses fat for fuel instead of carbs.

It occurs when you significantly reduce your consumption of carbohydrates, limiting your body’s supply of glucose (sugar), which is the main source of energy for the cells.

Following a ketogenic diet is the most effective way to enter ketosis. Generally, this involves limiting carb consumption to around 20 to 50 grams per day and filling up on fats, such as meat, fish, eggs, nuts, and healthy oils (6Trusted Source).

It’s also important to moderate your protein consumption. This is because protein can be converted into glucose if consumed in high amounts, which may slow your transition into ketosis (10Trusted Source).

 

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Practicing intermittent fasting could also help you enter ketosis faster. There are many different forms of intermittent fasting, but the most common method involves limiting food intake to around 8 hours per day and fasting for the remaining 16 hours (11Trusted Source).

Blood, urine, and breath tests are available, which can help determine whether you’ve entered ketosis by measuring the amount of ketones produced by your body.

Certain symptoms may also indicate that you’ve entered ketosis, including increased thirst, dry mouth, frequent urination, and decreased hunger or appetite (12Trusted Source).

SUMMARYKetosis is a metabolic state in which your body uses fat for fuel instead of carbs. Modifying your diet and practicing intermittent fasting can help you enter ketosis faster. Certain tests and symptoms can also help determine whether you’ve entered ketosis.

Ketogenic diets can help you lose weight

A ketogenic diet is an effective way to lose weight and lower risk factors for disease (1Trusted Source2Trusted Source3Trusted Source4Trusted Source5Trusted Source).

In fact, research shows that the ketogenic diet may be as effective for weight loss as a low fat diet (13Trusted Source14Trusted Source15Trusted Source).

What’s more, the diet is so filling that you can lose weight without counting calories or tracking your food intake (16Trusted Source).




One review of 13 studies found that following a very low carb, ketogenic diet was slightly more effective for long-term weight loss than a low fat diet. People who followed the keto diet lost an average of 2 pounds (0.9 kg) more than the group that followed a low fat diet (13Trusted Source).

What’s more, it also led to reductions in diastolic blood pressure and triglyceride levels (13Trusted Source).

Another study in 34 older adults found that those who followed a ketogenic diet for 8 weeks lost nearly five times as much total body fat as those who followed a low fat diet (17Trusted Source).

The increased ketones, lower blood sugar levels, and improved insulin sensitivity may also play a key role (18Trusted Source19Trusted Source).

For more details on the weight loss effects of a ketogenic diet, read this article.

SUMMARYA ketogenic diet can help you lose slightly more weight than a low fat diet. This often happens with less hunger.

Ketogenic diets for diabetes and prediabetes

Diabetes is characterized by changes in metabolism, high blood sugar, and impaired insulin function (20Trusted Source).

The ketogenic diet can help you lose excess fat, which is closely linked to type 2 diabetes, prediabetes, and metabolic syndrome (21Trusted Source22Trusted Source, 23Trusted Source24Trusted Source).

One older study found that the ketogenic diet improved insulin sensitivity by a whopping 75% (25Trusted Source).




A small study in women with type 2 diabetes also found that following a ketogenic diet for 90 days significantly reduced levels of hemoglobin A1C, which is a measure of long-term blood sugar management (26Trusted Source).

Another study in 349 people with type 2 diabetes found that those who followed a ketogenic diet lost an average of 26.2 pounds (11.9 kg) over a 2-year period. This is an important benefit when considering the link between weight and type 2 diabetes (Trusted Source24Trusted Source27Trusted Source).

What’s more, they also experienced improved blood sugar management, and the use of certain blood sugar medications decreased among participants throughout the course of the study (Trusted Source27Trusted Source).

SUMMARYThe ketogenic diet can boost insulin sensitivity and cause fat loss, leading to significant health benefits for people with type 2 diabetes or prediabetes.

Other health benefits of keto

The ketogenic diet actually originated as a tool for treating neurological diseases such as epilepsy.

Studies have now shown that the diet can have benefits for a wide variety of different health conditions:

  • Heart disease. The ketogenic diet can help improve risk factors like body fat, HDL (good) cholesterol levels, blood pressure, and blood sugar (28Trusted Source29Trusted Source).
  • Cancer. The diet is currently being explored as an additional treatment for cancer, because it may help slow tumor growth. (4Trusted Source30Trusted Source, 31Trusted Source).
  • Alzheimer’s disease. The keto diet may help reduce symptoms of Alzheimer’s disease and slow its progression (5Trusted Source32Trusted Source33Trusted Source).
  • Epilepsy. Research has shown that the ketogenic diet can cause significant reductions in seizures in epileptic children (3Trusted Source).
  • Parkinson’s disease. Although more research is needed, one study found that the diet helped improve symptoms of Parkinson’s disease (34Trusted Source).
  • Polycystic ovary syndrome. The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome (35Trusted Source36Trusted Source).
  • Brain injuries. Some research suggests that the diet could improve outcomes of traumatic brain injuries (37Trusted Source).



However, keep in mind that research into many of these areas is far from conclusive.

SUMMARYA ketogenic diet may provide many health benefits, especially with metabolic, neurological, or insulin-related diseases.

Foods to avoid

Any food that’s high in carbs should be limited.

Here’s a list of foods that need to be reduced or eliminated on a ketogenic diet:

  • sugary foods: soda, fruit juice, smoothies, cake, ice cream, candy, etc.
  • grains or starches: wheat-based products, rice, pasta, cereal, etc.
  • fruit: all fruit, except small portions of berries like strawberries
  • beans or legumes: peas, kidney beans, lentils, chickpeas, etc.
  • root vegetables and tubers: potatoes, sweet potatoes, carrots, parsnips, etc.
  • low fat or diet products: low fat mayonnaise, salad dressings, and condiments
  • some condiments or sauces: barbecue sauce, honey mustard, teriyaki sauce, ketchup, etc.
  • unhealthy fats: processed vegetable oils, mayonnaise, etc.
  • alcohol: beer, wine, liquor, mixed drinks
  • sugar-free diet foods: sugar-free candies, syrups, puddings, sweeteners, desserts, etc.

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A sample keto meal plan for 1 week
To help get you started, here’s a sample ketogenic diet meal plan for one week:

Monday
breakfast: veggie and egg muffins with tomatoes
lunch: chicken salad with olive oil, feta cheese, olives, and a side salad
dinner: salmon with asparagus cooked in butter
Tuesday
breakfast: egg, tomato, basil, and spinach omelet
lunch: almond milk, peanut butter, spinach, cocoa powder, and stevia milkshake (more keto smoothies here) with a side of sliced strawberries
dinner: cheese-shell tacos with salsa
Wednesday
breakfast: nut milk chia pudding topped with coconut and blackberries
lunch: avocado shrimp salad
dinner: pork chops with Parmesan cheese, broccoli, and salad
Thursday
breakfast: omelet with avocado, salsa, peppers, onion, and spices
lunch: a handful of nuts and celery sticks with guacamole and salsa
dinner: chicken stuffed with pesto and cream cheese, and a side of grilled zucchini
Friday

 

breakfast: sugar-free Greek, whole milk yogurt with peanut butter, cocoa powder, and berries
lunch: ground beef lettuce wrap tacos with sliced bell peppers
dinner: loaded cauliflower and mixed veggies
Saturday
breakfast: cream cheese pancakes with blueberries and a side of grilled mushrooms
lunch: Zucchini and beet “noodle” salad
dinner: white fish cooked in coconut oil with kale and toasted pine nuts
Sunday
breakfast: fried eggs with and mushrooms
lunch: low carb sesame chicken and broccoli
dinner: spaghetti squash Bolognese
Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefits.

For tons of recipes, check out these 101 healthy low carb recipes and this keto shopping list.

SUMMARY
You can eat a wide variety of tasty and nutritious meals on a ketogenic diet. It’s not all meats and fats. Vegetables are an important part of the diet.

Healthy keto snacks
In case you get hungry between meals, here are some healthy, keto-approved snacks:

fatty meat or fish
cheese
a handful of nuts or seeds
keto sushi bites
olives
one or two hard-boiled or deviled eggs
keto-friendly snack bars
90% dark chocolate
full-fat Greek yogurt mixed with nut butter and cocoa powder
bell peppers and guacamole
strawberries and plain cottage cheese
celery with salsa and guacamole
beef jerky
smaller portions of leftover meals
fat bombs
SUMMARY
Great snacks for a keto diet include pieces of meat, cheese, olives, boiled eggs, nuts, raw veggies, and dark chocolate.

Keto tips and tricks
Although getting started on the ketogenic diet can be challenging, there are several tips and tricks that you can use to make it easier.

Start by familiarizing yourself with food labels and checking the grams of fat, carbs, and fiber to determine how your favorite foods can fit into your diet.
Planning out your meals in advance may also be beneficial and can help you save extra time throughout the week.
Many websites, food blogs, apps, and cookbooks also offer keto-friendly recipes and meal ideas that you can use to build your own custom menu.
Alternatively, some meal delivery services even offer keto-friendly options for a quick and convenient way to enjoy keto meals at home.
Look into healthy frozen keto meals when you’re short on time
When going to social gatherings or visiting family and friends, you may also want to consider bringing your own food, which can make it much easier to curb cravings and stick to your meal plan.
SUMMARY
Reading food labels, planning your meals ahead, and bringing your own foods when visiting family and friends can make it much easier to stick to the ketogenic diet.

Tips for eating out on a ketogenic diet
Many restaurant meals can be made keto-friendly.




Most restaurants offer some kind of meat or fish-based dish. Order this and replace any high carb food with extra vegetables.

Egg-based meals are also a great option, such as an omelet or eggs and bacon.

Another favorite is bun-less burgers. You could also swap the fries for vegetables instead. Add extra avocado, cheese, bacon, or eggs.

At Mexican restaurants, you can enjoy any type of meat with extra cheese, guacamole, salsa, and sour cream.

For dessert, ask for a mixed cheese board or berries with cream.

SUMMARY
When eating out, select a meat-, fish-, or egg-based dish. Order extra veggies instead of carbs or starches, and have cheese for dessert.

Side effects and how to minimize them
Although the ketogenic diet is usually safe for most healthy people, there may be some initial side effects while your body adapts.

There’s some anecdotal evidence of these effects often referred to as the keto flu (38Trusted Source). Based on reports from some on the eating plan, it’s usually over within a few days.

Reported keto flu symptoms include diarrhea, constipation, and vomiting (39Trusted Source). Other less common symptoms include:




poor energy and mental function
increased hunger
sleep issues
nausea
digestive discomfort
decreased exercise performance
To minimize this, you can try a regular low carb diet for the first few weeks. This may teach your body to burn more fat before you completely eliminate carbs.

A ketogenic diet can also change the water and mineral balance of your body, so adding extra salt to your meals or taking mineral supplements may help. Talk to your doctor about your nutritional needs.

At least in the beginning, it’s important to eat until you’re full and avoid restricting calories too much. Usually, a ketogenic diet causes weight loss without intentional calorie restriction.

SUMMARY
Many of the side effects of starting a ketogenic diet can be limited. Easing into the diet and taking mineral supplements can help.

Risks of the keto diet
Staying on the keto diet in the long term may have some negative effectsTrusted Source, including risks of the following:

low protein in the blood
extra fat in the liver
kidney stones
micronutrient deficiencies
A type of medication called sodium-glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes can increase the risk for diabetic ketoacidosis, a dangerous condition that increases blood acidity. Anyone taking this medication should avoid the keto diet (40Trusted Source, 41Trusted Source).

More research is being done to determine the safety of the keto diet in the long term. Keep your doctor informed of your eating plan to guide your choices.

SUMMARY
There are some side effects to the keto diet about which you should speak to your doctor if you plan to stay on the diet long term.

Supplements for a ketogenic diet
Although no supplements are required, some can be useful.

MCT oil. Added to drinks or yogurt, MCT oil provides energy and helps increase ketone levels. Shop for MCT oil online (42Trusted Source, 43Trusted Source).
Minerals. Added salt and other minerals can be important when starting out due to shifts in water and mineral balance (44Trusted Source).
Caffeine. Caffeine can have benefits for energy, fat loss, and performance (45).
Exogenous ketones. This supplement may help raise the body’s ketone levels (46Trusted Source).
Creatine. Creatine provides numerous benefits for health and performance. This can help if you are combining a ketogenic diet with exercise (47Trusted Source).
Whey. Use half a scoop of whey protein in shakes or yogurt to increase your daily protein intake (48Trusted Source, 49Trusted Source). Shop for tasty whey products on online.
SUMMARY
Certain supplements can be beneficial on a ketogenic diet. These include exogenous ketones, MCT oil, and minerals.

Frequently asked questions
Here are answers to some of the most common questions about the ketogenic diet.

1. Can I ever eat carbs again?

Yes. However, it’s important to significantly reduce your carb intake initially. After the first 2 to 3 months, you can eat carbs on special occasions — just return to the diet immediately after.

2. Will I lose muscle?

There’s a risk of losing some muscle on any diet. However, protein intake and high ketone levels may help minimize muscle loss, especially if you lift weights (50Trusted Source, 51Trusted Source).

3. Can I build muscle on a ketogenic diet?

Yes, but it may not work as well as on a moderate carb diet (52Trusted Source, 53Trusted Source). For more details about low carb or keto diets and exercise performance, read this article.

4. How much protein can I eat?

Protein should be moderate, as a very high intake can spike insulin levels and lower ketones. Around 35% of total calorie intake is probably the upper limit.

5. What if I am constantly tired, weak, or fatigued?

You may not be in full ketosis or be utilizing fats and ketones efficiently. To counter this, lower your carb intake and revisit the points above. A supplement like MCT oil or ketones may also help (42Trusted Source, 43Trusted Source).

6. My urine smells fruity. Why is this?

Don’t be alarmed. This is simply due to the excretion of by-products created during ketosis (54Trusted Source).

7. My breath smells. What can I do?

This is a common side effect. Try drinking naturally flavored water or chewing sugar-free gum.

8. I heard ketosis was extremely dangerous. Is this true?

People often confuse ketosis with ketoacidosis. Ketoacidosis is dangerous, but the ketosis on a ketogenic diet is usually fine for healthy people. Speak to your doctor before starting any new diet.

9. I have digestion issues and diarrhea. What can I do?

This common side effect usually passes after 3 to 4 weeks. If it persists, try eating more high fiber veggies (55Trusted Source, 56).




The bottom line
A ketogenic diet can be great for people who:

are overweight
have diabetes
are looking to improve their metabolic health
It may be less suitable for elite athletes or those wishing to add large amounts of muscle or weight.

It may also not be sustainable for some people’s lifestyles and preferences. Speak with your doctor about your eating plan and goals to decide if a keto eating plan right for you.

SUMMARYAvoid carb-based foods like grains, sugars, legumes, rice,

potatoes, candy, juice, and even most fruits.