The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[42] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[18] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]

With grains, most fruits, and many vegetables off the menu, your digestive tract will bog down. “It’s really hard to get adequate fiber eating that way,” says Notte. “A common side effect is significant constipation.” Not only is constipation unpleasant, but it’s also a sign that your gut isn’t happy. “Everything in the keto diet is low in fiber—and that does not support gut health.”
A review of multiple studies in the journal Nutrients found that ketogenic diets are connected to significant reductions in total cholesterol, increases in “good” HDL cholesterol levels, dips in triglycerides levels and decreases in “bad” LDL cholesterol; there are questions as to whether diets high in saturated fat negate these benefits. The same paper reports that a ketogenic may slightly reduce blood pressure, but science is still very scant on this point.

In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[54]
Contrary to what most people think, the keto diet isn’t a high-protein plan; it’s really about cutting carbohydrates and protein. And that protein deficit can be hard on your muscles, research suggests. When you limit carbs from things like fruits, vegetables, and grains, your body starts to steal protein from your muscles and other tissues to transform it into carbohydrate, Notte says. “Protein makes up our organs, our heart, our muscles as well as some hormones, antibodies, and neurotransmitters.”
“A lot of folks find that batch cooking once or twice a week saves a tremendous amount of time and keeps you from spending every evening in the kitchen,” Weaver says. “When keto meal planning, you want to follow general good meal planning practices, like shopping for the week’s food all at once, which helps to save money, and prepping your vegetables when you get home. These 10 keto recipes are so good you’ll forget you’re on a diet.
There are several types of the keto diet, but essentially, to achieve a state of ketosis, you have to severely reduce the amount of carbs you eat. (You can use this ketogenic calculator to create a custom food plan.) Data suggest the average American man over age 20 consumes 47.4 percent of his daily calories from carbs, and the average American woman over age 20 consumes 49.6 percent of her daily calories from carbs. (3) But in the classic ketogenic diet, which was originally used for the management of 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.

The removal of many grains and fruits with such a large emphasis on fats can bring about its own set of side effects. “If not done properly — with most of your carbohydrates coming from fiber-rich vegetables — you may not be getting enough fiber, which can lead to constipation,” says Chris Mohr, PhD, RD, a sports dietitian based in Louisville, Kentucky, and co-owner of MohrResults.com. (5)
Diarrhea can also be due to a lack of fiber in the diet, says Kizer, which can happen when someone cuts way back on carbs (like whole-grain bread and pasta) and doesn’t supplement with other fiber-rich foods, like vegetables. It can also be caused by an intolerance to dairy or artificial sweeteners—things you might be eating more of since switching to a high-fat, low-carb lifestyle.
Hello Myriam, I am a dual certified personal trainer and Sports Nutrition Specialist. I really love how concisely you have put this article together. I did notice that on your macro breakdown for a 1500 calorie diet you actually listed the protein intake at around 31% of the daily calories (117*4=468..468/1500=.31). I was wondering if you did this to bring the protein amount closer to 1 gram per pound of body-weight to preserve lean mass?
One of the most common side effects of starting the ketogenic diet is the “keto flu.” 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 the keto flu, the body’s stored glucose begins depleting, and the body starts adapting to producing and utilizing ketones as energy. (2)
Wondering what fits into a keto diet — and what doesn’t? “It’s so important to know what foods you’ll be eating before you start, and how to incorporate more fats into your diet,” says Kristen Mancinelli, RD, author of The Ketogenic Diet: A Scientifically Proven Approach to Fast, Healthy Weight Loss, who is based in New York City. We asked her for some guidelines.
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