This means that to achieve ketosis, you have to limit your carb intake to less than 50 grams per day (most people should reach ketosis within a week of following the diet). To put this in perspective, the low-carb diet you’re most familiar with—the Atkins Diet—recommends about 130 grams of carbs per day. Also for reference, one bagel has about 55 grams of carbs.
Lastly, if you're active, you might need to make some adjustments to take that into account. "For the first one to two weeks, temporarily reducing your exercise load can be helpful as your body adjusts to being in ketosis," he says. "Additionally, for those who have an intense workout schedule, carb cycling may be a good option." Carb cycling essentially means you'll increase your carb intake on the days you're doing exercise, ideally just two to three days per week. "While low-carb days may be around 20 to 30 grams of net carbs daily, high-carb days can range all the way up to 100 grams, although it can vary based on your size and activity level," says Dr. Axe. (Related: 8 Things You Need to Know About Exercising on the Keto Diet.)
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.”
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 significant adjustments to medication and insulin to prevent dangerous side effects such as low blood sugar, called hypoglycemia. (8)
A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight. Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions. Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.
The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.
About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether. Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.
Cauliflower is a great base for low-carb meals and is popping up everywhere—especially on keto diet blogs. This cauliflower soup by All Day I Dream About Food is super simple to whip up in the Instant Pot and tastes decadent thanks to cheese, bacon, and sour cream. Plus, it only has 5.5 grams of net carbs and delivers nearly 3 grams of fiber thanks to the cauliflower.
Don’t stick to chicken and steak just because you’re comfortable cooking them. Make dinner time the place where you can try new meats and recipes that increase your keto recipe resources. “At lunch and dinner, you can be creative and experiment,” Weaver says. “Just focus on cooking meat—pork, chicken, lamb, beef, or seafood. Meat is rich in iron and fish contains omega-3 fatty acids and vitamin D. Use only organic oils, such as avocado oil, coconut oil, and olive oil.”
How did this diet, which was first developed in the 1920s as a treatment for children with epilepsy (and has been shown to reduce seizures in patients whose epilepsy symptoms aren’t responding to other medications), become the diet du jour, and why such a discrepancy between its fandom and expert opinion? Let’s take a closer look at what “going keto” entails.
Achieving optimal ketosis hinges on finding the right balance of macronutrients (or “macros” in keto-speak); these are the elements in your diet that account for the majority of your calories, a.k.a. energy—namely, fat, protein, and carbohydrates. By the way, it’s often “net grams” of carbohydrates that are counted toward your daily intake; “net” deducts the amount of fiber in a food from its carbohydrate total.
And good news for coffee addicts: you can still have your morning cup of joe. You’ll just need to adjust what you stir into it. Switch out flavored creamer for the real deal—full-fat heavy whipping cream, which has only 1 gram of carbs per tablespoon. If you want to give your java a jolt of sweet, stir in a low-carb sweetener that uses sugar alcohols. But if you can skip the sweet, even better. In time, you’ll retrain your palate to not crave a sugary start to the day.
During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. This changed in 1938 when H. Houston Merritt, Jr. and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox–Gastaut syndrome, declined further.
This week we’re introducing a slight fast. We’re going to get full on fats in the morning and fast all the way until dinner time. Not only are there a myriad of health benefits to this, it’s also easier on our eating schedule (and cooking schedule). I suggest eating (rather, drinking) your breakfast at 7am and then eating dinner at 7pm. Keeping 12 hours between your 2 meals. This will help put your body into a fasted state.
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 modifications are typically implemented by athletes looking to use the ketogenic diet to enhance performance and endurance and not by individuals specifically focused on weight loss.
Burgers. Everyone loves burgers, right? Even once I made the switch to Keto, I would still make an occasional allowance, as one bun wasn’t going to break the carb bank. But I came to learn that buns, much like other wheat based products, are in essence, just a delivery mechanism, they hold very little flavor, and in the quest for the best replacement, I made these delightful burger boats.
In a recent study in the Journal of Sports Medicine and Physical Fitness, Weiss and his colleagues found that participants performed worse on high-intensity cycling and running tasks after four days on a ketogenic diet, compared to those who’d spent four days on a high-carb diet. Weiss says that the body is in a more acidic state when it’s in ketosis, which may limit its ability to perform at peak levels.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients. Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term. Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.
macronutrient ratios in line: "Fat should be used as a satiating nutrient. People don't necessarily need to eat fat bombs and put extra fat on their food or in their coffee just to make it high-fat," says Mavridis. While this is a good strategy for when you're transitioning from a glucose-dependent diet to a fat-fueled one, it's not necessary once you’re fat-adapted, she adds. This is where intuitive eating comes into play. Learn to pay attention to your hunger cues. "If you’re feeling hungry shortly after a meal then you probably did not have enough protein or fat. But if you’re full and satiated, there is no reason to consume excess quantities of fat," explains the health expert.
Positive science on ketosis coupled with personal successes passed by word-of-mouth have driven more people to explore the ketogenic diet, says Volek. More recently, the keto diet hints at having a promising therapeutic role in cancer, Alzheimer’s, Parkinson’s and polycystic ovary syndrome (PCOS). Research is still early in many areas, but Volek suspects there will more definitive answers on the wider scope of the diet’s benefits within the next decade.
A keto diet is very restrictive—more so, even, than plans such as paleo and Atkins. One piece of fruit or a serving of steamed beets can put someone over his or her entire daily carbohydrate limit. “Restrictive dieting is a psychological stressor,” says psychotherapist Shiri Macri, MA, LCMHC, clinical director at Green Mountain at Fox Run, who specializes in working with people who emotionally overeat or binge-eat. “When people deprive their bodies of the amount of nutrition and the nutrients that it needs, the body responds in a state of emergency. Levels of cortisol, a stress hormone, go up, and we also have a decrease in mood-boosting serotonin.” Check out the 11 hidden dangers of the keto diet.