Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD, MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP; Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD, DrPH, “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat,” Arch Intern Med. 2004;164(19):2141-2146. http://archinte.jamanetwork.com/article.aspx?articleid=217514.
That said, I think the biggest changes are the result of me dropping the sugars and breads. Tracking my eating and being more conscious about my foods has made a difference. I definitely plan to keep on this track for a while and slowly work towards a fuller keto-adapted diet/body. I’m not going with the “all-in” that some recommend, cutting out all artificial sweeteners and such, though I have limited them. I’m not really tempted to indulge in the sweets that have been tempting in the past.
Therefore, when you’re following a ketogenic diet, your body is burning fat for energy rather than carbohydrates, so in the process most people lose weight and excess body fat rapidly, even when consuming lots of fat and adequate calories through their diet. Another major benefit of the keto diet is that there’s no need to count calories, feel hungry or attempt to burn loads of calories through hours of intense exercise.
In some ways, it’s similar to the Atkins diet, which similarly boosts the body’s fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto diet and the Atkins diet is ketogenic emphasizes healthier fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.
• High-protein ketogenic diet — This method is a variant of the SKD. In a high-protein diet, you increase the ratio of protein consumption to 10 percent and reduce your healthy fat consumption by 10 percent. In a study involving obese men that tried this method, researchers noted that it helped reduce their hunger and lowered their food intake significantly, resulting in weight loss.11
• Cyclic ketogenic diet (CKD) — Whereas TKD is focused on fitness enthusiasts, CKD is focused more on athletes and bodybuilders. In CKD, you cycle between a normal ketogenic diet, and a short period of high carb consumption or "re-feeds."8 The idea here is to take advantage of the carbohydrates to replenish the glycogen lost from your muscles during athletic activity or working out.9
It’s important to remember that the goal of 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.
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. (13)
• Standard ketogenic diet (SKD) — SKD is the type I typically recommend for most people, because it is very effective. It focuses on high consumption of healthy fats: As I explain in my book, "Fat for Fuel," you should aim for having 70 to 85 percent of your total daily calories to come from healthy fats. For your protein intake, the general rule of thumb is to follow the formula of 1 gram of protein for every kilogram of your lean body mass.
You can use the Ketone Test Strips to test your ketone level. These are strips that use urine to measure excreted ketones. These are inexpensive and popular, but unfortunately highly inaccurate. They only measure the level of ketones that are excreted as waste, and not used by the body. They show that you’re producing ketones, but not necessarily using them for energy.
But what does the science say? Results are mixed. In one Spanish study of 20 obese adults, participants were put on a low-calorie keto diet and lost an average of 40 pounds over four months. Another small experiment had a similar outcome. In a six-month Experimental & Clinical Cardiology study of 83 obese adults, those on the keto diet lost an average of 33 pounds, while lowering their bad (LDL) cholesterol levels and increasing their good (HDL) cholesterol.
• Potassium: With the approved list of foods being so brief, you might not be getting in enough fruits and veggies on keto. One of the biggest impacts? A potassium deficiency—and all of the lovely constipation and muscle cramps that accompanies it. Aim to up your intake of foods like spinach, avocado, tomatoes, kale and mushrooms to get your potassium fix.
Cyclical ketogenic diet: The Bulletproof Diet falls into this category. You eat high fat, low carb (less than 50 grams of net carbs a day) five to six days of the week. On day seven, you up your carb intake to roughly 150 grams, during what’s called a carb refeed day. Carb cycling this way helps you avoid the negative effects some people experience when they restrict carbs long term, like thyroid issues, fatigue and dry eyes.  Full ketosis isn’t for everyone, and adding carbs such as sweet potatoes, squash, and white rice one day a week keeps your body systems that need some amount of carbs functioning properly.
There are several medical studies — such as two conducted by the Department of Radiation Oncology at the Holden Comprehensive Cancer Center for the University of Iowa, and the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, for example — that show the ketogenic diet is an effective treatment for cancer and other serious health problems. (12)
Quick update – been doing a keto-type diet for a couple of months now. My BP is down to the lowest it’s been in something like 10 years, though still on 1/2 dose for my meds. I’ve lost about 30 pounds in the last 4 months (give or take a bit as I’m not sure exactly where I started). I’ll admit I still use Truvia and will have a Coke Zero every now and then, but eliminating the wheat and corn breads and sugars to reduce my carb intake to < 50g/day on average has made a huge difference. (I'm sure some still sneaks in with some of the food I eat out, but for the most part it's pretty good.)
To be confident about being in ketosis, especially at the beginning when you're not quite sure how you should feel, it’s best to measure your ketone levels. By monitoring your ketone levels, you can assure that you’re doing the diet correctly and make dietary adjustments based on what you measure. People also respond to diet and exercise differently, so the best way to cater the keto diet to your own biology is to measure.
Although fat is the centerpiece of any keto diet, that doesn't mean you should be subsisting on butter-topped steaks, says Kristen Mancinelli, RD, author of The Ketogenic Diet. “A big misconception is that you should just put meat at the center of your plate and add more fat on top,” she says. You also shouldn't be relying on fatty meats to hit your fat quota, she adds.
• Cardiovascular Disease: This is definitely a point of confusion and controversy since a diet that relies so heavily on meat and fat is naturally thought to raise blood cholesterol and cause heart issues. However, some evidence suggests that this may not be the case. In fact, the keto diet may help improve triglyceride, HDL and LDL levels. A 2017 review looked at all of the available evidence around the ketogenic diet and cardiovascular health and found that the diet may be associated with some improvements in cardiovascular risk factors. Mind you, the authors also expressed their concerns with maintaining the diet in the long term, and they proposed that these benefits may not be long-lasting. It's clear that we need long-term studies to fill that gap.
In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.
Most alcoholic beverages don’t list the ingredients or nutritional information on the label, so be prepared and check your favorite drinks online so you know your limits beforehand. Most apps and trackers list many types of alcohol in their database, and this is the easiest way to be sure of what you’re drinking. Be warned, when you’re in ketosis your alcohol tolerance will go down, so you might not want to drink as much as you might be used to.
I came across your site yesterday, signed-up, and am a fan; thank you for all your exhaustive efforts which I have yet to explore. I have no issues re-welcoming more fatty, whole, and nutritious items into my daily regimen and am a healthy-eater to begin with; that is, I choose quality any day. Recently, I decided to give Keto a go. I don’t like “diet” nor am I a die-ter. I have to lose about 50lbs and began the transition (to Keto) a week ago. How? I removed all bread-related carbs, pasta, and the treats I’d been indulging in for a few years now.
Absolutely Steve. I love ranch salad dressing, cheese, cream cheese, steak, shrimp, and some vegetables. I am making “fakery” to satisfy my sweet tooth. (Fakery is baking using almond or coconut flour instead of wheat and white flour, and Swerve sweetener instead of sugar (made with Erythritol which has no impact on GI and is good for your teeth) I am over half way to my goal already. Thank you for your article. I appreciate your dedication, knowledge and sharing with the world. (and your cute animal gifs)
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