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)
Totally agree that it’s not something for everyone, though. Even one of the authors I read said he sometimes sneaks a french fry or a bite of cheesecake/ice cream, though he’s able to stop after just a little bit and it doesn’t throw him off horribly. Of course, that’s not license to eat junk all the time, but it does mean that once you’re well-adapted, you can sometimes indulge.
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)
•Sodium: Believe it or not, depending on your diet, you may be low on salt. When carb intake is low and insulin isn't being excreted, the kidneys absorb less sodium and potassium and excrete more as waste, leaving you feeling dizzy, fatigued and grumpy. Rather than reaching for more processed food, try seasoning your food a little more liberally with sea salt.
Certain studies suggest that ketogenic diets may “starve” cancer cells. A highly processed, pro-inflammatory, low-nutrient diet can feed cancer cells causing them to proliferate. What’s the connection between a high-sugar diet and cancer? The regular cells found in our bodies are able to use fat for energy, but it’s believed that cancer cells cannot metabolically shift to use fat rather than glucose. (11)
Sharon M. Nickols-Richardson, PhD, RD, , Mary Dean Coleman, PhD, RD, Joanne J. Volpe, Kathy W. Hosig, PhD, MPH, RD, “Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High-Protein vs High-Carbohydrate/Low-Fat Diet,” The Journal of Pediatrics: Vol 105, Issue 9: 1433–1437; September 2005. http://www.sciencedirect.com/science/article/pii/S000282230501151X.
Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD, “Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women,” JAMA. 2007;297(9):969-977. http://jama.jamanetwork.com/art icle.aspx?articleid=205916.
Most condiments below range from 0.5–2 net grams per 1–2 tablespoon serving. Check ingredient labels to make sure added sugar is not included, which will increase net carbs. (Stevia and erythritol will become your go-to sweeteners because neither raise your blood sugar — combine for a more natural sweet taste and, remember, a little goes a long way!)
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.)
If you’d like to try intermittent fasting, it’s best to start by gradually decreasing your feeding window. Start with not eating for a 12 hour stretch, including the time that you’re sleeping. For example, you could stop eating at 8 in the evening, then have breakfast at 8 in the morning. Ultimately, you’ll want to be mostly done with digestion by the time you go to bed, and not be hungry until late morning, so for most people a feeding window of 10am to 6pm would be a good goal.
On the other hand, the types of foods you’ll avoid eating on the keto, low-carb diet are likely the same ones you are, or previously were, accustomed to getting lots of your daily calories from before starting this way of eating. This includes items like fruit, processed foods or drinks high in sugar, those made with any grains or white/wheat flour, conventional dairy products, desserts, and many other high-carb foods (especially those that are sources of “empty calories”).
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more
This is an adaptation period, where we’re essentially re-training our muscles and our brain to use fat as the primary fuel source instead of glucose. This adaptation can take a couple of weeks to a couple of months. As a hallmark of being keto-adapted and not just in ketosis, the skeletal muscles are able to burn fat directly for fuel, and the brain relies on the higher volume of ketones in the blood as its main source of energy.

For some, ketosis can cause more negative than positive side effects. Dorena Rode, a 52-year-old author, and speaker from Occidental, California, tried the diet for a month and experienced heart palpitations and dizziness. Unlike Drew, Rode says her cholesterol increased from 192 to 250 mg/dL after she introduced more fat into her diet. (Less than 200 mg/dL is considered desirable, while anything over 240 mg/dL is considered high.)
Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
Clinical improvement was observed in Alzheimer’s patients fed a ketogenic diet, and this was marked by improved mitochondrial function. (14a) In fact, a European Journal of Clinical Nutrition study pointed to emerging data that suggested the therapeutic use of ketogenic diets for multiple neurological disorders beyond epilepsy and Alzheimer’s, including headaches, neurotrauma, Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis. (14b)
When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).
Paleo and keto can overlap, though there are some major differences in the core of each way of eating. The Paleo diet focuses on whole, natural foods that would have been available as food to our paleolithic ancestors. If it could have been hunted or foraged, then it would have been eaten. Some people on a Paleo plan also focus on what would have been growing in season, and in a certain region of the world for their genetic ancestors. Carbs are overall allowed in a Paleo plan, but they would come from whole foods like potatoes, sweet potatoes, fruits, honey, and other unprocessed sources.

Keto breath, on the other hand, is less of a side-effect and more of a major (not harmful) inconvenience (your breath literally smells like nail polish remover). Basically, when your body breaks down all that extra fat on the keto diet, it produces ketones—one of which is the chemical acetone (yes, the same stuff that's in nail polish remover), Keatley previously told WomensHealthMag.com.
The second tip is to “carb-up”, meaning to eat high fat, low carb all day, and at night basically eat all carbs, no fat. Carbs like sweet potatoes, plantains, and grains, are some of the prefered foods when practicing “carb-up”. The reason why the “carb-up” practice can be helpful is because, once you are fat-adapted, your body burns carbohydrates first, and then goes into the fat-burning mode but, once you increase the amount of carbs eaten, your body’s ability to better burn fat is increased. To sum up “carb-up”: helps you go from fat-adapted back to the fat-burning mode.

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For athletes, research on the keto diet highlights potential improvements in athletic performance, especially when it comes to endurance activities. An article suggests ketogenic-type diets may allow endurance athletes to rely mostly on stored fat for energy during exercise rather than having to refuel with simple carbohydrates during endurance training and competition while additionally improving recovery times. (10)
I like it – and I’m surprised I like it. I’m only down 5 lbs. after a month but I’m down 3 inches on my waist and 2 inches on my hips. I do feel better physically and I love not being hungry! I used to be that person who could eat pasta like a lumberjack – now I often don’t even finish my food. I have had a hard time sticking to 20 net carbs, I usually end up in the high 20’s somewhere, but I’m in ketosis according to the testing strips. It’s much harder to stick to 20 net as a vegetarian. Everything you eat has some level of carbs and they do add up. But overall, this is the only thing I’ve lost any weight or inches on in about 7 or 8 years. Starvation used to work until I hit 45 and then, forget it, I could eat 700 calories a day and not lose a pound. I’m so excited *something* is actually working.
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This process of burning fat provides more benefits than simply helping us to shed extra weight — it also helps control the release of hormones like insulin, which plays a role in development of diabetes and other health problems. When we eat carbohydrates, insulin is released as a reaction to elevated blood glucose (an increase in sugar circulating in our blood) and insulin levels rise. Insulin is a “storage hormone” that signals cells to store as much available energy as possible, initially as glycogen (aka stored carbohydrates in our muscles) and then as body fat.
From the early understanding of the keto research and literature, it looks like we're just scratching the surface understanding some of the potential therapeutic roles of the keto diet. While it's unclear if it's any better or worse than any other diet for weight loss, the reality is that there is no one-size-fits-all model for diets. This doesn't even consider that weight-loss diets, in general, don't really work. While researchers can't agree on a specific statistic, it's commonly accepted that the vast majority of dieters will regain the weight lost (and often pack on extra pounds, as well). The long-term outcome of the keto diet is likely to be no different, especially given how challenging and restrictive it is to maintain.
I’m really interested in that article also. We had a baby almost a year ago. We decided to give the plant-based diet a go, and has been successful. But, I’m stuck now. Haven’t lost any more weight. And recently just learned of the keto diet! I started last week, but I’m a mess with what to eat, being plant-based and all. Can’t wait for that post! I’ve bookmarked this for future reference.
Some people like to weigh their food when they first transition from a normal diet to a ketogenic diet, in order to have a fuller understanding of the amount of carbohydrates that they consume, although this can be used just in the beginning as a guide. But ultimately no, you do not have to weigh your food in order to be successful with a keto diet.

The keto diet works for such a high percentage of people because it targets several key, underlying causes of weight gain — including hormonal imbalances, especially insulin resistance coupled with high blood sugar levels, and the cycle of restricting and “binging” on empty calories due to hunger that so many dieters struggle with. Yet that’s not a problem with what’s on the keto diet food list.
According to the USDA, a 100-gram serving of red tomatoes has 3.89 grams of carbohydrates.43 You may add this fruit to your ketogenic diet safely and gain its beneficial nutrients, particularly lycopene. Researchers from Ohio State University suggest that this antioxidant may help protect your skin from sun damage, which may result in a lowered risk of skin cancer tumors.44
Oh man, this is a great read. Entertaining and full or resources and digestible content even though it is a long article. But I appreciate the research you went through it. I remember 5 years ago researching about Keto diet took forever because of how spread out the sources were. This is great work as a guide. Thanks for the article. Before reading this article I thought the requirements were too strict, but now that I read it, I am already doing a third of that list. I am trying IF right now, but I think this will help me with my satiety problem with meals, plus help me with weight loss. Thanks for the motivation and information Steve. I am starting my plan of attack and try a Keto diet.

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