[iv] Hussein M Dashti, MD PhD FICS FACS, Thazhumpal C Mathew, MSc PhD FRCPath, Talib Hussein, MB ChB, Sami K Asfar, MB ChB MD FRCSEd FACS, Abdulla Behbahani, MB ChB FRCS FACSI PhD FICS FACS, Mousa A Khoursheed, MB ChB FRCS FICS, Hilal M Al-Sayer, MD PhD FICS FACS, Yousef Y Bo-Abbas, MD FRCPC, and Naji S Al-Zaid, BSc PhD. "Long-term effects of a ketogenic diet in obese patients"
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.
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.

Net carbs are what we track when following a ketogenic diet. This calculation is pretty straightforward. Net Carbs = Total Carbs – Fiber. For example, one cup of broccoli has 6g of total carbs and 2.4g of fiber. That would mean one cup of broccoli has 3.6g of net carbs. We count Net Carbs  because dietary fiber does not have a significant metabolic effect. 


Having tempting, unhealthy foods in your home is one of the biggest reasons for failure when starting any diet. To maximize your chances of success with the keto diet, you need to remove as many triggers as you can. This crucial step will help prevent moments of weakness from ruining all your hard work.If you aren’t living alone, make sure to discuss with your family or housemates before throwing anything out. If some items are simply not yours to throw out, try to compromise and agree on a special location so you can keep them out of sight.
Over the past century, ketogenic diets have also been used to treat and even help reverse neurological disorders and cognitive impairments, including epilepsy and Alzheimer’s symptoms. Research shows that cutting off glucose levels with a very low-carb diet makes your body produce ketones for fuel. This change can help to reverse neurological disorders and cognitive impairment, including inducing seizure control. The brain is able to use this alternative source of energy instead of the cellular energy pathways that aren’t functioning normally in patients with brain disorders.
Going into nutritional ketosis by following a ketogenic diet is one of the most radical but highly beneficial lifestyle changes you can make to improve your health. As with most dietary changes, always remember to listen to your body. If you feel any side effects other than the ones listed above, then necessary adjustments to your food intake may be needed.
Starting off with it, but with the ~ 50g carbs/day. I’ve been using MyFitnessPal to track, using some advice from ketovale and others to set the targets in the service to help. Only been doing it for ~ 10 days, but down about 8 pounds so far. My biggest problem – need more veggies in my diet and that’s a bit tougher. Working on that with salads and such. I also need to purge out the older salad dressings made w/ vegetable oils and such, but getting there. So – not fully into Keto, but working towards that. I’ve definitely found that I can eat quite a few foods I actually like so that’s not a huge downside. Do I miss pizza/pasta/tortillas? Sometimes. But there are keto pizza crusts (of a sort) and spaghetti squash works really well for me to replace pasta. I have yet to try a “zucchini” wrapped enchilada, but I think that might work as well.
To prevent side effects such as the keto flu, begin transitioning your meal plan gradually. Start by understanding how many carbohydrates you take in most days. Then begin slowly reducing your carbohydrate intake over a period of a few weeks while gradually increasing your intake of dietary fat to keep your calories the same. You should also make sure to seek guidance from a professional to make sure this plan works best for you and your health goals. “See a dietitian and adapt the diet to fit your long-term needs,” Spano recommends.
This also enables you to see what you were eating prior to a woosh of weight loss, or a stall, or even a gain. You can see possible triggers for these events, like having extra vegetables, or having too many nuts and cheeses. It also lets you see if you may have sensitivities. If you try a week without dairy but keep your calories the same, for example, you may or may not notice a spontaneous drop in weight.
Your glycogen stores can still be refilled while on a ketogenic diet. A keto diet is an excellent way to build muscle, but protein intake is crucial here. It’s suggested that if you are looking to gain mass, you should be taking in about 1.0 – 1.2g protein per lean pound of body mass. Putting muscle on may be slower on a ketogenic diet, but that’s because your total body fat is not increasing as much.5Note that in the beginning of a ketogenic diet, both endurance athletes and obese individuals see a physical performance for the first week of transition.
I have read your article and lots of other stuff on Keto, but I still don’t understand why it has to be so high in fat? I am on a calorie controlled diet which should also be pushing me into ketosis (Optifast + veges) nutritionist suggestion to go hard for a month. But after that was looking at moving to a Ketogenic diet. I am just having a hard time with understanding why it has to be high fat. Can you help me understand? Also love your writing style (particularly referencing Ace Ventura).
I’m honestly a little skeptical about it the idea of keto permanently. My brief glance at the literature seems to imply that it can have side effects of kidney stones, skeletal fractures, and slow the growth rate of children, but that was a study on kids with epilepsy (which it treated very effectively), so who knows how that applies to adults. And the other studies I found dealt with overweight and obese subjects, so it may be hard to find something on the long term effects on otherwise healthy adults.
Ketogenesis has existed as long as humans have. If you eat a very low amount of carbohydrates, you starve your brain of glucose, its main fuel source. Your body still needs fuel to function, so it taps into your reserve of ketones, which are compounds the liver creates from fat when blood insulin is low. This process is known as ketosis: It’s like when a hybrid car runs out of gas and reverts to pure electricity.

Bonnie J. Brehm, Randy J. Seeley, Stephen R. Daniels, and David A. D’Alessio, “A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” The Journal of Clinical Endocrinology & Metabolism: Vol 88, No 4; January 14, 2009. http://press.endocrine.org/doi/full/10.1210/jc.2002-021480.
The Atkins diet, on the other hand, is solely focused on weight loss. There is no restriction on artificial sweeteners or manufactured foods, as long as the foods consumed fit the Atkins prescribed ratios. There are four phases to the Atkins diet. The first phase is the most strict, designed to get you into ketosis. The second phase is a tolerance testing phase, where you add more foods to see how many grams of carbohydrate you can still eat and lose weight. The third phase is more generous with carbs, and the fourth phase is the most generous, and it’s in either the third or fourth phase that most people find a good maintenance level.
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)

A related clinical diet for drug-resistant epilepsy is called the medium-chain triglyceride ketogenic diet, in which MCT oil is extensively used because it’s more ketogenic than long-chain triglycerides. (13a) Another dietary therapy for epilepsy called Low Glycemic Index Treatment (LGIT) was developed in 2002 as an alternative to the ketogenic diet. LGIT monitors the total amount of carbohydrates consumed daily, and focuses on carbohydrates that have a low glycemic index.) (13b)


As of the moment, there is no industry standard as to how many calories should be consumed in a restricted ketogenic diet, but there are published studies that provide estimates. In one example, a 65-year-old woman who was suffering from glioblastoma multiforme (GBM), an aggressive type of brain cancer, was put into a restricted ketogenic diet that started with water fasting and then proceeded to consuming 600 calories a day only.

The diet that worked for me was keto. Thanks for the recommendation for the keto strips- I ordered the exact ones and used my first test strip this morning- it worked great!! So I’ve got something else to keep me in check. Dropped 100 pounds after my first child (I really went overboard about eating for two- I thought I was doing something good) and then dropped 30 after my second child. Since then, it’s the same 10-15 pounds that I keep losing and gaining back. Love your mantras- I’ve written a few down in my journal and some just ring in my head like a music track- never two in a row!! Can’t outrun your fork!! With keto, it gets me fantastic and very quick results and I go with a recarb meal (not recarb day) once a week. Eat a little more carbs after workouts. Now with the strips, I can see if what I’m doing post-workout keeps me in keto. Thanks for all your resources- they are so eye-opening and so motivating (and funny)!! I did hours of research about keto- if your article had come out a couple of months earlier- it would havr saved me all that time!! Great knowing that if I feel like I need the boost with 1-1 coaching it is available. Keep up the outstanding work!

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