• Type 2 Diabetes: This population has been studied heavily with the keto diet since it's technically as low-carb as you can get. While the research to date has been conducted in very small sample sizes, evidence suggests that an ultra-low-carb diet (like the keto diet) may help reduce A1C and improve insulin sensitivity by as much as 75 percent. In fact, a 2017 review found that a keto diet was associated with better glucose control and a reduction in medication use. Having said that, the authors cautioned that it was unclear whether the results were due to weight loss in general, or higher ketone levels.
Increasing numbers of people around the world are suffering from chronic diseases such as diabetes and obesity, and the main culprit is usually the food they eat. The standard American diet, for example, consists of excessive amounts of protein, processed grains and carbohydrates — particularly in the form of refined, added sugars — none of which is good for your health.
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
Your body is still growing — In one study, epileptic children experienced a reduction in symptoms and improved cognitive performance when a ketogenic diet was introduced.49 However, this may have a negative effect on the growth of their bodies in the long run, according to a study published in the journal Developmental Medicine & Child Neurology.50
• Constipation: No one likes to feel backed up, and sadly if you're not careful about your diet choices when going keto, it could become a regular concern. One 10-year (albeit small) study looking at the effects of a keto diet on young children found that 65 percent experienced digestive woes. Thankfully, going keto is not a life sentence for problem bowels. Since you're cutting out whole grains and fruit (two of the most common sources of fiber), aim to up your fiber-rich veggies, and consider a supplement.

The ketogenic diet is super high in fat (about 80 percent of your daily calories), super low in carbohydrates (less than 5 percent of your calories), and moderate in protein (typically 15 to 20 percent of your calories). This is a pretty drastic departure from the generally recommended macronutrient distribution of 20 to 35 percent protein, 45 to 65 percent carbohydrates, and 10 to 35 percent fat.

Symptoms of the keto flu include headache, fatigue, dizziness, sleep problems, heart palpitations, cramps, and diarrhea. These side effects usually lessen and eventually resolve in about two weeks. (2) But to lessen the effects of any discomfort, simply consider slowly transitioning onto a ketogenic diet rather than rushing to change your eating habits. By slowly lowering your carbohydrate intake, while gradually increasing your intake of dietary fat over time, you can transition with less of a negative impact and potentially prevent the keto flu.


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.
Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” N Engl J Med 2003; 348:2074-2081. http://www.nejm.org/doi/full/10.1056/NEJMoa022637.
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.
[i] 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"
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.

• Keto "Flu": Your body isn't accustomed to using ketones on the regular, so when you make the switch, you tend to feel unwell. The keto diet also influences electrolyte balance, resulting in brain fog, headaches, nausea and fatigue. Keto dieters also consistently complain about getting bad-smelling breath, sweat and pee as a result of the by-product of fat metabolism (acetone) seeping out. Thankfully, this effect is just temporary, so just know you won't have to spend your life smelling rank.
Chickpeas are naturally high in carbs — a single cup contains 45 grams of carbohydrates.31 However, you can modify the recipe to make it more nutritious. Try this recipe from Pete Evans, which replaces the chickpeas with beetroot.32 Beware, though, that beets have the highest sugar content of all vegetables, so consume them in very controlled amounts.

If you're new to keto, watch out for hidden carbs. Generally, dairy products and nuts are a good way to meet your daily fat intake, but know that some of those items may contain more carbohydrates than you think. For example, yogurt topped with nuts may seem like a great keto-friendly snack, but a 5.3 ounce serving of plain yogurt has 12 grams of carbohydrates. Vanilla flavored yogurt has 24 grams of carbohydrates. Add an ounce of cashews, weighing in at nearly nine grams of carbs, and you’re up to 21 to 33 grams of carbs for that snack, which could knock you out of ketosis. Be sure to read nutrition labels carefully and pay careful attention to serving sizes. Track foods using a keto-specific app like Senza or KetoDiet can help you stay within your recommended daily carb intake.


LCHF is a plan that is very similar to an Atkins approach, but the focus is placed on the higher ingestion of fats, and a perpetual restriction of carbohydrates to less than 20 grams per day, and in some cases nearly 0 grams a day are consumed. There is no specific restriction of artificial or manufactured foods, only that the fat is kept higher, around 70%-85% of the diet.
Although a standard ketogenic diet is even more restrictive in terms of carb intake, a “moderate keto diet” (just as some folks have followed a modified Atkins diet) is another option that will very likely still be able to provide substantial weight loss results and other improvements in symptoms. Including slightly more carbs can be very useful for maintenance, allow for more flexibility, provide a higher fiber intake, and overall may feel more sustainable long term socially and psychologically.
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.
A: The most common ways to track your carbs is through MyFitnessPal and their mobile app. You cannot track net carbs on the app, although you can track your total carb intake and your total fiber intake. To get your net carbs, just subtract your total fiber intake from your total carb intake. I have written an article on How to Track Carbs on MyFitnessPal.
Although studies have shown that the keto diet can reduce seizures for children with epilepsy, there is no evidence indicating that keto helps with other brain disorders or improves mental cognition, according to Harvard Health Publishing. Some studies show that keto may lower blood sugar for people with type 2 diabetes, but there is not enough long-term research to determine whether it’s safe and effective for diabetics.
Net carbs are used because fiber is not fully digested as energy, and does not impact your blood sugar the same as a regular carb.  This is why you should still eat plenty of high fiber, low net carb vegetables…your body needs that fiber, and it won’t hurt your ketosis.  Still confused on what a net carb is? Check out how to read a nutrition label on the keto diet.
Many books could be written on this very subject, and undoubtedly they have been. There are many answers, and they all depend on context. Lots of variables impact how well, and how consistently we lose weight. How much sleep do we get each night, and how restful is that sleep? What micronutrients are we not getting enough of? How much water are we drinking? How much are we exercising?
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.
• Athletic Performance Impediments: For those people who train heavy and hard, going keto might cramp your style. As important as protein is for muscle growth, carbs also play an equally critical role by releasing insulin to drive that protein into muscles faster. It also helps us build up glycogen stores for longer training sessions, runs or hikes. One comprehensive review of the literature in sports nutrition found that while research is lacking on the long-term impacts of the keto diet, in the short term, the keto diet is inferior to other diet protocols on anaerobic, aerobic and in some cases even strength performance measures.
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”).
If you start at 20g of carbohydrates a day, you should slowly move to 50 as you reach your goal. Once you reach your goal, you can up your carbs as you see how they effect your weight. If you eat fruit for a week and gain weight, cut back. You have to figure out what works best for you. Ketosis is usually reached by only consuming 50g of carbs or less each day so that should be your starting range. I would not move past this until you have reached your goal weight and started to exercise daily (more about exercise is at the bottom of this post).
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A lot of changes are happening in your body and you’re going to feel it! The first five to seven days can be pretty rough, but your body is getting over its dependency on sugar. During this time of transition it is essential that you supplement electrolytes. Your body is flushing out lots of water, and with that goes electrolytes. The Keto Flu can be greatly reduced if you add sodium, potassium and magnesium to your diet. Check out our supplements page for a list of electrolyte supplements we recommend. Stay on course and you’ll start feeling better in no time!

Anecdotally speaking, people do lose weight on the keto diet. Heather Wharton, a 35-year-old business relationship manager from Tampa, Florida, lost 140 pounds since starting the keto diet in January 2016: “I plan on being on the keto diet for the rest of my life,” says Wharton. “My husband and I consider ourselves to be food addicts, and the keto diet is what we use as a form of abstinence from trigger foods that have sugar and other carbohydrates." A typical day of eating for Wharton includes coffee with a protein supplement, a cup of unsweetened cashew milk, cauliflower rice with ground turkey and liquid aminos (a carb-free substitute for soy sauce), spinach, six slices of turkey bacon, six eggs, and a little salsa.
Drink lots of water. If you aren’t consuming enough water then the organs in your body can’t function properly. There is no point in eating right if your body can’t do what it is supposed to with the foods. Drinking plain water can get tiring so I like to either use MiO in my water (this kind also helps to replenish electrolytes) or I’ll turn to a detox water to change things up.
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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