If you “slip up” on a ketogenic diet, it is not the end-of-the-world nor does it mean you should continue to be off the wagon. Unfortunately, having frequent “slip-ups” or “cheat days” may prevent you from becoming “keto-adapted.” However, an occasional “slip-up” for someone who is already “keto-adapted” may not be as detrimental. Get back on track and get back in your routine. Find support groups and alternative recipes to avoid these pitfalls and setbacks.
How often you eat while on a keto diet plan is also up to your personal preference. "For most people, I recommend three to four meals per day with a few healthy keto snacks in between," says Dr. Axe. "This ensures that you're getting a good mix of protein and fat all day long to keep you feeling energized and satisfied." That being said, he encourages people to listen to their bodies and tune in to when they're truly hungry. "If you find that you feel better eating five to six smaller meals spread throughout the day, do what works best for you."
Increased Energy: Fat and ketone bodies can be utilized as a fuel source for nearly all of the cells in the body. Once the body begins to use ketones as its primary fuel source, there will be a noticeable increase in energy since you are avoiding the ups and downs associated with high-carbohydrate/high-glucose/high-insulin levels that result in feeling lethargic and tired throughout the day.

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.

One area where food tracking can be especially helpful, though, is ensuring that you're hitting the right ratios of macronutrients-protein, carbs, and fat. "The most researched version of the ketogenic diet derives 70 percent of calories from healthy fats, 20 percent from protein, and only 10 percent from carbs," explains Charles Passler, D.C., nutritionist, and founder of Pure Change. "In the ideal world, each keto meal and snack should have that same (70/20/10) ratio of macronutrients, but studies have shown that you'll still achieve great results even if each meal varies slightly from that ratio, just as long as you don't exceed 50 grams per day of carbs, or eat those carbs in one sitting," says Passler. In order to achieve these ratios without a preset meal plan from a dietitian or doctor, some food tracking is probably going to be necessary. But once you get the hang of things, you may not need it anymore.
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44] 

Having too much protein: This is likely not an issue for most people, but for others having too much protein can negatively impact ketosis, due to its glucogenic effects. The level needed to achieve this is still unknown, but likely higher than we originally thought. To prevent this, try to eat whole foods as much as possible instead of isolated protein sources (i.e., straight protein shakes).

People use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases, and even acne, but there needs to be more research in those areas. Talk with your doctor first to find out if it’s safe for you to try a ketogenic diet, especially if you have type 1 diabetes.


It seems strange that a diet that calls for more fat can raise “good” cholesterol and lower “bad” cholesterol, but ketogenic diets are linked to just that. It may be because the lower levels of insulin that result from these diets can stop your body from making more cholesterol. That means you’re less likely to have high blood pressure, hardened arteries, heart failure, and other heart conditions. It's unclear, however; how long these effects last.
People use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases, and even acne, but there needs to be more research in those areas. Talk with your doctor first to find out if it’s safe for you to try a ketogenic diet, especially if you have type 1 diabetes.
As for branched-chain amino acids, you'll find smart people who swear that they're keto-friendly, and others who don't. One of the BCAAs, valine, can be glucogenic, meaning that it can lead to glucose production and potentially contribute to leaving ketosis behind.[1] But does that mean it will happen? Not necessarily, particularly if you're just an occasional supplement user.
Electrolytes: To reiterate, maintaining electrolyte balances is critical on a ketogenic diet, in order to prevent side effects and the “keto-flu.” While this can be done exclusively through whole foods, some individuals may require additional sources. Sodium, magnesium, potassium, and in some cases, calcium, can all be replenished via supplementation.
Keto for Cancer: Cancer is now being discussed as primarily a metabolic disease in which glucose can fuel its progression. Due to recent light shed on this subject, intensive investigations are underway and have begun to reveal that restricting carbohydrate intake can slow oncogenesis and that a full ketogenic-state may elicit even greater therapeutic benefits. Furthermore, research also suggests that fasting and the state of ketosis may increase the sensitivity of cancer cells to radiation and chemotherapy.

When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]


Increased Energy: Fat and ketone bodies can be utilized as a fuel source for nearly all of the cells in the body. Once the body begins to use ketones as its primary fuel source, there will be a noticeable increase in energy since you are avoiding the ups and downs associated with high-carbohydrate/high-glucose/high-insulin levels that result in feeling lethargic and tired throughout the day.


Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >

Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[35] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[36] However, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.[9] Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[37]
A carbohydrate refeed is not necessary on a ketogenic diet, as the keto-adapted biological and metabolic changes do not require dietary carbohydrates. There are certain circumstances, however, in which an increase in small carbohydrate influx may be beneficial; however, more research is needed on this topic, specifically with respect to variations of ketogenic diet including “cyclic” and “targeted” ketogenic diets.
The remaining calories in the keto diet come from protein — about 1 gram (g) per kilogram of body weight, so a 140-pound woman would need about 64 g of protein total. As for carbs: “Every body is different, but most people maintain ketosis with between 20 and 50 g of net carbs per day,” says Mattinson. Total carbohydrates minus fiber equals net carbs, she explains.

Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]

Eggs are a healthy, nutrient-dense food that has been incorrectly maligned for years. Cholesterol in food doesn’t increase cholesterol in your blood, so eat eggs liberally – they’re packed with protein and lutein, and they fill you up for hours. Make a healthy omelet with some cheddar, crumbled breakfast sausage, and shredded spinach and you’re already looking at over 30g of protein, just for breakfast! Spinach is a great source of magnesium and potassium, too. Add some sea salt and you’ve got a big dose of electrolytes that are so vital to maintaining energy and staving off headaches. Get the recipe and instructions
This can look different for everybody, but some popular forms of this are the 16:8 diet, where you fast for 16 hours (usually from dinnertime until a late breakfast) and eat all your food within an eight-hour span. Another is the 5:2 diet, where you eat less than 500 calories for two non-consecutive days a week and then eat normally for the rest of the week.
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.[10]
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
Tip: Consuming a moderate dose of exogenous ketones during the initial “keto-adaptation” period could potentially accelerate the “adaptation,” while at a minimum increasing energy production. Once one is adapted, these products are excellent for achieving higher blood-ketone levels, which, in turn, can be beneficial for athletic and cognitive performance, energy production, and perhaps more effective therapeutic treatment.
A ketogenic diet (also known as the keto diet) is typically lower in carbohydrates and higher in fats than a standard American diet. Once your body adapts to a ketogenic diet, it switches from primarily using carbohydrates and glucose to fat and ketones as fuel. This adaptation within the body increases fat breakdown and oxidation, which can improve body composition, general health, performance, and perhaps even longevity! The amount of fat, carbohydrates, and protein needed to achieve a well-formulated keto diet for beginners differs from person to person and is goal-dependent. Any dietary protocol in which you are lowering carbohydrates sufficiently enough to induce a state of ketosis can be considered a ketogenic diet. However, throughout this guide you will begin to understand how to construct a well-formulated ketogenic diet to meet your goals.
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.
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