The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]


The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[43] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]
Wondering how u eat veggies without going over your carbs n how do you get all the fats in. I’ve put the requirements into my fitness pal(macros) but I’m still not losing. Mine are set at 5% carbs 25% protein n 70% fats. Don’t know what I’m doing wrong. I’m allergic to gluten some dairy n eggs. Any help would be great so I can start losing instead of gaining

I have been eating this way (very low carb, high fat, protein in between) for around 3 years now. I have found that for me I can MAINTAIN quite easily at an ideal weight and eating to satiety, but in order to actually LOSE weight, I have to at least have a very small calorie deficit. And though the change is gradual, it is sustainable and quite immediate (just little by little). The amount of that calorie deficit required in order to drop excess varies a lot from one individual to the next though, I think. I am particularly intolerant to hunger, and so I cannot overly emphasize how small of a deficit I will allow for. The nice thing about that though is that the hunger is far more pleasant in the absence of carbs.

First, a little background: Eric Westman, MD, director of the Duke Lifestyle Medical Clinic, explained to Health in a previous interview that in order to successfully follow the keto diet, you need to eat moderate amounts of protein, reduce your carb intake, and increase fats. When you reduce your carb consumption, your body turns to stored fat as its new fuel source—a process called ketosis. To stay in ketosis, followers of the keto diet must limit their carbs to 50 grams a day, Dr. Westman says.

Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[18] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[18]


Therapeutics: The ketogenic diet was originally developed in the 1920s as an alternative therapeutic option to treat children suffering from drug-resistant epilepsy. Since its inception, the utilization of the ketogenic diet has expanded as a therapeutic treatment for many other conditions such as Alzheimer’s disease, Parkinson’s disease, GLUT-1 deficiency syndrome, Bipolar disorders and even cancer.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
The answer to this question is often individualized and will depend on the metabolic state of each individual. One can enter a state of ketosis after an overnight fast. However, this slight elevation may not be high enough to allow for your body to efficiently utilize these ketones as a primary fuel source. Over time, as you become more adapted, your body will consistently be producing AND utilizing ketones. For some, this could take as little as one week, however, for others, it could take several weeks to accomplish. The length of time it takes to become keto-adapted also greatly depends on the composition of the ketogenic diet utilized (i.e., 20 grams versus 50 grams of carbohydrates per day) as well as personal activity level.
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.[3]

Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.

By cutting carb intake significantly, we can drastically reduce insulin resistance, the precursor to type 2 diabetes. In addition, low carb diets, along with exercise, can be very effective at helping alleviate the symptoms and progression of type 2 diabetes. Beyond that, ketosis itself is appetite-suppressing, meaning your hunger will naturally check itself, increasing your caloric deficit and making you lose fat even faster. Read more about ketosis: What Is Ketosis, and How Long Does It Take to Get into Ketosis?
A keto diet should be moderately high in protein and will probably be higher in fat, since fat provides the energy that you are no longer getting from carbohydrate. However, too much dietary fat means your body won’t use body fat for energy. Adequate protein is important, but protein above what your body needs can also contribute to excess calories. Avoid low-fat diet products.
Keto for Epilepsy: The ketogenic diet originated in the 1920s as an effective treatment for children suffering from drug-resistant epilepsy. Since then, its highly successful applications have expanded to treat adult epileptic patients as well. This was an important progression in treatment because, despite the introduction of anticonvulsant drugs in the 1930s, at least one third of patients suffering from epileptic seizures are still fully resistant to anticonvulsant drug therapy.[26] Early studies found that, when placed on a ketogenic diet, 12% of children suffering from epileptic seizures experienced full remission and 42% saw a reduction in seizures.[27]
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.
So question….what if you are watching your sodium intake due to high blood pressure? From what I read here, there is a lot of salt/sodium involved (more than my normal intake), how do I deal with this issue if doing keto? I do not take any medications. About three years ago I found that my thyroid levels were on the low end of the normal range and it affected my blood pressure. So I lowered my sodium intake and increased my iodine/iodide intake. This has worked for me for the past three years, in the sense that after a month of being on bp meds, I no longer needed those meds and my thyroid levels have stayed around the mid-range of normal. I have always eaten healthy with some junk foods here and there, but apparently being pregnant kicked off a thyroid issue and weight gain. What are my sodium options with keto? How do I balance it so my bp doesn’t take a freefall nor a significant increase?
Insulin is a hormone that lets your body use or store sugar as fuel. Ketogenic diets make you burn through this fuel quickly, so you don’t need to store it. This means your body needs -- and makes -- less insulin. Those lower levels may help protect you against some kinds of cancer or even slow the growth of cancer cells. More research is needed on this, though.

In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[54]
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.
Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.
A: The amount of weight you lose is entirely dependent on you. Obviously adding exercise to your regimen will speed up your weight loss. Cutting out things that are common “stall” causes is also a good thing. Artificial sweeteners, dairy, wheat products and by-products (wheat gluten, wheat flours, and anything with an identifiable wheat product in it).

You’ll quickly find that salads are your friend when in ketosis, and for a good reason: they provide lots of food to fill you up, but they’re not going to bog you down. A bed of spinach with some red onion, bacon, a little tomato, and a hot sauce vinaigrette is quick and delicious. Add in some protein – perhaps that leftover salmon from day 1 – and you’ve got a complete, healthy lunch.


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).
^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.

Blood Lipids on a Ketogenic Diet: Lack of proper education has incorrectly held a high-fat diet responsible for an increase in blood lipids. Decades of research, combined with efforts to shift the paradigm, are now revealing that increased dietary fat consumption does not directly result in increased blood lipids. It is actually carbohydrate consumption that tends to increase total cholesterol with noticeable decreases in the HDL “good” cholesterol. Often, researchers use a “high-fat diet” interchangeably with a “Western diet;” many confuse the term “high-fat diet” in the research with a ketogenic diet. A “high-fat diet” in the research indicates a diet with both high-fats and high-carbs, which is associated with increased blood lipids, whereas a ketogenic diet is not.
Conklin's fasting therapy was adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent endocrinologist Henry Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite having studied the patients for only a short time. Further studies in the 1920s indicated that seizures generally returned after the fast. Charles P. Howland, the parent of one of Conklin's successful patients and a wealthy New York corporate lawyer, gave his brother John Elias Howland a gift of $5,000 to study "the ketosis of starvation". As professor of paediatrics at Johns Hopkins Hospital, John E. Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.[10]
Endurance Performance: Traditionally, endurance athletes tend to consume a high amount of carbohydrates in order to “fill up” their fuel stores (i.e. glycogen) for competitions. Thus, a diet where carbohydrates are restricted seems counter-intuitive for these individuals. However, Dr. Jeff Volek’s research showed that once an individual is keto-adapted, not only is their performance the same or better than those consuming high levels of carbohydrates, but their glycogen “fuel stores” are the same as well.[11] Despite consuming a diet lower in carbohydrates, these athletes are able to adapt and utilize a nearly limitless supply of fat as their primary fuel source.
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]
Reaction to eggs could be due to the following: Read Healthy Traditions website regarding chickens being fed soy – soy will be in the eggs. If you can’t get truly organic soy corn free eggs, you may order through them. It is said all soy, even organic is contaminated GE, plus it is said by reliable sources that organic soy, if consumed, should only be fermented. Non organic soy and corn are GE and heavily sprayed with diluted white phosphorus and flamydahyde (sp?) embalming fluid i.e. glousphate (sp) in Roundup Ready among other toxic chemical witch’s brews that farmers use requiring wearing hazmat suits.
Cravings: As one begins to eliminate carbohydrates from the diet, it is common to experience carbohydrate cravings. Several suggestions for conquering these cravings are outlined below. However, it should be noted that as the body keto-adapts, hunger and appetite should become suppressed. One interesting study found that when you increase the occupied volume inside of the stomachs of subjects, this led to feelings of perceived fullness.[17] This means by doing things like drinking more water and eating more high volume foods we can improve our feeling of fullness.
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]
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.[3]
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.
You’ll quickly find that salads are your friend when in ketosis, and for a good reason: they provide lots of food to fill you up, but they’re not going to bog you down. A bed of spinach with some red onion, bacon, a little tomato, and a hot sauce vinaigrette is quick and delicious. Add in some protein – perhaps that leftover salmon from day 1 – and you’ve got a complete, healthy lunch.
In addition to the traditional ketogenic and Atkins diets described above, there are modifications that can be implemented to both of these diets in order to produce greater benefits on an individual basis. One such amendment, called the Modified Atkins Diet (MAD), is structured similarly to the Atkins diet where protein and fat are consumed freely but carbohydrate intake is further restricted, providing an intermediary diet between Atkins and ketogenic diet. This approach is commonly being used with great success among children with epilepsy due to its ability to increase the likelihood of adherence to the diet while still minimizing glucose intake from dietary carbohydrates.[2]

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]


When you’re eating the foods that get you there (more on that in a minute), your body can enter a state of ketosis in one to three days, she adds. During the diet, the majority of calories you consume come from fat, with a little protein and very little carbohydrates. Ketosis also happens if you eat a very low-calorie diet — think doctor-supervised, only when medically recommended diets of 600 to 800 total calories.

Restricting your calories may be important for some individuals depending on their goals. Additionally, it may aid in the initiation of ketosis; however, not everyone will require calorie tracking to maintain a deficit. It is not uncommon for caloric-restriction to occur inadvertently as a ketogenic diet tends to be satiating, leaving individuals satisfied with fewer calories.

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