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.
Most carbs you consume are broken down into sugar that enters the bloodstream. When you rein in carbohydrates on the keto diet, you have lower levels of blood glucose (high blood glucose can lead to diabetes). A study in the journal Nutrition reveals that a ketogenic diet improves blood glucose levels in type 2 diabetics more significantly than a low-calorie diet and can also decrease the dosage of your diabetes meds.
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones. The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone. About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone. The stones are treatable and do not justify discontinuation of the diet. Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones. However, this empiric usage has not been tested in a prospective controlled trial. Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:
As with other facets of the keto diet for beginners, the optimal ketone levels will vary on an individual basis. However, literature typically suggests that mild nutritional ketosis will begin once blood ketones are around 0.3–0.5 mmol/L. Upon “keto-adaptation,” this value may increase to around 1.0–3.0 mmol/L; however, that’s not always necessarily the case. If an individual is following a ketogenic diet strictly for therapeutic reasons, one may consider trying to achieve a deeper level of ketosis, but even those with a strict regimen may see only slight elevations in ketones due to rapid uptake into tissues.
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.
Now that ketogenic diets have become popular, many keto hybrid diets have sprung up, including plant-based versions. (One is “ketotarian,” which is predominantly plant-based but includes the option of eggs, ghee, and fish and shellfish.) While this approach can be healthy, Hultin cautions against trying keto as a vegan. “Because you can’t eat beans or lentils on a ketogenic diet, and nuts and seeds are even limited due to their carbohydrate content, you’re really just left with some tofu and will need to rely on low-carb protein powder,” she says. There is a good possibility this won’t pan out. “I don’t see this as a sustainable diet due to the extreme restrictions,” she says.
Everyone has to find their nutritional sweet spot for producing enough ketones and staying in ketosis, but “the core principle of the diet is to keep carbohydrate intake low enough, so your body continues producing ketones at elevated levels,” says Volek. “Your body adapts to this alternative fuel and becomes very efficient at breaking down and burning fat.”
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.
Note: Because you'll be excluding some major food groups on the keto diet (grains, many fruits) you should definitely think about taking a multivitamin—especially one that contains folic acid, which helps your body make new cells and is often found in enriched breads, cereals, and other grain products, says Julie Upton, R.D., cofounder of nutrition website Appetite for Health.
A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight. Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.
Detrimentally, this results in high levels of both ketones and glucose. Extremely high ketone levels in the blood will elicit a dangerous biological environment that can even result in death. It must be clarified that DKA is very different than nutritional ketosis or fasting ketosis; ketone levels cannot be produced at such high levels in healthy individuals as they are with those in DKA.
Unfortunately, there’s no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.
"I recommend only 5 percent of calories coming from carbs, which usually averages out to less than 30 grams," he says. "I understand why people get nervous and panic, thinking 'Can I even eat a salad?' This is why I recommend tracking only 'net carbs', which are total carbs minus fiber. For example, an avocado has 12 grams of carbs but 10 grams of fiber, which means it has 2 grams of net carbs. Also, green leafy vegetables are very nutritious and contain a lot of fiber, so you can almost eat them as much as you want and stay below your limit.
After increasing water intake and replacing electrolytes, it should relieve most all symptoms of Keto Flu. For an average person that is starting a ketogenic diet, eating 20-30g of net carbs a day, the entire adaptation process will take about 4-5 days. My advice is to cut your carbs to fewer than 15g to ensure that you are well on your way into ketosis within one week. If you are experiencing any more keto flu symptoms, double check your electrolyte intake and adjust.
A computer program such as KetoCalculator may be used to help generate recipes. The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.
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.
A simple standby, but one that ketoers adore. 2 or 3 fried eggs and some bacon might not sound like much, but it’s full of protein that will keep you full and energized all morning. Take the opportunity on the weekend to lay your bacon strips on a single cookie sheet and bake in the oven for 20 minutes at 400 degrees. The result is the best bacon you’ve ever had, in a big batch, with no sitting over a popping, hissing frying pan.