Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
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.
Meat products make up a big part of the keto diet, but experts stress the importance of choosing quality. "Since the keto diet is based a lot on animal proteins, it's important to buy organic poultry and grass-fed, organic beef," says Aimee Aristotelous, RD. "Not only do organic selections help with limiting environmental toxins, but grass-fed options of red meats even change the composition of fats." The result, she explains, is that your body is able to better absorb those healthy fats.
H. Guldbrand, B. Dizdar, B. Bunjaku, T. Lindström, M. Bachrach-Lindström, M. Fredrikson, C. J. Östgren, F. H. Nystrom, “In Type 2 Diabetes, Randomisation to Advice to Follow a Low-carbohydrate Diet Transiently Improves Glycaemic Control Compared with Advice to Follow a Low-fat Diet Producing a Similar Weight Loss,” Diabetologia (2012) 55: 2118. http://link.springer.com/article/10.1007/s00125-012-2567-4.
Lastly, if you're active, you might need to make some adjustments to take that into account. "For the first one to two weeks, temporarily reducing your exercise load can be helpful as your body adjusts to being in ketosis," he says. "Additionally, for those who have an intense workout schedule, carb cycling may be a good option." Carb cycling essentially means you'll increase your carb intake on the days you're doing exercise, ideally just two to three days per week. "While low-carb days may be around 20 to 30 grams of net carbs daily, high-carb days can range all the way up to 100 grams, although it can vary based on your size and activity level," says Dr. Axe. (Related: 8 Things You Need to Know About Exercising on the Keto Diet.)

Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] 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.[38] 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.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
^ 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.
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions.[19] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[18]
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 >
While macros will differ a little from person to person, the general rule of thumb for keto is to keep carbohydrates under 5% of your daily caloric intake. As long as you avoid the foods mentioned above, you should be fine. Google “TDEE calculator” if you need some additional guidance on how many calories to eat. I’ve had success following this way of eating as it allows me to eat foods that taste great. There are tons of resources online as well if you need additional guidance. A quick google search should turn up a ton of resources. Hope this helps!
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians who are needed to administer a ketogenic diet programme.[31]
“Combining a super restrictive diet with long periods of non-eating is not good,” says Keatley. “The body will cannibalize its own muscle for energy if intake from food is too low but the body does not differentiate between something like a calf muscle or a heart muscle. Keep in mind all your important organs are made of smooth muscle and going on a diet like this may harm something like your bladder or lungs just as much as provide fat loss.”
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.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:

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.


Meat products make up a big part of the keto diet, but experts stress the importance of choosing quality. "Since the keto diet is based a lot on animal proteins, it's important to buy organic poultry and grass-fed, organic beef," says Aimee Aristotelous, RD. "Not only do organic selections help with limiting environmental toxins, but grass-fed options of red meats even change the composition of fats." The result, she explains, is that your body is able to better absorb those healthy fats.

Thanks for trying to stick to the evidence! So often these “newer” diets and therapies are not fully researched and are of peoples opinions. As a physical therapist I try to keep up on what will help my patients. This article and website will be added to my resource list. It’s not possible to be the expert on everything, so thanks for putting out quality information.


Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]
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.
Electrolytes: Due to the increased water expulsion by the kidneys, many electrolytes are simultaneously lost. Electrolyte imbalances are heavily responsible for feeling the “keto-flu.” Important electrolytes one must consider replacing: sodium, potassium, and magnesium. These electrolytes can be replenished by increasing your intake of certain foods and/or supplementation.
Appetite Control: The high-fat nature of the ketogenic diet along with elevated ketone and stable blood glucose levels have been shown to have a profound effect on appetite. This may give individuals who have a difficult time controlling the amount of food they eat “freedom” in knowing that they won’t be as hungry and thus less likely to consume excess calories.
No matter what your diet has been before now, keto will be a big change. If you're coming from a standard American diet (SAD), your carbs will go way down, your protein may either go up or down, and your fat will go way up. If you're coming from a bodybuilding-style diet, your fat intake will jump to alarming levels, and your protein will likely drop significantly.
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