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]
There are numerous benefits that come with being on keto: from weight loss and increased energy levels to therapeutic medical applications. Most anyone can safely benefit from eating a low-carb, high-fat diet. Below, you’ll find a short list of the benefits you can receive from a ketogenic diet. For a more comprehensive list, you can also read our in-depth article here >
If you get pushback, announce: “I’ve done my research, I’ve figured out it’s safe, and I really want to try this,” recommends Mancinelli. They don’t have to like what you’re doing, but it does help if they have your back. In a study published in September 2014 research in Obesity, having the support of friends and coworkers helped dieters more successfully lose weight and maintain that loss over a two-year period. (4) It also can’t hurt if everyone knows your goals on a keto diet so they’re less likely to push office treats or suggest splitting a side of fries when you're out to dinner.
There’s also some evidence that it might help with type 2 diabetes. “An emerging body of research is finding that a keto plan may have some real benefits thanks to its ability to improve the body’s ability to use insulin and also help control appetite, which can result in easier weight loss,” says Karen Ansel, R.D.N., co-author of Healthy in a Hurry.
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre's experience with 76 children up to the year 2009) also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.[18][50]
The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
2) Now you need to do a little learning before we move any further. Start by learning a bit more about ketosis itself, and the pitfalls you may experience. I love Bodybuilding.com and think that this article on the Keto Diet is perfect for beginners, so go check it out. Unless you are planning to start bodybuilding part, 2 of the post will not apply to you. 😉
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.
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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
The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][10]

In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10]
Urine Strips: When tested in urine, these strips will elicit a color change based on the level of ketones, namely acetoacetate, which is present in the urine. It is important to note that acetoacetate is different than the ketones present in the blood, namely, beta-hydroxybutyrate (βHB). Due to its nature, urine ketone testing may be a sufficient initial method to test ketone production; however, it is not the ideal method for determining the utilization of these ketone bodies, especially once “keto-adapted.”
The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
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 ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy.[26][27] It is approved by national clinical guidelines in Scotland,[27] England, and Wales[26] and reimbursed by nearly all US insurance companies.[28] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][29] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[5][30]

Supplemental ketosis: This form of ketosis has recently gained momentum in the field of ketogenic dieting. Supplemental ketosis is a ketogenic state that is achieved through the ingestion of ketogenic supplements. Consuming these substances alone does not mean that an individual is “keto-adapted.” While these products can help during the keto-adaptation period, especially if one is experiencing the “keto-flu,” they will only elicit short-term increases in blood ketone levels. Exogenous ketones can acutely produce benefits similar to the ketogenic diet; however, these products are best used in conjunction with a well-formulated keto diet for beginners, or the very at least, a diet that restricts carbohydrates. The commonly used supplements on the market are medium-chain triglyceride (MCT) oil and exogenous ketones. MCT oil is a fat that, in contrast to other longer-chain fatty acids, travels straight from the intestines to the liver where it is readily metabolized. This allows for ketone production in the liver to occur faster than with other fats (long-chain fatty acids have to travel through the lymph and circulatory systems first). Exogenous ketones are synthetic substances that mimic the ketones produced in our body (endogenous ketones). Exogenous ketones can come in the form of ketone salts or ketone esters.
Blood Ketone Meter: Measuring ketone levels in the blood more accurately measures and indicates an individual’s metabolic state of ketosis. Similar to measuring blood glucose levels, this method also uses a blood meter and a chemo-sensitive strip made specifically to measure ketones in the blood called beta‑hydroxybutyrate (βHB). As with blood glucose measurements, a blood sample can be acquired from a finger prick. The ketone level displays on the meter within a few seconds of a sample placement on the strip.
Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D., “A Randomized Trial of a Low-Carbohydrate Diet for Obesity — NEJM,” N Engl J Med 2003; 348:2082- 2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207.
The ketogenic diet — a high-fat and very low carb eating plan — can be tough to start. After all, it’s likely a radical departure from the way you’re eating now (a typical standard American diet is high in carbohydrates and processed foods). But many people are trying the keto diet, which puts your body in a state of ketosis. That's what happens when your body’s carb-burning switch flips to a fat-burning one, a change that can cause weight loss and has even been credited with controlling type 2 diabetes, a small past study suggests. (1)
^ 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.
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.
This plan is very high on protein. I’ve learned that high healthy fat is what’s needed, not high protein.. as I am now kicked out of ketosis due to high protein intake (insulin’s fault). Given the fact i didn’t eat a bowl of salad per day (my tummy doesn’t digest salad well at all – i get bloated), but i do eat broccoli (i don’t get bloated from those strangely enough), cauliflower, asparagus, mushrooms… tomatoes (rarely, though). So, my question is… are you in ketosis following the menu you’ve presented? I’m 5 months into Keto and the last 3 weeks i am not in ketosis. My carb intake is 20-30g… but my protein is pretty high.
Yancy WS Jr, Westman EC, McDuffie JR, Grambow SC, Jeffreys AS, Bolton J, Chalecki A, Oddone EZ, “A randomized trial of a low-carbohydrate diet vs orlistat plus a lowfat diet for weight loss,” Arch Intern Med. 2010 Jan 25;170(2):136-45. http://www.ncbi.nlm.nih.gov/pubmed/20101008?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2.
First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48]

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.
While a keto diet for beginners is also low in carbohydrates, it is NOT synonymous with traditional low-carbohydrate diets seen in popular media or even some scientific research. Since there is no strict definition of a “low carbohydrate diet,” some research studies utilize 30–40% carbohydrate diets and indicate that they are “low-carb.” However we now know that is roughly the same percentage as a standard American diet that has plagued our society with obesity and metabolic syndrome. Thus, while lowering carbohydrate intake in general is beneficial, it must be reinforced that traditional low-carbohydrate diets DIFFER from a well-formulated ketogenic diet.
Here’s what we do know: The keto diet may be useful in treating symptoms of epilepsy, a seizure disorder. “The use of keto in treating epilepsy has the most evidence,” Angelone says. One study conducted by Johns Hopkins Medicine, for example, followed epileptic patients on the keto diet and found that 36 percent of them had a 50 percent reduction in seizures after three months on the diet, and 16 percent were seizure-free. However, experts aren't entirely sure why the keto diet has this affect, she adds.
The ketogenic diet may seem like the Jekyll to the Hyde-like low-fat craze of the 1990s. The bulk of current research finds that the middle ground between the two extremes is more beneficial for overall health. Make it easy for yourself: Eat at least two servings a week of fatty fish (salmon, sardines, mackerel) and cook with a variety of quality fats (olive oil, canola oil, avocado oil) throughout the week.

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.


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]
“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.”
One thing many people love about keto diet plans is that tracking your food is optional. "One of the biggest benefits of the ketogenic diet is that there's no need to meticulously track your calories as you may in other diets," notes Dr. Josh Axe, D.N.M., C.N.S., D.C., founder of DrAxe.com, best-selling author of Eat Dirt, and cofounder of Ancient Nutrition. "Because you're filling up on fat and protein, you're more likely to feel satisfied and energized all day long, which causes you to naturally eat less." This isn't to say that food tracking on a keto meal plan is discouraged. "Some people may find calorie counting a useful tool to be more mindful and aware of what they're eating, but it's not necessary on the ketogenic diet," says Dr. Axe, but there's no need to get too stressed about hitting a certain caloric goal, especially if you're not trying to lose weight. (Related: The #1 Reason to Stop Counting Calories)
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