In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.
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.
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.
I would love to share your journey on my blog. If you are planning to start this keto diet, please take before pictures, progress pictures, keep a food diary, and keep track of your weight and measurements. Then when you are ready maybe at your halfway point, or once you reach your goal weight, you can send me your results for me to share with others.
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.
When something is popular, it’s pretty much a guarantee that people are going to come up with new or easier ways of doing it. Enter the lazy keto and dirty keto diets. With lazy keto, people try to limit their carb intake to 20 to 50 grams a day but don’t really track it; with dirty keto, people generally follow the same macronutrient breakdown as "regular" keto, but it doesn't matter where those macronutrients come from.
Those issues can be part of what's known as the “keto flu,” Warren says. Other side effects of the keto diet, all of which are tied to carb withdrawal, can include lightheadedness, nausea, mental fog, cramps, and headaches, in addition to tiredness. Luckily, the keto flu doesn't usually last more than a week—which is coincidentally about when people start to see the number on the scale go down, says Warren.
“People are afraid of fat because they’ve been told that it’ll kill them,” says Mancinelli. What is confusing is that research today remains mixed. Some studies suggest that replacing saturated fat with polyunsaturated fat (and avoiding unhealthy trans fat) is important for mitigating heart disease risk, while others suggest that total fat and types of fat weren’t associated with cardiovascular problems, according to an article published in June 2018 in BMJ. (2) Deciding exactly how to eat then becomes confusing. What is helpful, the authors note, is to remember that food is more than a single nutrient, and it’s the overall quality of the diet that counts. (They do say that high-fat, low-carb diets still need more research to assess their long-term health benefits and risks.)
A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[20] and followed-up by a report published in 2001.[21] As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.[21][22]

The meal plan is designed to ensure you get three balanced, healthy meals a day that address fiber, satiation, and adequate protein intake. The greatest part of a ketogenic diet is the fact that it spares muscle loss, where a carb-based diet doesn’t. Weight lost in a high carb, calorie-restricted diet will often come both from muscle and fat, whereas with keto, you can burn fat without sacrificing muscle. This is referred to often as “body recomposition” and leaves you with a much more preferred physique after weight loss.
Diabetic Ketoacidosis: Diabetic ketoacidosis (DKA) is the variation of ketosis that is responsible for deterring society from considering the adoption of a keto diet for beginners. DKA occurs primarily in those suffering from Type 1 diabetes. The inability to secrete insulin prevents ingested carbohydrates (glucose) from entering our insulin-dependent cells (i.e., muscle and adipose tissue) as a substrate for energy production. Due to this induced cellular starvation, the body will begin to produce ketones at an uncontrolled rate.
So you've decided you want to try out the high-fat, low-carb diet, better-known as the fat-burning ketogenic diet. Whether it's to lose weight, have more energy, or fuel workouts differently, going keto is a popular choice right now. But figuring out a keto diet plan on your own is no easy feat, especially since eating a diet super high in fats doesn't come naturally to many people who are accustomed to the traditionally carb-heavy American diet. (It's especially hard if you're vegan and want to try keto.) But this should help: Keto experts explain how to set yourself up for success, plus provide ideas for exactly what keto foods to eat when you're first getting started. (While you're at it, check out these Low-Carb Keto drinks That Will Keep You in Ketosis.)
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?

But beyond that, experts aren't convinced that the keto diet has any other scientifically proven health benefits. In fact, it may have some distinct downsides. If you follow the keto diet incorrectly, for example (like by eating lots of saturated fats, versus healthy unsaturated fats), you're at risk of raising your cholesterol levels. “The best strategy to keep your heart healthy is to get as much fat as possible from unsaturated sources such as olive, avocado and canola oils, nuts, seeds, avocados, and olives," says Ansel. For some people, it's possible to actually improve cholesterol if the fats in their diet are from varied and healthy sources, says Harvey.

Cognitive Enhancement: Ketones may be the preferred fuel source for the brain. Due to the brain’s preference to uptake and utilize ketones as fuel it is very common for individuals to report an increase in cognitive performance. This is even more common in individuals with some degree of insulin resistance, as their brain is likely unable to effectively utilize glucose as a sole fuel source due to the resistance.
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.
^ Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, saccharin and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1).[17] The eggnog may also be cooked to make a custard, or frozen to make ice cream.[37]
Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 
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.
In pediatric patients whose seizures could not be treated with these anti-epileptic drugs, a ketogenic diet was able to reduce seizures by more than 50% in 54% of the young patients tested, with 10% of the cohort becoming seizure-free after one year on the diet.[28] Since this study, numerous additional studies have shown this modality to be effective for children and adults with epilepsy. Results of ketogenic diet–driven studies have included 55% of patients seeing a reduction in seizures by more than 50%,[29] and 27% of patients seeing a 90% or greater reduction in seizures with many entering into complete remission.[30]

More good news: Snacks are totally allowed (and I'm not just talking about carrot sticks). There are plenty of packaged options out there designed for keto fans. FATBAR is one of them. These snack bars have 200 calories, 16 grams of fat, and four grams of net carbs. They're also plant-based and are made with almond or cashew butter, cocoa butter, coconut, pea protein, sunflower seeds, and chia seeds.


The easiest macro to calculate in the ketogenic diet is fat. Once you've got your carbs and protein set, simply fill the rest of your daily calorie needs with fat sources. If you find yourself wanting to gain a bit of weight, add approximately 500 calories, or 55 grams. If you want to lose weight, cut down on your fat intake by 200-500 calories, or 22-55 grams.
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.

On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there can also be other, less obvious benefits, such as less hunger and a steady supply of energy (without the sugar peaks and valleys we can get from high carb meals). This may help keep you alert and focused.


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]

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]
Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 
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]
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.
A review of multiple studies in the journal Nutrients found that ketogenic diets are connected to significant reductions in total cholesterol, increases in “good” HDL cholesterol levels, dips in triglycerides levels and decreases in “bad” LDL cholesterol; there are questions as to whether diets high in saturated fat negate these benefits. The same paper reports that a ketogenic may slightly reduce blood pressure, but science is still very scant on this point.
The beauty of salmon is that you can cook it with marginal interference. A simple sauce of butter, lemon juice, chopped garlic, and some salt and pepper will go a long way to enhancing the natural flavor of the salmon. Drizzle the sauce over 4-6 oz portions of fish, bake at 450F for 5 minutes per 1/2″ thickness of fish. In another bowl, toss the asparagus with olive oil, salt, and pepper, spread it out evenly on a cookie sheet, and roast in the oven at 450 for 20 minutes. Easy dinner (with leftovers if you plan ahead) that’s full of nutrition, protein, and healthy fat, while keeping your carbs low. Get the recipe and instructions
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]
You can have a completely smooth transition into ketosis, or…not. While your body is adapting to using ketones as your new fuel source, you may experience a range of uncomfortable short-term symptoms. These symptoms are referred to as “the keto flu.” Low-sodium levels are often to blame for symptoms keto flu, since the kidneys secrete more sodium when you’re in ketosis, says Volek. A few side effects:
Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[18] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[51] Other formula products include KetoVolve[52] and Ketonia.[53] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[53]
Carbohydrate-restricted ketosis: This type of ketosis mimics the same biological alterations seen during lengthy fasts, but without the complete restriction of food. Carbohydrate-restricted ketosis is achieved primarily through a very low-carbohydrate ketogenic diet. This restriction, in turn, results in reductions of insulin and blood glucose levels similar to that of fasting, which again increases blood ketone levels. For most individuals, nutritional ketosis is much more sustainable than fasting or starvation ketosis. Fasting can still have its place in a keto diet for beginners. Many individuals following a ketogenic diet like to implement a regular fasting protocol such as intermittent fasting (IF) (12–20 hours daily) or every-other-day fasts (EOD), depending on their goals. This practice is not critical for success on a ketogenic diet, but it can enhance the level of ketone production, and thus magnify the benefits.
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]

In the 1960s, medium-chain triglycerides (MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides).[15] MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system.[16] The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[15] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[10]


Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.1There are scientifically-backed studies that show the advantage of a low-carb, ketogenic diet over a low-fat diet. One meta-analysis of low-carbohydrate diets showed a large advantage in weight loss. The New England Journal of Medicine study resulted in almost double the weight loss in a long-term study on ketone inducing diets.


A review of multiple studies in the journal Nutrients found that ketogenic diets are connected to significant reductions in total cholesterol, increases in “good” HDL cholesterol levels, dips in triglycerides levels and decreases in “bad” LDL cholesterol; there are questions as to whether diets high in saturated fat negate these benefits. The same paper reports that a ketogenic may slightly reduce blood pressure, but science is still very scant on this point.
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