Unveiling the Keto Diet: Ultimate Guide to Mastering Ketosis for Rapid Fat Loss

The ketogenic diet, often shortened to the "keto" diet, has gained significant popularity in recent years. You may have heard of friends and family trying the keto diet. The ketogenic or keto diet includes eating high-fat, low-carbohydrate foods to reach ketosis. But what exactly is it, how does it work, and is it right for you? This article delves into the details of the keto diet, exploring its origins, mechanisms, potential benefits, and possible drawbacks.

Origins and Evolution of the Keto Diet

Though it may seem newer to your newsfeed, the ketogenic diet has been around since the 1920s. The keto diet is all about cutting carbs and eating more fat, similar to the Atkins diet from the 1970s. The keto diet was first used as a treatment for pediatric drug-resistant epilepsy to reduce seizures in the 1920s when medications alone aren't enough. The ketogenic diet was commonly used in the 19th century to help control diabetes. In 1920 it was introduced as an effective treatment for epilepsy in children in whom medication was ineffective. It wasn't until the low-carb diet craze of the 1970s, spurred by the Atkins diet, that the keto diet began to gain traction as a weight-loss strategy.

Understanding Ketosis: The Core of the Keto Diet

"Keto" refers to ketogenesis, a process in the body that results from significantly reducing the carbohydrates in your diet and increasing your fat intake. Normally your body gets energy from readily available carbohydrates, but on a keto diet, your carb intake is slashed. The key to keto is knowing what's in your food. When you're on the ketogenic diet, you are in a state similar to fasting - your body is using fat for fuel. When these stores are full, they are converted into fat.

The keto diet reduces your total carb intake to less than 50 grams a day. This is the equivalent of a cup of white rice. The keto diet excludes carb-rich foods like grains, beans, fruits and starchy vegetables. Roshini G. Merneedi, RD, a dietitian at Northwestern Medicine, explains that your body's primary energy source is glucose, which comes from the breakdown of carbohydrates. The keto diet limits carbohydrates, forcing your body to burn fat for fuel instead. In this state, your body breaks down fats into molecules called ketones. Ketones serve as an alternative fuel source. Without regular replenishing of carbohydrates, the body begins to break down fat for energy, resulting in the formation of ketones. Therefore, your blood has high levels of ketones during ketosis.

How the Keto Diet Works

The ketogenic (keto) diet changes the way your body uses food. Typically, carbohydrates in your diet provide most of the fuel your body needs. The keto diet reduces the number of carbs you eat and teaches your body to burn fat for fuel instead. On a standard diet, most people consume approximately 50-55 percent carbohydrates, 20-25 percent protein and 20-25 percent fat," says Bede.

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When you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis.

When you eat a diet high in carbohydrates, your insulin levels rise after you eat, but then quickly fall. This decrease in insulin alerts the hunger center of your brain to provide more food. “If you're on a ketogenic diet, and you're not eating carbs, then your insulin levels stay pretty level, at a steady, low level,” Swerdlow said. “So, you don't get the fluctuations in insulin. And because fats and proteins take the body longer to digest, you may feel fuller longer.

Types of Ketogenic Diets

There are several different styles of keto diets. The keto diet is high in fat, moderate in protein and low in carbohydrates. The standard keto diet consists of 70% to 80% fats, 10% to 20% proteins and 5% to 10% carbohydrates. Here are some of the most common:

Classic Ketogenic Diet: This is the original and best-studied of the different diet strategies. All foods must be weighed on a scale to achieve a relative weight distribution of 4 grams of fat for every 1 gram of combined protein and carb eaten throughout the day. In other words, you will likely need to avoid all carb-rich foods (like pasta, potatoes, fruit, etc.). A typical meal might look like half an avocado with a small piece of salmon cooked in a lot of olive oil with a side salad. It will all be topped with a cream sauce made with heavy cream and cheese.
Modified Ketogenic Diet: This diet generally still requires a scale for weighing food. It's defined by a ratio closer to 3 grams of fat for every 1 gram of combined protein and carb (generally with a focus on more protein than carbs). In other words, you'll still avoid most carb-rich foods except for maybe one or two servings per day.
User-Friendly Keto Diet: This diet is the more user-friendly keto diet and likely the most popular. These diets generally avoid all starchy foods (pasta, rice, potatoes, bread, corn, peas, beans and legumes). Desserts and any other high-carb foods are also not part of the diet.
Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
High protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.
Cyclical ketogenic diet (CKD): This diet involves periods of higher carb refeeds, such as 5 ketogenic days followed by 2 high carb days.

Foods to Eat and Avoid on a Keto Diet

Many nutrient-rich foods contain high amounts of carbohydrates. This includes whole grains, fruits and vegetables. Carbs from all sources are restricted on the keto diet. So you’ll have to cut out all bread, cereal and other grains and make serious cuts to your fruit and vegetable intake.

Here’s a list of foods that need to be reduced or eliminated on a ketogenic diet:

Sugary foods: soda, fruit juice, smoothies, cake, ice cream, candy, etc.
Grains or starches: wheat-based products, rice, pasta, cereal, etc.
Fruit: all fruit, except small portions of berries or strawberries
Beans or legumes: peas, kidney beans, lentils, chickpeas, etc.
Root vegetables and tubers: potatoes, sweet potatoes, carrots, parsnips, etc.
Low fat or diet products: low fat mayonnaise, salad dressings, and condiments
Some condiments or sauces: barbecue sauce, honey mustard, teriyaki sauce, ketchup, etc.
Unhealthy fats: processed vegetable oils, mayonnaise, etc.
Alcohol: beer, wine, liquor, mixed drinks
Sugar-free diet foods: sugar-free candies, syrups, puddings, sweeteners, desserts, etc.

The types of foods that provide fat for the keto diet include:

Meats and fish.
Eggs.
Nuts and seeds.
Butter and cream.
Cheese.
Oils such as olive oil and canola oil.

You should base the majority of your meals around these foods:

Meat: red meat, steak, ham, sausage, bacon, chicken, and turkey
Fatty fish: salmon, trout, tuna, and mackerel
Eggs: pastured or omega-3 whole eggs
Butter and cream: grass-fed butter and heavy cream
Cheese: unprocessed cheeses like cheddar, goat, cream, blue, or mozzarella
Nuts and seeds: almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds, etc.
Healthy oils: extra virgin olive oil, and avocado oil
Avocados: whole avocados or freshly made guacamole
Low carb veggies: green veggies, tomatoes, onions, peppers, etc.
Condiments: salt, pepper, herbs, and spices

It’s best to base your diet mostly on whole, single-ingredient foods.

Potential Benefits of the Keto Diet

Research has shown that ketosis may have several health benefits. One of the biggest benefits of ketosis may be weight loss. The process can help you feel less hungry, which may lead to eating less food. It can help you lose belly fat (visceral fat) while maintaining a lean mass. Here are some of the researched and anecdotally reported benefits of the Keto Diet:

Helps with weight loss: Research suggests that the keto diet helps people cut calories because the diet doesn't include many foods that people are likely to overeat. "There has been anecdotal evidence of people losing weight on the ketogenic diet. People also report feeling less hungry than on other types of restricted diets,” says Melinda R. Ring, MD, director of Northwestern Medicine Osher Center for Integrative Health. A ketogenic diet may help you lose more weight in the first 3 to 6 months than some other diets. This may be because it takes more calories to change fat into energy than it does to change carbs into energy. It’s also possible that a high-fat, high-protein diet satisfies you more, so you eat less, but that hasn’t been proved yet.
Epilepsy Treatment: Healthcare providers often put children with epilepsy on the keto diet to reduce or even prevent seizures by altering the “excitability” part of their brain. Ketogenic diets have helped control seizures caused by this condition since the 1920s.
Other Neurologic Conditions: Research has shown the keto diet may help improve neurological conditions such as Alzheimer’s disease, autism and brain cancers such as glioblastoma. These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage. The keto diet can show positive results for helping the brain. Researchers are looking to see if the keto diet can help treat age-related brain decline and potentially Alzheimer's disease. There are many different theories as to why the keto diet may be beneficial for brain health. These include the direct benefit from the presence of ketone bodies, especially one called beta hydroxybutyrate.
Type 2 Diabetes Management: The keto diet can help people with Type 2 diabetes lose weight and manage their blood sugar levels. Low-carb diets seem to help keep your blood sugar lower and more predictable than other diets. But when your body burns fat for energy, it makes compounds called ketones. If you have diabetes, particularly type 1, too many ketones in your blood can make you sick. So it’s very important to work with your doctor on any changes in your diet.
Heart Disease Risk Reduction: The keto diet may lower your risk of developing cardiovascular disease by lowering your blood pressure, improving your HDL (“good”) cholesterol levels and lowering your triglycerides. 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.
Metabolic Syndrome Improvement: The keto diet may reduce your risk of developing metabolic syndrome, which is associated with your risk of heart disease.
Increased Focus and Energy: Ketosis has also been shown to increase your focus and energy. The keto diet delivers your body’s energy needs in a way that reduces inflammation. Research suggests your brain works more efficiently on ketones than on glucose.
Cancer Prevention: 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.
Acne Improvement: 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.
Polycystic Ovary Syndrome: This is when a woman’s ovaries get larger than they should be and small fluid-filled sacs form around the eggs. High levels of insulin can cause it. Ketogenic diets, which lower both the amount of insulin you make and the amount you need, may help treat it, along with other lifestyle changes, like exercise and weight loss.
Exercise performance: A ketogenic diet may help endurance athletes -- runners and cyclists, for example -- when they train. Over time, it helps your muscle-to-fat ratio and raises the amount of oxygen your body is able to use when it’s working hard. But while it might help in training, it may not work as well as other diets for peak performance.

Potential Risks and Side Effects

While the keto diet offers potential benefits, it's crucial to be aware of the possible risks and side effects. The keto diet has many benefits, but it may come with some side effects.

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Can lead to nutrient deficiencies: The keto diet is very low in carbs which means you can't eat many fruits and vegetables. “Because the keto diet is so restricted, you’re not receiving the nutrients - vitamins, minerals, fibers - that you get from fresh fruits, legumes, vegetables and whole grains,” says Dr. Ring.
Possible negative effects on heart health: There are mixed results in studies that examine the specific effects of the keto diet on heart health. The high-fat nature of the diet could also have negative impacts on heart health. The American Heart Association recommends limiting saturated fat intake to less than 6%. “In practice, many people eat high amounts of saturated fats, which could increase your risk of heart disease,” says Dr. Cheema. “You may be eating a lot of fatty meat thinking it’s a good thing for you because it's high in fat. This can dramatically alter your lipid profile. While high-fat diets can elevate LDL (“bad”) cholesterol, the type of saturated fat matters. The bottom line is that having more fats in your diet can lead to higher cholesterol. “We know that higher cholesterol tends to increase your chances of heart attacks and strokes,” says Dr. Cheema.
Constipation and other gastrointestinal (GI) troubles: Constipation is likely the greatest long-term complication of the keto diet because of a low fiber intake. Fiber is a form of carb that is digested not by our human cells, but by the microbes in our gut. Any high-fiber foods (like beans, whole grains, and certain fruits) are also high in carbs, which is not typically part of the keto diet.
Keto Flu: One of the signs of ketosis may include “keto flu,” which includes symptoms such as upset stomach, headache and fatigue. Reported keto flu symptoms include diarrhea, constipation, and vomiting. Other less common symptoms include: poor energy and mental function, increased hunger, sleep issues, nausea, digestive discomfort, decreased exercise performance. People report feeling foggy, irritable, nauseous and tired.
Kidney Problems: The keto diet may not be appropriate for everyone, specifically people with kidney disease. “Although more research is needed in that area, there is some suggestion that it can make kidney disease worse over time,” says Dr.
Dehydration: Some people also experience dehydration on the keto diet because they’re eliminating glycogen, which holds water, from the bloodstream.
Drop in Blood Pressure: The keto diet can cause your blood pressure to drop in the short term due to a reduction in blood volume and changes in your fluid balance. Symptoms of low blood pressure include dizziness, lightheadedness or fainting, especially when standing up quickly.
Drop in Blood Sugar: Following a keto diet can also cause your blood sugar to drop, which can be dangerous for people living with diabetes. Common symptoms of low blood sugar include weakness or shaking, sweating, a fast heartbeat and dizziness.
Micromanaging Food Intake: When you micromanage your food intake by tracking how much you eat, it disconnects you from what your body is asking for. You start using outside numbers to determine what to eat instead of listening to your body. “Being intuitive and understanding what your body needs is essential for proper nourishment,” says Merneedi. Monitoring food so closely can lead to psychological distress, such as shame and binge eating.
Bone Health Issues: There can be issues with bone health when people switch to low-carb keto diets. Researchers see that markers for bone breakdown are higher and markers for bone building are lower.

Important Considerations Before Starting

Before starting the keto diet, you should get a blood test to look at your lipids. Some people will actually find that their high-density lipoproteins (HDL) - the good cholesterol - go up and their triglycerides go down. You may experience multiple days of headache, fatigue and constipation a few weeks into the keto diet, which can be attributed at least in part to the body losing water. (See fact 6.) But you might also experience brain fog, irritability or difficulty sleeping. Jessica Keller, dietitian and study coordinator in Sullivan’s Nutritional Assessment Laboratory at KU Medical Center, counsels clinical trial participants who are set to begin a keto diet. She said many of the symptoms can be alleviated with water, rest and time.

"As a dietitian and a nutrition scientist, we often don’t like to cut out whole food groups. And it’s not something I would recommend to the general population. Sullivan suggests meeting with a dietitian to understand how much fat intake is needed and what kinds of fats should be consumed. “On keto, we are increasing the amount of fat in someone’s diet, but we need to make sure it’s a healthier type of fat.” Too much of the wrong kind of fat can negatively affect the heart and the cardiovascular system.

Alternatives to the Keto Diet

For long-term weight loss, Dr. Ring, Dr. Intermittent fasting is an approach that allows you to receive the benefits of ketosis while still eating a varied and balanced diet, says Dr. Ring. By cycling between periods of eating and fasting, your body enters “mild ketosis” during the fasting phase. “Unlike the keto diet, which requires strict food restrictions, intermittent fasting lets you enjoy a variety of nutrient-dense foods, such as fruits, vegetables, whole grains and legumes, during eating windows,” Dr. Ring explains.

Dr. Cheema advocates making small changes based on your health goals. “People tend to burn out on those big goals and challenges, and then they go back into their own habits,” he explains. “Just because you were super fit between the ages of 36 and 38 may not extend your healthy life. But if you make small changes consistently every day from ages 36 to 66, that probably will have a big impact. No one diet fits all, and what works for one person may not work for another.

Mediterranean-DASH Intervention for Neurodegenerative Delay: Short for "Mediterranean-DASH Intervention for Neurodegenerative Delay," this diet is similar to the Mediterranean diet, but with stricter requirements for what you can eat. It emphasizes eating more vegetables, fruits (specifically berries), high-fiber foods, beans, nuts, seafood, poultry and olive oil. The MIND diet can possibly help reduce the cognitive decline associated with aging.

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