The ketogenic diet, often shortened to "keto," is a dietary approach characterized by a very low carbohydrate intake and a high fat intake. This forces the body to burn fat for energy instead of carbohydrates. This dietary shift can lead to several health benefits, including weight loss and a reduced risk of certain diseases.
Keto Basics: Understanding the Fundamentals
The ketogenic diet is a very low-carb, high-fat diet that shares similarities with the Atkins and other low-carb diets. It involves drastically reducing carbohydrate intake and replacing it with fat, pushing your body into a metabolic state called ketosis. When this occurs, your body becomes highly efficient at burning fat for energy, converting fat into ketones in the liver, which can fuel the brain. Ketogenic diets can significantly lower blood sugar and insulin levels. This, along with the increased ketones, offers several health benefits.
Types of Ketogenic Diets
Several versions of the ketogenic diet exist, each with slightly different macronutrient ratios:
- Standard Ketogenic Diet (SKD): This is a very low-carb, moderate-protein, and high-fat diet, typically consisting of 70% fat, 20% protein, and only 10% carbs.
- Cyclical Ketogenic Diet (CKD): This diet involves periods of higher carb refeeds, such as five ketogenic days followed by two high-carb days.
- Targeted Ketogenic Diet (TKD): This diet allows you to add carbs around workouts.
- High-Protein Ketogenic Diet: Similar to SKD, but includes more protein, with a ratio of approximately 60% fat, 35% protein, and 5% carbs.
The standard and high-protein ketogenic diets are the most extensively studied. Cyclical or targeted ketogenic diets are more advanced methods typically used by bodybuilders or athletes.
Achieving Ketosis: Shifting Your Body's Fuel Source
Ketosis is a metabolic state in which your body uses fat for fuel instead of carbs. It occurs when you significantly reduce your consumption of carbohydrates, limiting your body’s supply of glucose (sugar), which is the main source of energy for the cells.
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Following a ketogenic diet is the most effective way to enter ketosis. Generally, this involves limiting carb consumption to around 20 to 50 grams per day and filling up on fats, such as meat, fish, eggs, nuts, and healthy oils. It’s also important to moderate your protein consumption because protein can be converted into glucose if consumed in high amounts, potentially slowing your transition into ketosis.
Practicing intermittent fasting could also help you enter ketosis faster. There are many different forms of intermittent fasting, but the most common method involves limiting food intake to around 8 hours per day and fasting for the remaining 16 hours.
Blood, urine, and breath tests are available, which can help determine whether you’ve entered ketosis by measuring the number of ketones produced by your body. Certain symptoms may also indicate that you’ve entered ketosis, including increased thirst, dry mouth, frequent urination, and decreased hunger or appetite.
Weight Loss and Disease Risk Factors: Exploring the Benefits
A ketogenic diet is an effective way to lose weight and lower risk factors for disease. Research indicates that the ketogenic diet may be as effective for weight loss as a low-fat diet. The diet's filling nature can lead to weight loss without strict calorie counting or food intake tracking.
One review of 13 studies found that following a very low-carb, ketogenic diet was slightly more effective for long-term weight loss than a low-fat diet. People who followed the keto diet lost an average of 2 pounds (0.9 kg) more than the group that followed a low-fat diet. Another study in 34 older adults found that those who followed a ketogenic diet for 8 weeks lost nearly five times as much total body fat as those who followed a low fat diet. The increased ketones, lower blood sugar levels, and improved insulin sensitivity may also play a key role.
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Health Benefits: Beyond Weight Loss
Studies have shown that the ketogenic diet can have benefits for a wide variety of different health conditions:
- Diabetes: The ketogenic diet can boost insulin sensitivity and cause fat loss, leading to significant health benefits for people with type 2 diabetes or prediabetes. One older study found that the ketogenic diet improved insulin sensitivity by a whopping 75%. A small study in women with type 2 diabetes also found that following a ketogenic diet for 90 days significantly reduced levels of hemoglobin A1C, which is a measure of long-term blood sugar management.
- Heart Disease: The ketogenic diet can help improve risk factors like body fat, HDL (good) cholesterol levels, blood pressure, and blood sugar.
- Cancer: The diet is currently being explored as an additional treatment for cancer because it may help slow tumor growth.
- Alzheimer’s Disease: The keto diet may help reduce symptoms of Alzheimer’s disease and slow its progression.
- Epilepsy: Research has shown that the ketogenic diet can cause significant reductions in seizures in epileptic children.
- Parkinson’s Disease: Although more research is needed, one study found that the diet helped improve symptoms of Parkinson’s disease.
- Polycystic Ovary Syndrome: The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome.
- Brain Injuries: Some research suggests that the diet could improve outcomes of traumatic brain injuries.
Keep in mind that research into many of these areas is far from conclusive.
Foods to Embrace and Avoid: Navigating the Keto Landscape
When starting a new diet, knowing what you can and cannot eat is often the most stressful part of the transition. To make your meal prep as simple as possible, it’s helpful to know which foods to avoid and which to embrace.
Foods to Avoid
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.
Foods to Embrace
You should base the majority of your meals around these foods:
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- Meat: Red meat, steak, ham, sausage, bacon, chicken, and turkey. When opting for meat, you pretty much have the green light on what to choose, but grass-fed varieties are the best option.
- Fatty Fish: Salmon, trout, tuna, and mackerel.
- Eggs: Pastured or omega-3 whole eggs. Egg-based meals are a great option, such as an omelet or eggs and bacon.
- Butter and Cream: Grass-fed butter and heavy cream. On a keto diet, you need to ditch the low-fat yogurts and go full fat.
- Cheese: Unprocessed cheeses like cheddar, goat, cream, blue, or mozzarella.
- Nuts and Seeds: Almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds, etc. Walnuts, macadamias, and almonds are good choices.
- 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. You have to be careful with your choice of vegetables because some are very high in carbs.
- Condiments: Salt, pepper, herbs, and spices.
It’s best to base your diet mostly on whole, single-ingredient foods.
Sample Keto Meal Plan: A Week of Delicious and Nutritious Meals
Here’s a sample 7-day keto meal plan. People can tailor these meals and snacks to their liking, but they should be careful not to exceed their total carbohydrates daily.
Monday
- Breakfast: Veggie and egg muffins with tomatoes.
- Lunch: Chicken salad with olive oil, feta cheese, olives, and a side salad.
- Dinner: Salmon with asparagus cooked in butter.
- Snacks: Roast turkey and cucumber roll-ups and sticks of celery and pepper with guacamole.
Tuesday
- Breakfast: Egg, tomato, basil, and spinach omelet.
- Lunch: Almond milk, peanut butter, spinach, cocoa powder, and stevia milkshake with a side of sliced strawberries.
- Dinner: Cheese-shell tacos with salsa.
- Snacks: Olives and a smoothie with almond milk, nut butter, chia seeds, and spinach.
Wednesday
- Breakfast: Nut milk chia pudding topped with coconut and blackberries.
- Lunch: Avocado shrimp salad.
- Dinner: Pork chops with Parmesan cheese, broccoli, and salad.
- Snacks: Nuts, and slices of cheese and bell peppers.
Thursday
- Breakfast: Omelet with avocado, salsa, peppers, onion, and spices.
- Lunch: A handful of nuts and celery sticks with guacamole and salsa.
- Dinner: Chicken stuffed with pesto and cream cheese, and a side of grilled zucchini.
- Snacks: A boiled egg and flax crackers with cheese.
Friday
- Breakfast: Sugar-free Greek, whole milk yogurt with peanut butter, cocoa powder, and berries.
- Lunch: Ground beef lettuce wrap tacos with sliced bell peppers.
- Dinner: Loaded cauliflower and mixed veggies.
- Snacks: Kale chips and slices of cheese and bell peppers.
Saturday
- Breakfast: Cream cheese pancakes with blueberries and a side of grilled mushrooms.
- Lunch: Zucchini and beet “noodle” salad.
- Dinner: White fish cooked in olive oil with kale and toasted pine nuts.
- Snacks: Celery sticks with almond butter dip and a handful of berries and nuts.
Sunday
- Breakfast: Fried eggs with and mushrooms.
- Lunch: Low-carb sesame chicken and broccoli.
- Dinner: Spaghetti squash Bolognese.
- Snacks: Sugar-free turkey jerky and an egg and vegetable muffin.
Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefits.
Eating Out on Keto: Navigating Restaurants with Confidence
When eating out, select a meat-, fish-, or egg-based dish. Order extra veggies instead of carbs or starches, and have cheese for dessert. A favorite is bun-less burgers. You could also swap the fries for vegetables instead. Add extra avocado, cheese, bacon, or eggs. At Mexican restaurants, you can enjoy any type of meat with extra cheese, guacamole, salsa, and sour cream. For dessert, ask for a mixed cheese board or berries with cream.
Potential Side Effects and How to Manage Them
Although the ketogenic diet is usually safe for most healthy people, there may be some initial side effects while your body adapts. There’s some anecdotal evidence of these effects often referred to as the keto flu. Based on reports from some on the eating plan, it’s usually over within a few days. 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, and decreased exercise performance.
To minimize this, you can try a regular low-carb diet for the first few weeks. This may teach your body to burn more fat before you completely eliminate carbs. A ketogenic diet can also change the water and mineral balance of your body, so adding extra salt to your meals or taking mineral supplements may help. Talk to your doctor about your nutritional needs. At least in the beginning, it’s important to eat until you’re full and avoid restricting calories too much. Usually, a ketogenic diet causes weight loss without intentional calorie restriction.
While the keto diet has its benefits, staying on it in the long term may have some negative effects, including risks of the following: low protein in the blood, extra fat in the liver, kidney stones, and micronutrient deficiencies.
A type of medication called sodium-glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes can increase the risk for diabetic ketoacidosis, a dangerous condition that increases blood acidity. Anyone taking this medication should avoid the keto diet.
More research is being done to determine the safety of the keto diet in the long term. Keep your doctor informed of your eating plan to guide your choices.
Supplements for Keto: Enhancing Your Diet
Although no supplements are required, some can be useful.
- MCT Oil: Added to drinks or yogurt, MCT oil provides energy and helps increase ketone levels.
- Minerals: Added salt and other minerals can be important when starting out due to shifts in water and mineral balance.
- Caffeine: Caffeine can have benefits for energy, fat loss, and performance.
- Exogenous Ketones: This supplement may help raise the body’s ketone levels.
- Creatine: Creatine provides numerous benefits for health and performance. This can help if you are combining a ketogenic diet with exercise.
- Whey: Use half a scoop of whey protein in shakes or yogurt to increase your daily protein intake.
Keto for Vegetarians and Vegans: A Plant-Based Approach
It may be challenging for vegetarians and vegans to follow a keto diet, as they may usually get many of their calories from carbohydrates. Even sources of nonanimal protein, such as lentils and beans, can be relatively high in carbs. In the standard keto diet, animal products tend to make up a large portion of meals because these foods are naturally high in fat, high in protein, and low in carbohydrates.
Though challenging, it is possible to follow a vegetarian or vegan keto diet. Those who do not eat meat or fish can replace these products with high-fat plant-based foods. Vegetarians can also eat eggs and some forms of dairy as part of the diet. People can include avocados, coconut products, olives, and fruit and nut oils, such as avocado, coconut, olive, and sesame, as part of a keto diet.
Tips for Sticking to Keto: Setting Yourself Up for Success
The following tips may help people stick to the keto diet:
- Set a start date.
- Reorganize the pantry and refrigerator so they do not contain high carbohydrate foods.
- Make a weekly meal plan. This is key to eating balanced meals and preventing hunger.
- Stock up on keto-friendly foods and beverages.
- Read product labels carefully and check the ingredients list and carb content of each item.
- Prepare meals ahead of time and freeze or refrigerate them in batches.
- If hunger pangs occur regularly, try eating five or six small meals instead of three large ones.
- To avoid “keto flu” in the early stages, drink plenty of fluids and supplement with electrolytes.
- Consider temporarily reducing physical activity during the first week or two while the body adjusts to the new diet.
- Discuss any queries or concerns with a doctor or dietitian.