A 2014 review published in the International Journal of Environmental Research & Public Health states “One of the most studied strategies in the recent years for weight loss is the ketogenic diet. Many studies have shown that this kind of nutritional approach has a solid physiological and biochemical basis and is able to induce effective weight loss along with improvement in several cardiovascular risk parameters.” (1)
New to the ketogenic diet (or ketosis diet) and keto diet food list and wondering how it works? Want to know what the pros and cons of eating “very low carb” are? Here are some of the the benefits of the ketogenic diet at a glance:
- Weight loss is a huge benefit of ketogenic diets due to lowered insulin levels and the body’s ability to burn stored fat. I’ve personally found that the classic ketogenic diet is quite possibly the best diet for weight loss, especially considering how quickly it usually works.
- Following a ketogenic diet may also help prevent and even kill cancer cells. There are several medical studies — such as two conducted by the Department of Radiation Oncology at the Holden Comprehensive Cancer Center for the University of Iowa, and the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, for example— that show the ketogenic diet is an effective treatment for cancer and other serious health problems. (2)
- A modified ketogenic diet (what most people think of as a moderately low-carb diet) can be beneficial for most relatively healthy adults who are at an increased risk for metabolic syndrome, including those struggling with losing weight or controlling levels of blood sugar (glucose). Studies show that high-fat diets like the ketogenic diet also do not typically raise cholesterol and may actually reduce cardiovascular disease risk factors, especially in those who are obese. (3)
- Additionally ketogenic diets have been used to treat and even help reverse cognitive impairments, including Alzheimer’s symptoms.
Common Questions About the Ketogenic Diet
1. What Is the Ketogenic Diet?
The Ketogenic diet is a very low-carb diet plan that was originally designed in the 1920s for patients with epilepsy by researchers working at Johns Hopkins Medical Center. Researchers found that fasting — avoiding consumption of all foods for a brief period of time, including those that provide carbohydrates — helped reduce the amount of seizures patients suffered, in addition to having other positive effects on body fat, blood sugar, cholesterol and hunger levels. (4)
Unfortunately, long-term fasting is not a feasible option for more than a few days, therefore the ketogenic diet was developed to mimic the same beneficial effects of fasting. Essentially the keto diet works by “tricking” the body into thinking it is fasting, through a strict elimination of glucose that is found in carbohydrate foods. Today the ketogenic diet goes by several different names, including the “no-carb diet” or “very low carbohydrate ketogenic diet”(LCKD or VLCKD for short).
What does “keto” stand for exactly? Keto is short for ketosis. Following a ketogenic diet puts your body into a state of “ketosis,” which is a metabolic state that occurs when most of the body’s energy comes from ketone bodies in the blood, rather than from glucose. This is in contrast to a glycolytic state, where blood glucose (sugar) provides most of the body’s fuel (or energy).
Once ketone levels in the blood rise to a certain point, you officially enter into a state of ketosis. This state results in fairly rapid and consistent weight loss until you reach a healthier (and stable) body weight. Overall, people enter into ketosis at different rates, usually after 3–4 days of fasting or following a very low-carbohydrate diet (20 grams of net carbs or less) that forces the need for an alternative energy source. (5)
When you’re following a ketogenic diet, your body is burning fat for energy rather than carbohydrates, so in the process most people lose excess body fat rapidly, even when consuming lots of fat and adequate calories through their diet.
2. What Are the Stages of Ketosis?
Ketosis occurs when the liver breaks down fat into fatty acids and glycerol — a process called beta-oxidation. In particular, three primary types of ketone bodies that are water-soluble molecules are produced: acetoacetate, beta-hydroxybutyrate and acetone.
Rather than drawing energy from glucose, a person in ketosis stays fueled off of these circulating ketones or ketone bodies — essentially, burning fat for fuel. This is the principal goal of the ketogenic diet, which can be achieved by adhering to a very low-carbohydrate, high-fat diet with only moderate amounts of protein.
3. What Is a Ketogenic Diet Plan Like?
Wondering how many carb foods you can eat and still be “in ketosis”? The traditional ketogenic diet created for those with epilepsy consisted of getting about 75 percent of calories from sources of fat (such as oils or fattier cuts of meat), 5 percent from carbohydrates and 20 percent from protein. For most people a less strict ketogenic diet (what I call a “modified keto diet”) can still help promote weight loss in a safe, and often very fast, way.
Reducing calories coming from carbohydrates to just 5 percent may not be appropriate or many people, but this shouldn’t mean that the keto diet is completely ruled out (more on following a modified keto diet can be found below).
Keep in mind that if a strict ketogenic diet is being followed, experts recommend that children following the diet be closely monitored, in addition to those who have who are taking medications or existing conditions like high blood pressure or diabetes.
For adults who are relatively healthy, it’s usually safe to follow a very low carb diet while not being monitored as closely, as long as they’re watching out for any unusual warning signs of a negative reaction (such as lots of fatigue or brain fog that lasts for more than about a week).
In some ways, it’s similar to the Atkins diet, which similarly boosts the body’s fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto diet and the Atkins diet is ketogenic emphasizes healthier fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.
4. How Does the Ketogenic Diet Work?
Ketogenic diets, like most low carb diets, work through the elimination of glucose. Because most folks live on a high carb diet, our bodies normally run on glucose (or sugar) for energy. We cannot make glucose and only have about 24 hours’ worth stored in our muscle tissue and liver. Once glucose is no longer available from food sources, we begin to burn stored fat instead, or fat from our diets. The ketogenic diet, therefore, eliminates glucose and causes the body to burn its own fat quickly.
This process of burning fat provides more benefits than simply helping us to shed extra weight — it also helps control the release of hormones like insulin, which plays a role in development of diabetes and other health problems. When we eat carbohydrates, insulin is released as a reaction to elevated blood glucose (an increase in sugar circulating in our blood). Insulin is a “storage hormone” that signals cells to store as much available energy as possible, initially as glycogen (aka stored carbohydrates in our muscles) and then as body fat.
The ketogenic diet works by eliminating carbohydrates from the diet and keeping the body’s carbohydrate stores almost empty, therefore preventing too much insulin from being released following food consumption. This can help reverse “insulin resistance,” which is the underlying problem contributing to diabetes. Optimal ketosis is reached when they body stays in ketosis for at least a few weeks, when both any side effects diminish greatly while the benefits are more pronounced with the body becoming a fat burner.
5. Will I Get the “Keto Flu”? Or Am I Simply Going Into “Ketosis”?
Remember, the ketogenic diet will actually change your metabolism, put you into ketosis and turn you from a sugar burner to a fat burner. Those are significant changes for your body, and you’re bound to notice some symptoms of the so-called keto flu.
Keto flu symptoms can include feeling tired, having difficulty sleeping, digestive issues like constipation, weakness during workouts, being moody, losing libido and having bad breath. Fortunately, these side effects don’t affect everyone and often only last for 1–2 weeks. Overall, symptoms go away as your body adjusts to being in ketosis.
4 Major Benefits of a Ketogenic Diet
1. Improved Weight Loss
Today, it’s still true that most people choose to lose weight by focusing on cutting calories, eating mostly high levels of carbohydrate foods (like more veggies and fruit) and reducing fat content of their diet. While this can have some benefits, some studies show that low-fat diets yield only modest weight loss results long-term due to compliance issues and the tendency for people to feel hungry while cutting their fat intake. (6)
Low-carb diets can help diminish hunger and also boost weight loss through their hormonal effects. As described above, when we eat very little foods that supply us with carbohydrates, we release less insulin. With less insulin around, the body doesn’t store extra energy in the form of fat for later use, and instead is able to reach into existing fat stores for energy.
Diets high in healthy fats and protein also tend to be very filling, which can help reduce overeating of empty calories, sweets and junk foods. (7) For most people eating a healthy low-carb diet, it’s easy to consume an appropriate amount of calories, but not too many, since things like sugary drinks, cookies, bread, cereals, ice cream or other desserts and snack bars are off-limits.
2. Reduced Risk for Type 2 Diabetes
A ketogenic diet can be beneficial for those with type 2 diabetes (who are not on insulin medications) or pre-diabetics wishing to reverse their condition. Studies show that low-carbohydrate diets, which limit intake of sugar and processed grains, encourage improvements in the dyslipidemia of diabetes and other risk factors for metabolic syndrome. (8)
Low-carb diets have shown benefits for improving blood pressure, postprandial glycemia and insulin secretion. Diabetics on insulin should contact their medical provider prior to starting a ketogenic diet, however, as insulin dosages may need to be adjusted.
3. Possible Protection Against Cancer
Certain studies suggest that ketogenic diets may “starve” cancer cells. A highly processed, pro-inflammatory, low-nutrient diet can feed cancer cells causing them to proliferate. What’s the connection between a high-sugar diet and cancer? The regular cells found in our bodies are able to use fat for energy, but it’s believed that cancer cells cannot metabolically shift to use fat rather than glucose. (9) Therefore, a diet which eliminates excess refined sugar and other processed carbohydrates may be effective in reducing or fighting cancer.
Following a ketogenic diet is not the only way to lower your risk cancer risk, but some proponents of ketogenic diets believe that these diets should be prescribed for just about anyone with a family history of cancer or higher risk for other reasons in order to minimize the likelihood of the disease developing.
4. Protection Against Heart Disease Risk Factors
Even though the ketogenic diet is a high-fat diet, research suggests that eating this way will not raise your overall cholesterol score as you might suspect, or increase your risk for heart disease. Today we know, that heart disease is mostly caused by inflammation, influenced predominately by intake of unhealthy foods like trans-fats, too much sugar and lots of processed/packaged foods — but not due to eating heart-healthy fats like olive oil, nuts and fish.
Lower-carb diets that are high in unprocessed non-starchy plant foods, healthy fats like olive oil and nuts, and healthy proteins can help lower risks for risk factors like obesity or heart disease as well as decreasing likelihood of complications due to these conditions.
The “Modified Ketogenic Diet” for Lasting Fat Loss
You might be thinking that the ketogenic diet seems very difficult to get started with or restrictive, but remember that a diet consisting of 75 percent fat and 20 percent protein diet may not be necessary for the majority of adults to reap the benefits of this diet.
Most adults find weight loss success with a more moderate approach to the low-carbohydrate ketogenic diet, simply by focusing on eliminating carbohydrates and increasing calories from healthy fats and protein. Many will experience weight loss by just reducing carbohydrates to 30 percent of their total calorie intake, while increasing fat and protein to 40 percent and 30 percent respectively. This is similar to the modified Atkins diet, when you reintroduce select carbohydrates while monitoring your weight.
I’ve laid out my exact recommendations below for following the ketogenic diet to reduce blood glucose, burn fat and reverse disease in your body. First and foremost, consider that the type of fats you consume are very important— as not all fats are created equally.
- To get enough healthy fats in your diet, I recommend eating mostly: coconut or coconut oil, avocado, chia seeds or flaxseeds, non-starchy vegetables, sprouted nuts, organic grass-fed meat and raw dairy products. Aim for a ratio that is about 40 percent fat, 30 percent protein, and 30 percent carb. The exact ratio of these macronutrients will differ depending on your specific goals and current state of health.
- In particular, I recommend consuming a large amount of MCFA’s (Medium Chain Fatty Acids) from sources like unrefined coconut oil and MCT oil since this is probably the easiest type of fat for your body to metabolize properly and burn as fuel. In addition to MCFA’s, consume a moderate amount of saturated fat from sources like grass-fed beef or raw dairy products. Finally, other sources of fat, like polyunsaturated or monounsaturated fats, should come from healthy, whole foods like nuts, seeds and wild-caught fish.
- If you find it difficult to stick to a very low-carb diet every day, especially for months on end, you might want to consider a carb-cycling diet instead. Carb cycling increases carbohydrate intake (and sometimes calories in general) only at the right time and in the right amounts, usually about 1–2 times per week.
- Alternating days of higher vs. lower carb intake, especially when timed around workouts if you’re active, is beneficial for cutting your body fat percentage down while still not sacrificing your muscle mass. How many carbs should you aim for if you go with approach? Higher-carb days might include 200–300 grams of carbohydrates, while lower-carb days might include 50–150 grams. Exact numbers will differ, with men who are bigger and more active requiring more of both calories and carbs than smaller, less active women.
- Remember that carbs are not the enemy — they actually have many important roles in the body! Eating enough carbohydrates at the right time can help “reset your metabolic thermostat” and signal your body to create enough beneficial hormones (like leptin and thyroid hormones) that keep you at a healthy weight, feeling energized and mentally remaining satisfied with your diet overall. Eating a very low-carb diet nonstop can lead some to feel overly restricted, tired and demotivated — but for many adding in carbs at certain times makes it easier to follow a healthy way of eating long-term that won’t cause weight regain or strong carb cravings.
- Finally, consuming at least moderate carbohydrates also enables you to eat enough plant foods and to get enough fiber. Carbs are the primary type of macronutrient found in most plant foods, although exactly how many carbs a plant food has depends on the specific type. Some of the healthiest foods in the world — such as leafy green veggies, cruciferous veggies, artichokes, asparagus, sea veggies, herbs and spices, for example — are actually pretty low in carbohydrates and, therefore, suitable on the ketogenic diet or even on “low-carb days” if you’re carb cycling. Whole foods that are higher in carbs — such as sweet potatoes and other root veggies, beans/legumes, and fruit — are often encouraged on “higher-carb days” when carb cycling, or if you’re very active. A bonus of eating these foods is that they contain plenty of dietary fiber and antioxidants, helping with things like digestion, heart health and more.
Best Foods & Recipe Ideas for a Ketogenic Diet:
Regarding specific foods to include on a ketogenic or very low-carb diet, plus those to eliminate, here is an outline of what you might choose to grocery shop for:
- Eat lots of different vegetables, especially: leafy greens, mushrooms, tomatoes, carrots, broccoli, cabbage, Brussels sprouts, spinach, kale, sea veggies, peppers, etc.
- Healthy food choices that are high in protein but low-carb or no-carb include: grass-fed meat, pasture-raised poultry, cage-free eggs, bone broth protein, wild-caught fish, organ meats and raw dairy products, such as raw goat cheese.
- Healthy fats, which are also low-carb or no-carb, include: olive oil, coconut oil, grass-fed butter, palm oil, nuts and seeds.
- Avoid processed and ultra-processed foods high in calories and bankrupt in terms of nutrients: those made with white flour or wheat flour products, added table sugar, conventional dairy, bread and other processed grains like pasta, sweetened snacks like cookies and cakes, most boxed cereals, sweetened drinks, ice cream and pizza.
- When adding more carbs to your meals choose those that are complex and unprocessed, such as: sweet potatoes; ancient grains (ideally sprouted) like oats, quinoa, buckwheat, amaranth and brown rice; whole fruits; beans and legumes; and natural sweeteners in small amounts like raw honey.
Precautions When Following the Ketogenic Diet
If a ketogenic diet is being used for a child to treat epilepsy, close medical monitoring is necessary. If you’re very active, consider trying carb cycling or at least eating a modified keto diet that does not severely restrict carb intake. Reason being: post-workout you have what’s known as an “anabolic window.” (10) Carbs help restore your energy and provide muscles with glucose for rebuilding, or glycogen to be stored for future energy. Consuming at least some healthy carbs can keep you feeling energized and strong if you’re prone to fatigue and weakness when eating low carb.
If you experience any of the following side effects while eating a very low-carb diet, consider adding in more carbs (about 20 grams more at a time) until you find an amount that helps you feel your best and maintain a healthy weight:
- Feeling fatigued or more tired than usual
- Craving carbs at times
- Constipation or bloating due to water retention (especially after higher carb days)
- Feeling weaker during workouts and not recovering well
- Having trouble sleeping
- Being moody or irritable
- Losing libido
- Ketogenic diets were originally developed to help improve symptoms of epilepsy (specifically in children who didn’t improve from other treatments), but today very low-carb diets are used to help adults, too, including those suffering from many other chronic health problems like obesity, cancer and diabetes.
- Rapid and reliable weight loss for people following a ketogenic diet is due to lowered insulin levels and the body being forced to burn stored body fat for energy.
- To prevent side effects, boost weight loss and still provide enough fiber and antioxidants, I recommend eating a modified ketogenic diet that consists of about 30 percent of calories from carbohydrates, 40 percent from fat and 30 percent from protein.
Read Next: Why I Don’t Eat a Paleo Diet … But Close
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