Ketogenic diet: Is the ultimate low-carb diet good for you?

By Harvard Health Publishing Staff

Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.

What is a ketogenic (keto) diet?

In essence, it is a diet that causes the body to release ketones into the bloodstream. Most cells prefer to use blood sugar, which comes from carbohydrates, as the body’s main source of energy. In the absence of circulating blood sugar from food, we start breaking down stored fat into molecules called ketone bodies (the process is called ketosis). Once you reach ketosis, most cells will use ketone bodies to generate energy until we start eating carbohydrates again. The shift, from using circulating glucose to breaking down stored fat as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualized process, and some people need a more restricted diet to start producing enough ketones.

Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.

Is a ketogenic diet healthy?

We have solid evidence showing that a ketogenic diet reduces seizures in children, sometimes as effectively as medication. Because of these neuroprotective effects, questions have been raised about the possible benefits for other brain disorders such as Parkinson’s, Alzheimer’s, multiple sclerosis, sleep disorders, autism, and even brain cancer. However, there are no human studies to support recommending ketosis to treat these conditions.

Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.

A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more controversy when we consider the effect on cholesterol levels. A few studies show some patients have increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.

Key takeaways from a ketogenic diet review?

A ketogenic diet could be an interesting alternative to treat certain conditions and may accelerate weight loss. But it is hard to follow, and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time. It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.

Adapted from a Harvard Health Blog post by Marcelo Campos, MD.

Image: mphillips007/Getty Images

A Detailed Beginner’s Guide to Keto

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The ketogenic diet involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. Health benefits can include weight loss and lowering your risk for certain diseases.

The ketogenic diet (or keto diet, for short) is a low carb, high fat diet that offers many health benefits.

In fact, many studies show that this type of diet can help you lose weight and improve your health (1).

Ketogenic diets may even have benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease (2, 3, 4, 5).

Here is a detailed beginner’s guide to the keto diet.

Keto basics

The ketogenic diet is a very low carb, high fat diet that shares many similarities with the Atkins and low carb diets.

It involves drastically reducing carbohydrate intake and replacing it with fat. This reduction in carbs puts your body into a metabolic state called ketosis.

When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain (6).

Ketogenic diets can cause significant reductions in blood sugar and insulin levels. This, along with the increased ketones, has some health benefits (6, 7, 8).

SUMMARY

The keto diet is a low carb, high fat diet. It lowers blood sugar and insulin levels and shifts the body’s metabolism away from carbs and toward fat and ketones.

There are several versions of the ketogenic diet, including:

• Standard ketogenic diet (SKD): This is a very low carb, moderate protein and high fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs (9).
• Cyclical ketogenic diet (CKD): This diet involves periods of higher carb refeeds, such as 5 ketogenic days followed by 2 high carb days.
• 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.

However, only the standard and high protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.

The information in this article mostly applies to the standard ketogenic diet (SKD), although many of the same principles also apply to the other versions.

SUMMARY

There are several versions of the keto diet. The standard (SKD) version is the most researched and most recommended.

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.

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 (6).

It’s also important to moderate your protein consumption. This is because protein can be converted into glucose if consumed in high amounts, which may slow your transition into ketosis (10).

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 (11).

Blood, urine, and breath tests are available, which can help determine whether you’ve entered ketosis by measuring the amount 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 (12).

SUMMARY

Ketosis is a metabolic state in which your body uses fat for fuel instead of carbs. Modifying your diet and practicing intermittent fasting can help you enter ketosis faster. Certain tests and symptoms can also help determine whether you’ve entered ketosis.

Savanna Shoemaker, MS, RDN, LDTHE KETO DIET

A dietitian’s experience

My experiences with keto were really positive. As someone who has struggled with my weight, I absolutely loved that keto made it so easy to manage my hunger. I also felt really energized when I was in ketosis. Still, I couldn’t do keto when I was pregnant or breastfeeding, and I started having a lot of trouble sticking to it at certain points in my menstrual cycle. Now I’m following a whole food diet that’s still low in carbs, but a little easier and – in my opinion – better for my hormonal balance.

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A ketogenic diet is an effective way to lose weight and lower risk factors for disease (1, 2, 3, 4, 5).

In fact, research shows that the ketogenic diet may be as effective for weight loss as a low fat diet (13, 14, 15).

What’s more, the diet is so filling that you can lose weight without counting calories or tracking your food intake (16).

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 (13).

What’s more, it also led to reductions in diastolic blood pressure and triglyceride levels (13).

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 (17).

The increased ketones, lower blood sugar levels, and improved insulin sensitivity may also play a key role (18, 19).

For more details on the weight loss effects of a ketogenic diet, read this article.

SUMMARY

A ketogenic diet can help you lose slightly more weight than a low fat diet. This often happens with less hunger.

Diabetes is characterized by changes in metabolism, high blood sugar, and impaired insulin function (20).

The ketogenic diet can help you lose excess fat, which is closely linked to type 2 diabetes, prediabetes, and metabolic syndrome (21, 22, 23, 24).

One older study found that the ketogenic diet improved insulin sensitivity by a whopping 75% (25).

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 (26).

Another study in 349 people with type 2 diabetes found that those who followed a ketogenic diet lost an average of 26. 2 pounds (11.9 kg) over a 2-year period. This is an important benefit when considering the link between weight and type 2 diabetes (24, 27).

What’s more, they also experienced improved blood sugar management, and the use of certain blood sugar medications decreased among participants throughout the course of the study (27).

For more information, check out this article on the benefits of low carb diets for people with diabetes.

SUMMARY

The ketogenic diet can boost insulin sensitivity and cause fat loss, leading to significant health benefits for people with type 2 diabetes or prediabetes.

The ketogenic diet actually originated as a tool for treating neurological diseases such as epilepsy.

Studies have now shown that the diet can have benefits for a wide variety of different health conditions:

• Heart disease. The ketogenic diet can help improve risk factors like body fat, HDL (good) cholesterol levels, blood pressure, and blood sugar (28, 29).
• Cancer. The diet is currently being explored as an additional treatment for cancer, because it may help slow tumor growth. (4, 30, 31).
• Alzheimer’s disease. The keto diet may help reduce symptoms of Alzheimer’s disease and slow its progression (5, 32, 33).
• Epilepsy. Research has shown that the ketogenic diet can cause significant reductions in seizures in epileptic children (3).
• Parkinson’s disease. Although more research is needed, one study found that the diet helped improve symptoms of Parkinson’s disease (34).
• Polycystic ovary syndrome. The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome (35, 36).
• Brain injuries. Some research suggests that the diet could improve outcomes of traumatic brain injuries (37).

However, keep in mind that research into many of these areas is far from conclusive.

SUMMARY

A ketogenic diet may provide many health benefits, especially with metabolic, neurological, or insulin-related diseases.

Any food that’s high in carbs should be limited.

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 like 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.

SUMMARY

Avoid carb-based foods like grains, sugars, legumes, rice, potatoes, candy, juice, and even most fruits.

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. Here’s a list of 44 healthy low carb foods.

SUMMARY

Base the majority of your diet on foods such as meat, fish, eggs, butter, nuts, healthy oils, avocados, and plenty of low carb veggies.

To help get you started, here’s a sample ketogenic diet meal plan for one week:

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

Tuesday

• breakfast: egg, tomato, basil, and spinach omelet
• lunch: almond milk, peanut butter, spinach, cocoa powder, and stevia milkshake (more keto smoothies here) with a side of sliced strawberries
• dinner: cheese-shell tacos with salsa

Wednesday

• breakfast: nut milk chia pudding topped with coconut and blackberries
• lunch: avocado shrimp salad
• dinner: pork chops with Parmesan cheese, broccoli, and salad

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

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

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

Sunday

• breakfast: fried eggs with and mushrooms
• lunch: low carb sesame chicken and broccoli
• dinner: spaghetti squash Bolognese

Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefits.

For tons of recipes, check out these 101 healthy low carb recipes and this keto shopping list.

SUMMARY

You can eat a wide variety of tasty and nutritious meals on a ketogenic diet. It’s not all meats and fats. Vegetables are an important part of the diet.

In case you get hungry between meals, here are some healthy, keto-approved snacks:

• fatty meat or fish
• cheese
• a handful of nuts or seeds
• keto sushi bites
• olives
• one or two hard-boiled or deviled eggs
• keto-friendly snack bars
• 90% dark chocolate
• full-fat Greek yogurt mixed with nut butter and cocoa powder
• bell peppers and guacamole
• strawberries and plain cottage cheese
• celery with salsa and guacamole
• beef jerky
• smaller portions of leftover meals
• fat bombs

SUMMARY

Great snacks for a keto diet include pieces of meat, cheese, olives, boiled eggs, nuts, raw veggies, and dark chocolate.

Although getting started on the ketogenic diet can be challenging, there are several tips and tricks that you can use to make it easier.

• Start by familiarizing yourself with food labels and checking the grams of fat, carbs, and fiber to determine how your favorite foods can fit into your diet.
• Planning out your meals in advance may also be beneficial and can help you save extra time throughout the week.
• Many websites, food blogs, apps, and cookbooks also offer keto-friendly recipes and meal ideas that you can use to build your own custom menu.
• Alternatively, some meal delivery services even offer keto-friendly options for a quick and convenient way to enjoy keto meals at home.
• Look into healthy frozen keto meals when you’re short on time
• When going to social gatherings or visiting family and friends, you may also want to consider bringing your own food, which can make it much easier to curb cravings and stick to your meal plan.

SUMMARY

Reading food labels, planning your meals ahead, and bringing your own foods when visiting family and friends can make it much easier to stick to the ketogenic diet.

Many restaurant meals can be made keto-friendly.

Most restaurants offer some kind of meat or fish-based dish. Order this and replace any high carb food with extra vegetables.

Egg-based meals are also a great option, such as an omelet or eggs and bacon.

Another 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.

SUMMARY

When eating out, select a meat-, fish-, or egg-based dish. Order extra veggies instead of carbs or starches, and have cheese for dessert.

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 (38). 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 (39). Other less common symptoms include:

• poor energy and mental function
• increased hunger
• sleep issues
• nausea
• digestive discomfort
• 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.

SUMMARY

Many of the side effects of starting a ketogenic diet can be limited. Easing into the diet and taking mineral supplements can help.

Staying on the keto diet 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
• 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 (40, 41).

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.

SUMMARY

There are some side effects to the keto diet about which you should speak to your doctor if you plan to stay on the diet long term.

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. Shop for MCT oil online (42, 43).
• Minerals. Added salt and other minerals can be important when starting out due to shifts in water and mineral balance (44).
• Caffeine. Caffeine can have benefits for energy, fat loss, and performance (45).
• Exogenous ketones. This supplement may help raise the body’s ketone levels (46).
• Creatine. Creatine provides numerous benefits for health and performance. This can help if you are combining a ketogenic diet with exercise (47).
• Whey. Use half a scoop of whey protein in shakes or yogurt to increase your daily protein intake (48, 49). Shop for tasty whey products on online.

SUMMARY

Certain supplements can be beneficial on a ketogenic diet. These include exogenous ketones, MCT oil, and minerals.

Here are answers to some of the most common questions about the ketogenic diet.

1. Can I ever eat carbs again?

Yes. However, it’s important to significantly reduce your carb intake initially. After the first 2 to 3 months, you can eat carbs on special occasions — just return to the diet immediately after.

2. Will I lose muscle?

There’s a risk of losing some muscle on any diet. However, protein intake and high ketone levels may help minimize muscle loss, especially if you lift weights (50, 51).

3. Can I build muscle on a ketogenic diet?

Yes, but it may not work as well as on a moderate carb diet (52, 53). For more details about low carb or keto diets and exercise performance, read this article.

4. How much protein can I eat?

Protein should be moderate, as a very high intake can spike insulin levels and lower ketones. Around 35% of total calorie intake is probably the upper limit.

5. What if I am constantly tired, weak, or fatigued?

You may not be in full ketosis or be utilizing fats and ketones efficiently. To counter this, lower your carb intake and revisit the points above. A supplement like MCT oil or ketones may also help (42, 43).

6. My urine smells fruity. Why is this?

Don’t be alarmed. This is simply due to the excretion of by-products created during ketosis (54).

7. My breath smells. What can I do?

This is a common side effect. Try drinking naturally flavored water or chewing sugar-free gum.

8. I heard ketosis was extremely dangerous. Is this true?

People often confuse ketosis with ketoacidosis. Ketoacidosis is dangerous, but the ketosis on a ketogenic diet is usually fine for healthy people. Speak to your doctor before starting any new diet.

9. I have digestion issues and diarrhea. What can I do?

This common side effect usually passes after 3 to 4 weeks. If it persists, try eating more high fiber veggies (55, 56).

A ketogenic diet can be great for people who:

• are overweight
• have diabetes
• are looking to improve their metabolic health

It may be less suitable for elite athletes or those wishing to add large amounts of muscle or weight.

It may also not be sustainable for some people’s lifestyles and preferences. Speak with your doctor about your eating plan and goals to decide if a keto eating plan right for you.

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Is the keto diet right for you?

If you have been on a diet at least once, you must have noticed that it is very easy to get off of it. After all, it is impossible to pass by your favorite delicacies all your life and ignore a huge pile of products. The keto diet also provides restrictions, but there are much fewer of them than in conventional diets, and you don’t need to feel hungry. Today, the entire Internet and, perhaps, your girlfriend also talks about the incredible effectiveness of this power system. But is the keto diet right for you? Let’s figure it out.

Who should choose the keto diet? Anyone who wants to get rid of excess body fat as quickly as possible and improve overall well-being. The diet allows you to lose more than 5 kg in a month. And all this without hunger. But at the same time, in order to get a good and lasting result, you need to sit on a keto diet for a long time. If you love red meat and fatty foods, then the keto system should intrigue you. But if you can’t live without buns, cookies, and fries for a long time, then maybe you should pay attention to the standard calorie counting system.

In the classic keto diet, it is not calories that matter, but macros – the proportions of macronutrients (75-80% fat, 5-10% carbohydrates, 15-20% protein). It is also necessary to eat only 2 times a day, but until full, so that you feel full all day.

Authorized:

• Meat, seafood, fish, poultry, offal, eggs.
• Animal fats, butter and ghee.
• Certain vegetable fats: coconut oil, avocado, cocoa, olive oil, real palm oil, macadamia oil.
• Vegetables and herbs growing on the surface of the earth.
• Berries and nuts for dessert.
• Sweeteners – erythritol, stevia, monk.
• Fatty dairy products (cream, cheese, sour cream).

Prohibited:

• Sugar in any form, including honey and fructose sweets.
• Fruit.
• Cereals.
• Juices, soda.
• Any flour products: bread, pasta, pastries.
• Potatoes and tubers.
• Vegetable oils: sunflower, soybean, corn, linseed, etc.
• Surrogates, semi-finished products, processed products.

It corrects initially what makes people overweight – reduces the level of the hormone insulin, which is always in excess in those who adhere to a high-carbohydrate diet. Insulin is directly responsible for the accumulation of fat. If there is a lot of it, then fat burning does not occur. The keto diet adjusts the amount of insulin so that the body starts to burn fat. The diet provides for a high-fat, low-carbohydrate diet (up to 25 g of carbohydrates can be consumed per day). Thus, the body begins to use fats as fuel – both those that come with food, and from the buttocks.

Is there a scientific basis for such a diet?

In Sweden, this diet is recognized as the main strategy for obesity. And not so long ago, even the American Dietetic Association recognized the high benefits of reducing carbohydrates in diabetes.

Can the keto diet hurt?

If you accurately monitor the quality of food, do not completely ignore carbohydrates, then there will be no problems. In addition, you still have to monitor the level of fat intake. When decomposed, they form ketones. If their level is too high, it can poison the body. This condition is called ketoacidosis. True, such poisoning accelerates within 24 hours. But for diabetics, it is better not to face this.

Many people also complain about a loss of strength and a headache during the transition. This usually lasts 3-4 days, but sometimes this condition stretches for several weeks. But after that, the level of energy rises sharply, mood stabilizes, clarity of thought appears, and it is possible to sleep faster. This is ketosis.

Who shouldn’t go on a keto diet?

It is worth refraining from the keto diet for any gastrointestinal disease in the acute stage. Nonspecific ulcerative colitis, Crohn’s disease and Gilbert’s syndrome, as well as cancer and diabetes, it is better to consult a specialist. Not recommended for chronic fatigue syndrome.

What is the keto diet and who is it suitable for

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Today we will tell you how the keto diet works, who it suits and how effective it is for losing weight.

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If twenty or thirty years ago someone would have sorted all the products into two baskets, sorting them according to the principle of greatest and least utility, then today you would have to conduct a thorough revision in them. The strangest story happened during this time with fat – the recent main enemy of mankind is not only completely rehabilitated, but almost declared its savior. Is this true, nutritionist Chris More understands.

A patient recently confessed to me that she and her husband eat almost a kilo of bacon a week, three slices for breakfast and then two more with salad for lunch. I have been working as a nutritionist for more than twenty years, and it would seem that nothing surprises me, but then I still could not stand it and asked: why? The patient said that her husband watched a program on TV about the keto diet, and they decided to try it. Six months on bacon – and now the husband has lost nine kilograms and, according to his wife, is almost bursting from overflowing energy.

I hear more and more about the wonders that the keto diet does for them. They say that it burns body fat, energizes and conquers diseases, and that from now on it is not only possible, but also necessary to eat as much bacon as you like. But all their enthusiasm needs at least a serious test – is the keto diet, which does not limit the consumption of animal fat, really so useful?

The ketogenic diet, the ketogenic diet, is a low-carb, high-fat, moderate-protein diet. Initially used in the treatment of epilepsy in children by increasing the level of ketone bodies in the blood.

What is ketosis?

Let’s start with the name of the diet: where did this “keto” come from? When the body is desperately short of carbohydrates—for example, due to diabetes or prolonged starvation—it has to break down its own fat more than usual to get energy. Ketosis develops: metabolism is disturbed, and more than necessary ketone bodies accumulate in the tissues. Ketone bodies are products of fat metabolism. They are produced by the liver when insulin levels drop in the blood.

“The liver produces ketone bodies all the time, but their levels depend on the carbohydrates and proteins you eat—the body needs both,” explains Ohio University professor Jeff Volek.

The breakdown of fat in the body of a healthy person and the formation of ketone bodies is a normal process, it is called ketogenesis. Unlike ketosis, ketogenesis does not lead to massive weight loss. Ketosis is a pathology that, in addition to diabetes and prolonged fasting, the keto diet can cause, since it almost excludes carbohydrate foods from the diet. A person who has developed ketosis loses weight dramatically, as well as due to some other pathologies.

The ketogenic diet forces the body to use fat as its main source of energy. Usually, this role is played by carbohydrates, which, when taken with food, are processed into glucose, which is extremely important for the nutrition and functioning of the brain. However, if the diet is low in carbohydrates, the liver converts fat into fatty acids and ketone bodies. Ketone bodies enter the brain and are used as an energy source instead of glucose. An increase in the level of ketone bodies in the blood (ketosis) leads to a decrease in the frequency of epileptic seizures.

In the keto diet, the bulk of the daily diet – from 60 to 80% – is fat, proteins – about 15%, and carbohydrates account for only the remaining 10% (about half a small bun). At first glance, it looks like the Atkins diet, but the keto diet involves a more severe restriction of carbohydrates, according to Spencer Nadolsky, author of The Fat Loss Prescription. A number of theorists generally claim that the fewer carbohydrates we eat, the more fat our body burns, and for this reason, metabolism improves, immunity increases – and in general, various miracles begin to happen to our bodies.

However, in ordinary life, we get about half of our calories, and not a tenth of them, from carbohydrates. So basically the question is: can your body stay in ketosis long enough to reach the promised nirvana without serious health consequences? Will you start to literally freak out with fat?

Is the keto diet right for you?

It may sound strange, but the best diet for you is the one you are used to. For Volek, who has been on keto for twenty years, she is good, but is she right for you? Unfortunately, there are no studies on what happens in the body of a person who has been on a keto diet for a long time. During The A to Z Weight Loss Study, scientists studied the Atkins diet, the Zone, LEARN, and several other diets, but during the study, female subjects consumed from 25 to 35% of carbohydrates – this is not even close to the 10% that advises to limit the keto diet.

The only thing known for certain is that you will actually lose weight on the keto diet. In Italy, in 2015, they studied the performance of people sitting on it, and on average they lost about 10-12 kilograms in three months. A year earlier, in Spain, it turned out that in a year you can lose about 20 kilograms in this way. True, over the next year, the subjects often returned to the weight that they had before the experiment, as soon as they got off the strict diet.

What will you eat if you decide to try? First and second, the same bacon. Of the rest of the products, little will suit you. Starchy vegetables – potatoes, pumpkin, corn – are strictly prohibited, like most fruits. You will also have to forget about milk, beans, rice and pasta.

The keto diet can be difficult to follow and can be dangerous for some. “Extreme diets, in particular the keto diet, are strictly contraindicated for people with neurodegenerative diseases such as epilepsy,” says Dr. Alan Aragon.

The ketogenic diet is socially considered optimal for weight loss. However, according to scientific evidence, the effect of weight loss soon after switching to a ketogenic diet is due to a decrease in the amount of water in the body, and the amount of body fat is affected solely by energy balance. To lose weight, the energy coming from food should be less than the energy expended in physical activity. One of the benefits of a ketogenic diet, like other low-carbohydrate diets, is that the ketosis that occurs with a low-carbohydrate diet promotes weight loss in obesity. The difference in calories eaten can be up to a thousand kilocalories per day compared to low-fat diets. The effect of ketogenic diets is highly dependent on the protein content of the diet.

Can I take drugs that cause an increase in ketone bodies? In no case. Do not listen to those “consultants” who will assure you that even without any diet, you can use special drugs to induce ketosis in yourself.

So is the keto diet right for you or not? If you are an extreme athlete who is ready to experiment with your body, if you like to take risks and a quick result is important to you, then try it! If you just want to lose a few pounds and have already experienced the “yo-yo effect” (when, after a strict diet, a person breaks down after a strict diet and gains more weight than he managed to lose), then perhaps it’s not worth the risk. However, if you approach the keto diet wisely, there are three lessons you can learn from it that will definitely come in handy.

1. Cut down on empty carbohydrates. Analyze what foods you get most of your daily carbs from: fruits that are rich in fiber and antioxidants, then everything is fine, but if sweets, soda and any food made from white flour are your sources of carbohydrates, you know what to do: feel free to send them to the trash.
2. Don’t avoid fat. The low-fat food craze that began in the 90s can be safely left in the past. There is nothing good in this. Often, to compensate for the lack of fat, manufacturers increase the amount of sugar in such products. At least twice a week, eat fatty fish such as salmon, mackerel or sardines. And whatever you cook, do not skimp on vegetable, especially good – olive – oil.
3. Eat more greens. All kinds of leafy vegetables and greens go well with fatty and protein foods – fans of the keto diet eat them in plenty. And you do the same. Eat kale without restrictions (from this year it is sold in our supermarkets), spinach, bok choy, arugula and other types of salads.

What happened to my bacon-loving patients? Their experiments with nutrition continued right up to the moment when they had a baby. Of course, they immediately forgot about the diet (there is no time to think about it, as the young mother explained). So remember: sooner or later you will get tired of regularly stuffing bacon into yourself and you will return to normal, habitual food.

Recipes

Salad with salmon and asparagus

Ingredients:

• 150 g salmon fillet
• 80 g green asparagus
• 1/2 iceberg lettuce
• 2 eggs
• 4 anchovy fillets
• 5 cherry tomatoes
• 5 large capers (or 6-8 small capers) – take capers in salt, not in brine, rinse before use
• 1/2 medium red onion
• 6–8 st. l. extra virgin olive oil
• 1 tsp Dijon mustard
• juice of half a lemon

How to cook:

1. If you’ve ever cooked Nicoise, you can handle this salad. It practically repeats the main dish of Nice, only fatty salmon is taken instead of tuna, and asparagus is taken instead of green beans (however, you can also use beans).
2. Salmon is best cooked not in a hot pan or in a hot oven, but steamed or in a slow cooker: 20-30 minutes at a temperature of 80-85 degrees, not higher (otherwise the protein will curl up and the fish will turn out tough). But you can also fry in a pan (just don’t overdo it!) – the fish should be tender and retain some transparency inside.
3. Boil asparagus. It needs to stay crunchy, so don’t overcook it! Cooking time depends on its size, so we do not recommend moving away from the stove – asparagus cooks quickly.
4. On a plate, arrange the disassembled iceberg (the lettuce should be washed, dried and cut into medium-sized pieces), asparagus, salmon, disassembled into large pieces, cherry tomato halves, anchovies, capers, onion rings and hard-boiled eggs (ideally, the yolk should remain not liquid, but soft). Top with olive oil dressing with Dijon mustard and lemon juice. The dish can be left without salt – anchovies and capers are already quite salty.

The ketogenic diet is used by athletes involved in endurance sports such as ultramarathon, triathlon, cycling, etc. The body of athletes adhering to this diet more efficiently uses fat as an energy source and thereby helps to save glycogen stores during prolonged exercise.

Bacon and lettuce salad

Ingredients:

• 2 palm-sized lettuces
• 100 g bacon
• 8 sprigs of mint
• 1 egg yolk
• 6 Art. l. olive oil, plus more for frying
• 1 tsp grainy mustard
• 1 st. l. sherry vinegar

How to cook:

1. For this salad, you will need to make a slightly more complex sauce: put mint leaves and mustard in a tall glass, add egg yolk, pour in sherry vinegar.