Jade, congratulations for your keto approach! I’ve had lots of sugar cravings & binging and keto was my solution for “cooling down” and getting back on track. I am also very careful with animal fat and I tend to get the fats from other sources – at least until further notice. I have also made a list of super-foods as I like to call them, vegetables high in micronutrients and low in carbs and also others high in fiber. I actually managed to search these foods in the USDA database and rank them from top to bottom, depending on the micronutrient. This way I know how to get the richest foods that are less calorie dense. I could say I’ve had some revelations along the way.

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Such an in-depth post (and I applaud you for remaining so professional throughout some of these comments)! I’ve heard a lot about the keto diet and am glad that it does seem to work for some, but am definitely more on board with a more balanced diet. Kudos to the people it does work for though (I’ve had several patients with epilepsy who follow a ketogenic diet and it does seem to be helpful for them)!
One of the latest trends in weight-loss diets, the ketogenic or “keto” diet is so effective for some of its devotees that it may be here to stay. So, what exactly is this diet that you’ve heard so much — or so little — about? Simply put, a keto diet drastically reduces the amount of carbs you eat and increases the amount of healthy fats you consume. A percentage of protein is allowed. This is supposed to put your body in the metabolic state of “ketosis” where it burns fat instead of carbs. Sounds simple enough until you try to eat that way 24/7!

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When you consider what excessive consumption of carbohydrates (and I do consider the RDA of 250g excessive) do to the human body I find it kind of sad that nutritionists still by and large pedal carbs as a hugely necessary forerunner to being a functioning human. The sugar industry pedalled the “fat is bad” lie for decades and the introduction of low fat foods duped millions of people into becoming obese. A lot of people still don’t get, for instance, the difference between blood cholesterol and dietary cholesterol.

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This is of course just an overview of what you can eat, but these are things I’m most likely going to pick up from the grocery store. I also didn’t want to include crazy expensive specialty items like Erythritol for beginners. I think we all get excited about making our favorite junk foods in the style of our diets right away. This is fine…but it can be very expensive, time consuming and exhausting. Stick with the basics, especially when first starting out!
Even at what I now refer to my ignorant age of 20 years old — before Atkins became a household word— I remember a nutritionist telling me how the body works, and then telling me I needed to eat carbs and I recall thinking “wait a minute — if my body needs to use the carbs I consume before it begins to dip into my stored fat— why on earth is she TELLING me to eat so many carbs?”
So for all the dangers you listed on this, my dietician prescribes this diet to everyone who comes into his office looking for weightloss, he has a stack of packets with standardized information regarding the specific diet. For what it’s worth, most of the side effects you listed, I did go through, although the sugar withdrawal was the worst, but after a couple weeks, that passed too. Now I’m on the same 1200 calorie, <20g carb, 0 sugar diet, and it feels VERY sustainable. The only thing I really miss is pizza, and even then, there are keto friendly chicken based crusts that really hit the spot. I guess one thing that sticks out to me is my doctor told me that the human body doesn't need any sugar to survive, and while he makes the distinction between simple and complex carbs, still cuts them out in a normal keto diet style (no potatoes, corn, most beans in larger quantities, etc). Should I be concerned about my doctor? He came as a referral and has a large track record of long term success with his patients.

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What really killed it for me was the unrealistic restrictions of the entire day carbs count you should end up with – there is no f***ing way I can get by one full day with 20 grams of carbs and under. Just one of my meals ended up with at least 15 grams of carbs (half small onion-small red bell pepper-half cup chopped mushrooms-cup green beans), sometimes 20-25, times 4-5 meals (amature bodybuilder) and I end up with ~100 grams of carbs per day, at least.
The ketogenic or “keto” diet is a low-carbohydrate, fat-rich eating plan that has been used for centuries to treat specific medical conditions. In the 19th century, the ketogenic diet was commonly used to help control diabetes. In 1920 it was introduced as an effective treatment for epilepsy in children in whom medication was ineffective. The ketogenic diet has also been tested and used in closely monitored settings for cancer, diabetes, polycystic ovary syndrome, and Alzheimer’s disease.
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking. 

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The findings below have been limited to research specific to the ketogenic diet: the studies listed contain about 70-80% fat, 10-20% protein, and 5-10% carbohydrate. Diets otherwise termed “low carbohydrate” may not include these specific ratios, allowing higher amounts of protein or carbohydrate. Therefore only diets that specified the terms “ketogenic” or “keto,” or followed the macronutrient ratios listed above were included in this list below. In addition, though extensive research exists on the use of the ketogenic diet for other medical conditions, only studies that examined ketogenic diets specific to obesity or overweight were included in this list. (This paragraph was added to provide additional clarity on 5.7.18.)

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[…] “ANY diet, especially one that is as devastatingly restrictive as the keto diet, is likely to encourages disordered eating behaviors. I’ve written about my own experience with, and this is a pretty scary reminder of how UNHEALTHY that world can be. I’m a big believer that everything – especially carbs – can be enjoyed in moderation and the best diet is just whatever eating pattern you find most pleasurable that also meets your body’s unique needs.” [12]  […]
Great post, Abbey!! Thank you for taking the time to write this and share it with us! This diet may work in some cases as you pointed out but i find it very dangerous, eventhouh i’m not a dietician. I tried it and i felt horrible. I felt depressed, constipated, pain in my right side which i think was my gallbladder. Couldn’t sleep, terrible breath. AWFUL!!

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My Family went on Keto, it works for my son and his wife, but for me not so much. I was so sick for the 6 weeks I was on it, and when my heart started pounding several times a day – seriously thought I was having a heart attack, got weird rashes and my kidneys started hurting, I knew it was time to stop keto. I did loose 15lbs and have been able to still loose a few lbs on the low carb Mediterranean diet in the past 2 weeks, My son lost 25lbs and his wife lost 20lbs so far and they did not have the side effects I had.
Before I went into ketosis and before I cared anything about keto meals chicken was a staple in our home. While I do love all things chicken, I have found that going the boneless skinless route can sometimes get old, boring, and you lose some of the fat. Remember that you don’t have to choose lean meats anymore. Can you still eat it? Of course, but you need to try to dress it up with fat anytime you can. This low carb poultry list isn’t exhaustive, but I think it’s enough to get you started.
Why not just rest on the opinion that it is not a fad diet and has been around for a long time as a diet that works for some people. Some of our youth on reddit may be doing it because they have diabetes (like my Son) Many of these kids are getting this from the poor American diet and low activity because of computers and phones. So if they can take a break from that and try to take an active and creative interest in this diet (which is a good diet for some) then why not just be respectful of that. My Sons doctor put him on this diet, we are doing it as a family and loving it! His blood sugar is normal after 1 1/2 months and we have all lost weight. BTW most if not all the foods you tried I would def eat! ???? There is def some concern about doing this way of eating carefully and making sure we are in balance with our nutrients. We have cheat meals once a week, so not feeling deprived at all!
I had high blood pressure, was going into atrial flutter, obese, tired, moody and hurting and miserable, I kept having allergic reactions to the medication for my blood pressure which enhanced the atrial flutter, my doctor and cardiologist suggested that I go off all medication and approach this by getting rid of the problem, being obese. I started with a lower fat version of a Keto diet (I needed the fat on my body to be used before the fat in my diet). I eat small amounts of fruit and about 2 lbs a day of veggies and I manage to stay under 30 g of carbs a day, which works for me. I lost 40 lbs in 10 weeks. Here is the clincher, every 2 weeks by blood work was done by my doctors and everything is improving drastically, also I was getting the bod pod completed every 2 months to check my body weight / fat percentage, and I am not losing muscle, I am losing fat. I noticed that it was mentioned that it is too hard to sustain this way of eating, but there is really only one choice for me..putting that crap in my mouth is just putting poison in my system and I don’t want that ever again. I eat better now that I have ever ate as I am eating real food. I know dietitians were taught and trained to help people lose weight, but like any industry things evolve and change and things progress, and one must be open minded that there are different approaches that work for different people, and that as a professional dietician, I would expect them to see that there is more than one option to help people. Some people do just fine on 100 g carbs a day and I don’t, as I was addicted to carbs / sugar and now I am free of those drugs and I am healthy and happy. Everyone keep an open mind and try adaptations that work for your body and situation.

Also, plan for modifications to the meals for other people in your home. You wonít be able to make totally different meals for yourself and your family for the long term. The best approach is to use the main meat dish for your meal for the entire family and then a carbohydrate side dish for your family. For example, if you are eating meatloaf you can add half a potato for the other members of your family.

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A. When you first start a ketogenic diet, you may temporarily experience flu-like symptoms such as dizziness, brain fog, irritability, stomach trouble, insomnia, and more, as your body switches from burning glucose to burning fat. These symptoms can occur for a few days up to a few weeks and are a natural reaction that you’re encouraged to push through. You can alleviate symptoms by increasing hydration, electrolytes, and natural salt consumption. Get lots of rest and exercise gently. Lastly, consuming activated charcoal binds any toxins stored in the fat you’re shedding and can reduce nasty detox symptoms.

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I recently went to a walk in lab and found that I have high cholesterol and I am pre-diabetic. However, I am well on my way to healing my body with nutrition and supplements. I was able to reverse all my pre-diabetic symptoms in a few days (brain fog, blurry vision, thirst, frequent urination) and I have amazing energy and mental clarity now. I’m losing weight without hunger or counting calories. I eat low carb produce, poultry, fish, nuts and dairy. I believe that the key to avoid diabetes is to drastically reduce or eliminate grains, sugar and any type of processed food or cured meat from your diet. For cholesterol, I take plant sterols/stanols before meals and tumeric & black pepper, fish and flax oil. I believe that everyone who eats meat should take plant sterols (Try Minute Maid Heart Smart OJ!). It is the ultimate preventative, because it is not usually not possible to reduce your cholesterol enough with diet and exercise alone.

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I do want to point out an inaccuracy in your description of ketoacidosis. If a Type 1 diabetic “and/or does not eat enough carbohydrates,” they will not enter a state of ketoacidosis. It is the opposite. Ketoacidosis can occur if a diabetic consumes carbs without having enough insulin to allow the body to use glucose for energy. In contrast, not eating enough carbohydrates for insulin that was already injected causes hypoglycemia.
I went back to school for Medical Laboratory Science which involved a lot of chemistry and physiology. I pieced together what I had learned through dieting over the years and how the body works — and I have to say that I am really waiting for the medical community — doctors and nutritionists to finally get on board with lower carb diets. If dropping 80-100 pounds isn’t successful then I don’t know what is. I don’t really care how “unhealthy” you call it because of how rapid the weight loss is. How unhealthy is being obese in the first place?

This way of eating is a lifestyle and it has never failed, because we are all the same. The only variations are peoples environments/ temperature and food availability. Of course if someone lives in Siberia they will not eat the same as someone who lives in Phillipines; and not everyone has access to the healthiest environment and the healthiest cleanest food.
I appreciate your approach to the keto diet it is the most unbiased I’ve seen. I decided to take a more mindful approach to the keto diet. I took the allotted carbohydrates and decided to count the net carbohydrates. I researched the most healthy vegetables highest in nutrition value and antioxidants and use those for my net carbohydrate allowance. Then using my lean muscle mass calculated the necessary amount of protein using the healthiest options like lean chicken breast fish with no bacon and no fatty Meats. I decided to get my fat grams from avocado olive oil and coconut oil. Monitored my micronutrients and supplemented them as necessary to reach the daily requirement. Using a vegetables I attempt to get the highest fiber possible and supplement the rest. I’ve changed my concept of what is cheating on a diet to indulging in fresh pineapple and watermelon raspberries blueberries and blackberries. Grains have always caused problems with feeling bad gastric bloating and water gain for me. So it was not difficult to decide to leave those off research the nutrition and a tip to substitute. as far as gaining all the weight back if you return to the diet that got you overweight you can only expect to get it back. A calorie Surplus will put on weight. As I near my goal I will increase the carbohydrates using the healthy foods I have grown accustomed to to achieve the highest level of carbohydrates that does not have me regain the fat. Because remember my protein intake was based on my muscle mass. As I follow the diet I am mindful of the behavior changes choices that caused me to gain weight and there is no getting off the diet there is only bringing balance to the macronutrients. If dietitians everywhere find my Approach unhealthy that is their opinion they have a right to. I’m using this strict limited diet initially for the weight loss success as a positive reinforcer while modifying my behavior using the healthiest food choices. Which does not include heavy cream butter and fatty Meats.

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This whole post must have taken so much effort and I think it’s incredible that you do this. The issue with these diets is that people hear about it, think it sounds good and do it. No questions! We are so lucky to have dietitians like you actually laying out all the research, the good, the bad, and everything in between about these diets, so THANK YOU!
Next up is The Ketogenic Cookbook by Jimmy Moore and Maria Emmerich. This is another great resource for anyone on a keto diet. It has over 200 recipes, beautiful photography, and features good, simple food. The large number of recipes will ensure that you will never be stumped when deciding what to make. The Ketogenic Cookbook is a near encyclopedia from some of the best writers in the world of ketogenic diets. They understand the need to offer legible, understandable meal options for those who may not be too familiar with the diet. This is why it is such a great resource for beginners to the keto diet.

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People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.

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What really killed it for me was the unrealistic restrictions of the entire day carbs count you should end up with – there is no f***ing way I can get by one full day with 20 grams of carbs and under. Just one of my meals ended up with at least 15 grams of carbs (half small onion-small red bell pepper-half cup chopped mushrooms-cup green beans), sometimes 20-25, times 4-5 meals (amature bodybuilder) and I end up with ~100 grams of carbs per day, at least.

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I disagree with you. A calorie deficit leading to weight loss for YOU should be not accepted as a reasonable method for ALL. Also, a 5% weight loss is enough to show improvements in blood pressure, blood sugar and lipids. It doesn’t mean the ketosis caused it, but rather the reduction in weight which could just be from the calorie deficit. Additionally, if you enjoy carbs occasionally then you are not in ketosis and could be following a modified low carb diet. Using evidenced-based research findings is not spouting off guidelines- it is science. And when you’re dealing with hundreds, thousands and millions of different individuals each presenting with their own unique set of risks, genetics, behaviors and history -that must be taken into consideration for any weight management plan. It is more complicated than how you presented it above. Also, I don’t believe Abbey is calling it a “fad diet” but she is explaining that the specific ketogenic diet plan that is being described in mainstream media is a current trend, which is undeniable. It is such a trend that there is no long term research study yet because that is how new to the scene it is.

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