Thank you SO much for your blog post. My niece went into Ketoacidosis recently and I compared it to what a former RN in my neighborhood has been doing & recommending to everyone (& they believe her because she used to be a nurse, but definitely NOT a Dietitian). Anyway, after reading, I learned they are completely different, however if a healthy person does test for ketones in their blood, what are acceptable levels? (This same nurse tests for ketone levels). I appreciate how much work you put into this write-up and honest feedback! (I work with 2 RDs who agree with you!)

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I think I would be better is you would talk about how people could make the keto diet better instead of dismissing it, more emphasis should be put on eat vegetables, fermented veggies and healthy sources of fat. Those studies that showed the negatives of the keto all used man made polyunsaturated seed oil, the worst possible type pf oil that people can eat.
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On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.

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I have never tried a keto diet (don’t like the idea myself) but I am what you could call moderately (or “liberal”) low carb. Around 125g max net per day, which as you likely know is half the RDA of 250g. I get most of the rest of my energy from protein and some for fat. The RDA of protein, around 50g, is only just enough to sustain muscle of a sedentary or low movement individual – and this is proven by the fact that a lot of people who hit the gym eat easily 2-3x the RDA of protein.

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. 

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The BMR is simply a number of calories we burn while our bodies are at rest and from eating and digesting food. Together they form what’s known as TDEE, or total daily energy expenditure. This is the keto calculator’s estimate for your total calories burned per day. If you use a heart rate monitor or third party software to monitor your calories, you can use the custom input in the activity level section for an even more accurate macro profile.
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.
Thank you for creating this list! I have an article from Bodybuilding.com to advise how to prepare and be successful before giving up on this plan but the food list was quite short. My trainer suggested this eating plan for me so I found your list so I can go purchase the foods now. I believe I have my macro counts right to start so wish me luck! And thanks again for sharing this !! Rebecca
Depending on the info that you enter into our keto calculator, you will get different ratios of fat, protein, and carbs. In general, carbs should remain low because they will prevent you from entering into ketosis and getting all of the benefits of the keto diet. By limiting carb consumption to this degree, many people will lose a considerable amount of water weight as well.

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Done Keto diet for over a year now. I started it due to increased liver enzymes showing a start on a path towards low-level diabetes due to being about 30 lbs overweight (229 lbs, 5’10” endomorphic, muscular build). After a year, my Cholesterol is excellent, I dropped to 192 lbs (37 lbs lost), maintained muscle mass through maintenance workouts and cardio, resting heart rate is 50bpm, EKG shows perfect results, blood pressure is excellent, and full panel of bloodwork shows zero abnormal liver enzymes.

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Sustainable is Key. Thank you for the article, it explained so much! I have been inclined to follow this diet but what has worked for me before is a diet that’s called “The AntiDiet” and is simply starting your day with fruits, while strictly separating complex carbs and proteins during lunch and dinner, and still being opened to consume all kinds of food. I had been trying the Whole30 for so long and so many times and I simply can’t, does not make sense for me and so does Keto in the sense of overloading on fats and meat. Thank you!

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Hi. I have been on the keto diet for 6 weeks and have not lost any weight but even more concerning, my gerd is much worse. I’m taking ppi’s just to stay on the diet. Constipation which has always been an issue for me is now much worse, hello laxatives! For these reasons, I have decided to go back to a more balanced diet leaning towards vegetarian. Keto works for some, I’m not one of them. I appreciate your info.

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Here’s why. All of these effects take time, but a reasonable explanation as to why the keto diet leads to rapid weight loss is due to the loss of water weight. One of the concerns with the keto diet is the loss of muscle mass and the depletion of glycogen stores. Glycogen, which stores our glucose, also stores water, so when stores are depleted, we flush out excess water. In other words, that rapid weight loss isn’t fat, it’s just water.
Thermal Effect of Activity, also known as Activity Level, determines additional energy expenditure due to moving around and exercising. According to Lyle McDonald, broadly speaking, there are 5 categories / activity levels. We readjusted the multipliers from Lyle McDonald's book to better reflect different activity levels that work for most people.

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I can buy clothes off the rack. Better than being obese. My brain is sharper. I get more stuff done. I don’t sit around. I feel like I can feel the fat melting off. I have trouble sometimes eating enough. After 40 years if being very obese on and off, I think I am better off. I hope to use it when I need it after I reach my goal. The blood tests will prove it.
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.
All I know is that by cutting out foods like bread, that have arguably no nutritional value whatsoever, I’ve lost fat weight and have been able to retain (and grow) muscle through workouts. Not only that, but I am markedly stronger, and I don’t suffer any effects of malnutrition. I don’t want to be one of these people that despite eating a “balanced diet” simply gets fatter as they get older, because of how carbs screw up your insulin resistance levels and cause your body to store fat (particularly visceral fat in men) where it isn’t needed.

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From a personal standpoint. I’ve been on the Ketogenic diet now for 5 months. My A1C went from 8.6 to 6.3. I no longer require medication. I get a full panel done on my blood every 6 months and my blood pressure is dropping. The doctor says if it continues, I won’t need the medication anymore either. I do not find it hard to stay on the diet as there are many delivery services that you can use when you simply don’t. I’ve lost 41 lbs. I work out 5 days a week, lifting weights, about 1 hour a day. The mistake most people make is thinking of this as a diet. This mentality will cause a person to fail. It is a life style change that needs to be permanent. The medical community and bad advice from gurus and nutritionists that really do not understand this diet or are informed of the latest research and studies continue to provide inaccurate information. 

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