A systematic review of 26 short-term intervention trials (varying from 4-12 weeks) evaluated the appetites of overweight and obese individuals on either a very low calorie (~800 calories daily) or ketogenic diet (no calorie restriction but ≤50 gm carbohydrate daily) using a standardized and validated appetite scale. None of the studies compared the two diets with each other; rather, the participants’ appetites were compared at baseline before starting the diet and at the end. Despite losing a significant amount of weight on both diets, participants reported less hunger and a reduced desire to eat compared with baseline measures. The authors noted the lack of increased hunger despite extreme restrictions of both diets, which they theorized were due to changes in appetite hormones such as ghrelin and leptin, ketone bodies, and increased fat and protein intakes. The authors suggested further studies exploring a threshold of ketone levels needed to suppress appetite; in other words, can a higher amount of carbohydrate be eaten with a milder level of ketosis that might still produce a satiating effect? This could allow inclusion of healthful higher carbohydrate foods like whole grains, legumes, and fruit. [9]

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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.

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“Net carbs” and “impact carbs” are familiar phrases in ketogenic diets as well as diabetic diets. They are unregulated interchangeable terms invented by food manufacturers as a marketing strategy, appearing on some food labels to claim that the product contains less “usable” carbohydrate than is listed. [6] Net carbs or impact carbs are the amount of carbohydrate that are directly absorbed by the body and contribute calories. They are calculated by subtracting the amount of indigestible carbohydrates from the total carbohydrate amount. Indigestible (unabsorbed) carbohydrates include insoluble fibers from whole grains, fruits, and vegetables; and sugar alcohols, such as mannitol, sorbitol, and xylitol commonly used in sugar-free diabetic food products. However, these calculations are not an exact or reliable science because the effect of sugar alcohols on absorption and blood sugar can vary. Some sugar alcohols may still contribute calories and raise blood sugar. The total calorie level also does not change despite the amount of net carbs, which is an important factor with weight loss. There is debate even within the ketogenic diet community about the value of using net carbs.

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My husband has been on keto for 4 months since being diagnosed with Type II diabetes, and it seems to be working very well for his blood sugar issue, his levels have all improved drastically and he has lost so much weight I’m starting to worry about his liver. In the spirit of not making his life hell, I joined him on a modified version. My version still includes fruit and milk, I just gave up added sugars, liquor, and grain flour. Mostly. I definitely haven’t lost weight the same way he has, but I am slowly and steadily losing weight, and eating potatoes or apples doesn’t seem to change that. The biggest thing is that, for the ONLY time in all the many, many times I have tried to change my eating habits, I’m not STARVING. I don’t feel horribly deprived and ready to kill a man for a cookie.
It is now a mainstream dietary regime used wih the intent to reduce weight as it is safe for most people, but one should be especially aware of going ketogenic if one takes diabetes medicine, medication for high blood pressure or is breastfeeding. Typical foods include cheese, eggs, fish and seafood, natural fats, meet, vegetables that grow above ground. The key to maintaining the diet is low carb intake - usually with the goal of eating less than 50 grams or even less than 20 grams of carbohydrates per day. The fewer the carbs, the better, usually. Things to avoid include: fruit, potatoes, pasta, beer, bread, soda, chocolate, candy, donuts, etc.
I won’t comment on the diet itself but dietitians do not simply rely on guidelines handed to them, nor on anecdotal cases. This article refers to specific studies all throughout, some that support the diet and others that don’t. The goal of a dietitian is to help clients reach their optimal health while still enjoying a high quality of life. I’m sure Abbey is genuinely happy for those it has helped. That does not mean this diet is best for everyone regardless of their unique circumstances, goals and medical history. Sadly there is not enough high quality research that Keto promotes sustained weight loss in the general population. Maybe there will be in the near future, but right now it would be unethical to recommend such a restrictive diet to the broad audience of a blog. I am truly happy it has worked for some people and I wish them luck on their journey. Thank you Abbey for a great article!
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?”
I think every body responds to diets differently. What works for one person doesn’t work for another. There is not true, standard diet that’s one-size-fits-all. My sister eats a diet of mostly carbs and very little protein – and she functions just fine on this. Personally, even a moderate amount of carbs gives me brain fog, fatigue, irritability, and bloat.

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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I am with you! I have been a WW member and been years without going outside of my suggested guidelines. I would lose weight, plateau, go on one of their plateau breaking diets for two weeks then have to go off and slowly gained weight again. I was teaching my body to live on less. I have been down as low as 800 kcal a day and not losing. Eat more fiber so you feel full was what I was told. Try eating 800 kcal, high fiber and see how balanced your diet is. I am eating between 1800 – 2000 kcal now and dropping 10 – 15 lbs a month on Keto. Long term diuretic user, I no longer have water retention. I am salting and using fat and I am off my blood pressure medicine. I am not hungry so I am wondering why is this not sustainable? I eat mostly carbs from vegetables, I eat a variety of meats, I eat a variety of vegetables, I feel great and my blood tests are better than they have been in 2 decades. I am starting to feel that the carb revolution is because we are told by the government what is good to eat. We all know that vegetables are good to eat but the government subsidizes corn, wheat and soy, not spinach, kale and cucumbers. Do your research, follow your hearts, do what works for you.
I think you should take some of your own advice…you are being judgmental and thinking your diet will work for everyone. Look at the scientific facts; your body’s life blood is carbohydrates, the bread of life. Simple carbohydrates are what is killer to American society. Any diet that cuts out junk food like greasy potato chips and ice cream and cake will make you lose weight, not rocket science. Where do you think your body is getting fuel from? Muscle mass! It has to use that because you are depriving it of fuel! Why go on extreme diets when all you need to do is practice portion control and get up off the couch and walk around?

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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 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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So where did the ketogenic diet come from? Interestingly enough, this fad diet didn’t spark from a celebrity endorsement or some guy missing a medical license. There’s evidence of the keto diet being used back in the early 1920s to treat severe childhood epilepsy and it’s still being used today for that purpose. Research suggests that the production of ketones may influence neurotransmitter activity in neurons allowing for a reduction in seizure attacks. A recent Cochrane Review demonstrated a 30-40% reduction in seizures compared with non-keto diet controls. One thing to keep in mind, however (which is a theme when discussing the keto diet) is that it’s generally difficult to adhere to and difficult to tolerate for a lot of people. In other words, people go on it and then come off it pretty damn quick.
With more than 125 recipes on offer in The Keto Diet: The Complete Guide to a High-Fat Diet by Leanne Vogel, you’ll be certain to have something interesting and delicious to eat every day of the week. This book does not only offer delicious meal options, there are also a number of meal options for those looking to transition into a keto diet or for those already on the plan. The high-fat options in this book are also paleo diet friendly. They avoid products which are highly refined or high in sugar.
Studies found that endurance performance, whether it was anaerobic or aerobic was impaired or maintained with a ketogenic diet. This is still a complicated area to study, since majority of studies used in this review had small sample sizes, no control group or were very short in duration (no more than six weeks). Because of this, it is still unclear whether endurance performance is enhanced or impaired with a ketogenic diet.

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Hi Danielle, it’s all about learning to read labels and the nutrition label before purchasing something! I also double heck the ingredients before I buy packaged products. I also have an ongoing list of approved veggies that I keep in my phone so that I know what I can buy and the variety I can buy so I don’t get in a food funk! Definitely let me know how I can help further! Like posting a label guide? Complete veggie list? Let me know!

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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?
Such a thorough article. Thank you! I have a friend who swears by the KETO diet. However, I’m of the same thinking as you are, that cutting out or eating next to nil of any food group, is not what God meant. Discipline in portion size, and perhaps not combining certain food groups (proteins with heavy carbs is a not best for our digestive system), but both can be eaten when not combined, hence no cutting out of any food group. Thanks again!

The volumes of knowledge on display here make this book a mainstay in the field of ketogenic dieting.  This also makes it a really great option for anyone who’s interested in this high-fat diet. While this book is a superb document for anyone looking to enjoy the keto diet, don’t be scared as there is nothing too crazy in here! One of the best keto cookbooks for anyone just starting out and looking to learn the ropes.

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A ketogenic diet may be an option for some people who have had difficulty losing weight with other methods.  The exact ratio of fat, carbohydrate, and protein that is needed to achieve health benefits will vary among individuals due to their genetic makeup and body composition. Therefore, if one chooses to start a ketogenic diet, it is recommended to consult with one’s physician and a dietitian to closely monitor any biochemical changes after starting the regimen, and to create a meal plan that is tailored to one’s existing health conditions and to prevent nutritional deficiencies or other health complications. A dietitian may also provide guidance on reintroducing carbohydrates once weight loss is achieved.

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?
Have been on low carb high fat diet for 5 months. Just had blood work done. Was prediabetic now normal. So lucky to have Dr. who supports lchf and Keto way of eating. Maybe Keto is not right for everyone but it certainly is for huge numbers of people. Personally, I have never felt better and I will keep promoting it to everyone wanting to listen. Pain in knees so much better. I haven’t taken a painkiller in 5 months.
There is not one “standard” ketogenic diet with a specific ratio of macronutrients (carbohydrates, protein, fat). The ketogenic diet typically reduces total carbohydrate intake to less than 50 grams a day—less than the amount found in a medium plain bagel—and can be as low as 20 grams a day. Generally, popular ketogenic resources suggest an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. For a 2000-calorie diet, this translates to about 165 grams fat, 40 grams carbohydrate, and 75 grams protein. The protein amount on the ketogenic diet is kept moderate in comparison with other low-carb high-protein diets, because eating too much protein can prevent ketosis. The amino acids in protein can be converted to glucose, so a ketogenic diet specifies enough protein to preserve lean body mass including muscle, but that will still cause ketosis.
In 2014 — for the first time — I discovered a low carb diet called Ideal Protein. It’s different from Keto in that you also keep a low fat intake as well. I can’t speak for Keto as I’ve not done it personally, but I lost 80 pounds on Ideal Protein in 5 months. It fit into my life as a busy mom and returning college student because I didn’t have to spend hours at the gym. I just ate low carb and moderate protein.

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2 days from grains my stomach bloat was gone and I knew at that point everything this article and American diet was a lie. I’ve been on keto for over 16 months. Down 50lbs. In 6 months. I am ripped. Haven’t lost any muscle mass. I eat greens protein and healthy fat. I whole juice to get macros and yes I add watermelon or berries fo palatability purposes. I still eat carbs just healthy choices. I’ve become carb tolerant.. your liver will produce all glucose without ever eating 1 carb. This is biased and poor representation of keto lifestyle. When your starving and no carbs to choke keto will still thrive on either or fuel.
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.

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Who are the healthiest people on the planet? Not those on Atkins diets, Keto diets, Paleo diets, Weight watcher diets or soup diets. As mentioned above, plants rule, and this is evident with communities who eat ‘carb dense’ foods, 90 -95% plants. They are often disease free, disability free and drug free. This is basedvon living an entire life this way – never dieting like we do.

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Anyways, I am feeling so much better without the weight, my sleep apnea is gone, my blood glucose is lower and the edema in my legs is gone. But I do have concerns about the saturated fat, my HDL/LDL and I do not like the “nail polish breath”. Once I reach my goal, I plan to transition to more of a Mediterranean style diet but still with logging and I hope to be able to keep the weight off.

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Hi Leigh, I like to inform myself before I make my arguments, so I try to do as much research as possible. Same goes for when I was looking into the keto diet. I’m so glad you’ve seen improvements with the keto diet. I still believe that for the majority of people, the keto diet has its side effects and may not be successful. If it helps some people, then I’m glad!
But this sort of “low-carbohydrate, high-fat” (LCHF) diet, as Noakes calls it, is still far from mainstream. It takes serious dedication to drop your daily total carb intake to below 50 grams (or 20–30g of net carbs, which are sans fiber), the equivalent of a single cup of brown rice. The USDA Dietary Guidelines were just changed in January to mention the need to limit intake of added sugars and refined carbs like bread, rice, pasta, cookies, and crackers, which spike blood sugar more rapidly than candy. Check the label of nearly any sports drink, and it’s most likely loaded with natural or added sugar. Go to the grocery store today and the labels are awash with the message of “low fat,” “no fat,” or “zero fat.”
Get Plenty of Sodium. This might sound counter to what you’ve been told before, but your body really needs sodium. It’s one of the ways that your cells transport nutrients in and out of cells. And when you stop eating processed grains and sugar, you often get much less sodium. So when you go keto, just be sure that you’re eating salt or sodium-rich foods. If not, you will often experience fatigue.

Look, keto is simple. Please stop complicating it. You can honestly eat any food and stay in ketosis as long as you eat less than 25-50 grams of carbs a day. If you are an athlete you can eat up to 100 carbs per day. No food, I repeat NO FOOD is a keto food. Like hummus? Eat it! Like pineapple? Eat it! Unless you have a metabolic disease that causes your body to be super sensitive to sugar you can eat pretty much any whole food and remain in ketosis.  

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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.

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