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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Not long after he got the news, he happened to receive an e-mail about a book title The New Atkins for a New You, and realized he recognized many of the authors’ names on the cover, which belonged to respected exercise experts Stephen Phinney, M.D., Ph.D; Jeff Volek, Ph.D., R.D.; and Eric Westman, M.D. They argued that the late Dr. Robert Atkins, who famously promoted a low-carb, high-fat diet in the 1980s—and was routinely lampooned for promoting eggs, bacon, and cheese as healthy foods that worked great for weight loss—had been right all along. The professors backed up their position with more than 50 new dietary studies and an action plan for getting lean and maintaining weight loss. Noakes says he learned more about nutrition that year than in his previous 42 years as a doctor.

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While I do appreciate the amount of research that went into this article, I need to weigh in here— no pun intended. I am a 44 year old woman who suddenly and inexplicably gained a lot of weight at about age 20 and pretty much (albeit a few bouts of massive dieting and exercising) have remained fat until the age of 42. I had always been thin without having to give my lifestyle much thought before my sudden weight gain — so I have spent the last 20+ years becoming pretty proficient on learning how the body uses fuel. I have had success losing great amounts of weight a few times in my life — twice reducing my calories the “nutritional counseling” way — using the old school and outdated food pyramid and tons of exercise. It took literally having to spend hours and hours at the gym — being miserably hungry all the time — only to achieve slow progress at the scale. Months and months I would spent this way only to gain the weight right back the minute that I let go of the reins. I’m always hearing about “sustainable lifestyle changes” from you nutritionists— an I believe in daily exercise — but that lifestyle was completely unsustainable in the long term which is why so many people are unsuccessful.
A study of 89 obese adults who were placed on a two-phase diet regimen (6 months of a very-low-carbohydrate ketogenic diet and 6 months of a reintroduction phase on a normal calorie Mediterranean diet) showed a significant mean 10% weight loss with no weight regain at one year. The ketogenic diet provided about 980 calories with 12% carbohydrate, 36% protein, and 52% fat, while the Mediterranean diet provided about 1800 calories with 58% carbohydrate, 15% protein, and 27% fat. Eighty-eight percent of the participants were compliant with the entire regimen. [12] It is noted that the ketogenic diet used in this study was lower in fat and slightly higher in carbohydrate and protein than the average ketogenic diet that provides 70% or greater calories from fat and less than 20% protein.
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.
To start with you don’t really need to worry about macros. Just eat when you’re hungry and stop when you’re full. An air fryer is awesome for keto! If you don’t like the juices toss them, you can always add butter or oil for more fat. If you find that you’re getting hungry or craving carbs add some type of healthy fat to your meals, otherwise keep doing what you’re doing. Thanks for stopping by!
Two years ago, LeBron James famously lost 25 pounds and upped his late-game endurance by cutting carbs and sugars from his diet. Tim Ferriss, the author of the Four-Hour self-improvement book series, followed a strict keto diet to cure his Lyme disease, and performs a long multi-day fast every four months as a means, he says, of pushing ketosis further and starving incipient pre-cancerous cells of sugar (more on that later). Last summer, Sami Inkinen, the ultrafit co-founder of real estate juggernaut Trulia, rowed with his wife from California to Hawaii in record time on a keto diet, to promote high-fat eating and raise awareness about the dangers of too much sugar. The Keto Diet, say its ardent supporters, is a natural way to literally reprogram your metabolism and transition to an upgraded operating system. You’ll ultimately feel better and perform better, and your body fat will plummet.

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Truly Dr. Colbert is also a reputable source for more thorough science and modification of previous Keto extremes. The statements about Keto diets with dairy everyday are not true…I am a 66 year old professional (University trained) and have found medical people often very unknowledgable or partially knowledgeable which may be worse. I ask you Abbey to dig deeper…meet Dr. Colbert-not a quack and more in depth than your overview. Personally I am finding switch to more green’s and low glycemic vegetables and fruits with healthy fats, occasional dairy and healthy protein; a way of life that is helping our whole family. Please watch The Magic Pill…the help for family’s caught in old thinking from poor science (ie. Alex Keys) and with autism etc. and so much modern disease is in itself, motivation to search out more truth.

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Eliminating several food groups and the potential for unpleasant symptoms may make compliance difficult. An emphasis on foods high in saturated fat also counters recommendations from the Dietary Guidelines for Americans and the American Heart Association and may have adverse effects on blood LDL cholesterol. However, it is possible to modify the diet to emphasize foods low in saturated fat such as olive oil, avocado, nuts, seeds, and fatty fish.
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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Disagree. I’ve been eating like this for ten months. I still enjoy carbs on the rare occasion but stick to a ketogenic diet most of the time. Ive lost 94lbs. I understand people lose weight in other ways but for me this worked. I eat 10x as many green vegetables as I ever have (at least 2 meals a day). My blood pressure dropped drastically in the first month. My cholesterol, triglycerides and blood sugar all normalized within the first 90 days. I don’t see any reason not to continue. I find this way of eating empowering and not restrictive. Before you call something a fad, because you obviously don’t fully understand this, you ought to read something from people other than the people you agree with. This is the problem I have with dieticians and most doctors. You don’t think for yourselves. You follow whatever the accepted guidelines are and spout them off without ever asking if they are right. It’s easier to stand with the crowd. I get that. But do not use your expertise as a means to criticize real progress. I would think as an expert your would be a proponent of what works! Have you ever been morbidly obese? Do you know what it is like to think your going to die from a heart attack at a young age? Do you know what it’s like to know your going to get type 2 if you can’t overcome your weight? Eating this way got me out of all of that and gave me my life back. Come down from the Ivory tower… Just maybe a little less judgement, a little more open minded 

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It’s always good to go into the grocery store with a game plan so you don’t buy things you’ll regret later. I also like to keep things as simple as possible. Going through Pinterest, every recipe seems to have a bazillion ingredients, take hours & a culinary degree to make, or require random ingredients that are annoying to find and super expensive.
Con: Results can vary depending on how much fluid you drink. By drinking more water, you dilute the concentration of ketones in the urine and thus a lower level of ketones will be detected on the strips. The strips don’t show a precise ketone level. Finally, and most importantly, as you become increasingly keto-adapted and your body reabsorbs ketones from the urine, urine strips may become unreliable, even if you’re in ketosis.
I tried the ketogenic diet and it really helped me even out my energy levels and I don’t grave sugar anymore. I had issues absorbing my B vitamins. I had high candida and l-acidophylis levels. I was also addicted to sugar. I started this 3 years ago, and since about a year ago, I’ve added fruit. Now I enjoy a little rice and potatoes as well. I even had a bite of chocolate cake and didn’t die. I started out at 112, lost 10 pounds within a month and have slowly gained most of it back. I am happy I did it, but I will be more confident to add more carbs, although it will mostly be in the form of more fruit and starchy veggies. Thanks for your article.

No one is trying to diminish your success, but it does not work for everyone, and studies show it can have long term negative effects on your overall health. If you look at the Meta-analysis it shows a calorie restricted diet and Keto for 12 weeks had the same weight loss. There are also many studies that suggest looking back at people after one year those on a calorie restricted diet kept more of their weight off. The only one it does better than is just a low fat diet, which Dieticians stopped suggesting long ago. And as Health Care professionals we read the “REAL SCIENCE” not the internet articles, You Tube, Blog, book writers. One of the books written about it by Dr. Jason Fung. Have you looked him up on PUBMED? He has not written one article published in a real medical journal to be such an expert. It is not magic, it is not a cure. If you like the diet and it does not mess up your cholesterol then so be it but promoting it to others not knowing their medical history can be dangerous. What people don’t realize is that for year’s we have known that if you lose 7-10% of your own body weight your blood sugars will improve, cholesterol, and blood pressure. But you don’t have to do the fasting and put more burden on your Liver or potentially increase your risk for cardiac problems eating such high fat. If you do high fat at least do plant fats and not animal fats. But of course everyone is happy with your success but just keep a tab on your lab work.

The low-carbohydrate diet options available in this book are also sugar-free, gluten-free, legume-free and in some cases dairy-free. While these may seem like restrictions on your diet, this book has so many delicious recipes to offer that you’ll not even miss carbohydrates or sugars, so often a major part of contemporary diets. This book also contains an in-depth list of foods which are suitable for eating when following keto. This ketogenic diet food list will help you stick to the diet while enjoying delicious food.

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Excessive ketone bodies can produce a dangerously toxic level of acid in the blood, called ketoacidosis. During ketoacidosis, the kidneys begin to excrete ketone bodies along with body water in the urine, causing some fluid-related weight loss. Ketoacidosis most often occurs in individuals with type 1 diabetes because they do not produce insulin, a hormone that prevents the overproduction of ketones. However in a few rare cases, ketoacidosis has been reported to occur in nondiabetic individuals following a prolonged very low carbohydrate diet. [4,5]
This debate is pretty typical of most debates you see. The people who are fanatics for the diet will not accept any negative evidence or opinions about it. On the other hand, many critics of the diet clearly don’t have very much knowledge about it. I’m not referring to the author, who wrote a very well-informed and researched article, but some of the comments about Keto being a starvation diet and about glucose being the only energy source for the body.
The aim is to find the level best suited for you. There are two ways to count carbs - you can either count total carbs or net carbs (net carbs are total carbs minus fibre). According to Volek and Phinney, you should not eat more than 50 grams of total carbs (25-30 grams of net carbs) on a ketogenic diet. If your aim is to lose weight or maintain a healthy weight, eating 20-30 grams of net carbs (up to 50 grams of total carbs) is a great way to start. If you want to learn more about total vs net carbs, read this post.

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.”
Fortunately, I read your post before I watched your video. I am considering trying the Keto diet and am looking for honest, scientific, and wise counsel about it. Your research seems to be pretty thorough, though missing some facts, but still decent information. I feel like I can make an informed decision based on what I read, plus have a good direction for more research. However, after watching your juvenile and exaggerated video, based on the weirdest things (possibly ONE person actually eats) that “Keto Dieters eat,” I’m not sure what I think of your post. The video completely undermines your believability as a “dietician.” If someone told you they ate dog poop for breakfast, would you have tried that? Come on. Professionalism goes a long way. As a dietician, I would think you would be shooting for credibility. Aside from “seriously pissing off” your viewers, you killed your own voice of credibility.

I am Keto proponent. I have been through muscle cramps when missing greens while riding my bike for 100 km in 5.5 hours (and I am going on 64!) Getting kale and spinach and parsley is a must, getting the fruit whole is a must. Consumption of “good” fats like coco, olive, avocado oils definitely does not hurt. Consumption of meat – and of organs, yes, organs – is very important. And finally, monitoring the body reaction and measuring ketones and glucose helps; I am doing observations regularly. What about G=4.2 and K=.3 in the morning? It is not ketogenic state per se, but in the morning my muscles do not need much fuel, and my frontal cortex and red blood cells need only minimum glucose. What about G=5.4 and K=3.6 in the third hour of bike ride, with acetone in the breath high and ketone disposal in urine very low? What about post-exercise levels of G=4.4 and K=1.2, with almost no acetone in breath and urine levels going sky-high because the body needs not ketones any more?


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.

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Thank you for the information on the pros and cons of the keto diet. I have heard so much about it, a lot of people in my age group (55-65) are on it and have had success. I have NOT had the success that everyone else has had, I lose 7 gain back 2. Lose 3, gain back 4. I work out almost every day during my lunch break, which gives me only about 20 minutes of fast hard sweat. I have to wonder if this diet is NOT working for me because of this. I follow the dietary guidelines very strictly and I have experienced the effects of it, such as constipation, stinky pee and stinky breath. People tell me that by week 5 you should start to see a dramatic drop in weight. Not so for me, but then, I had the same issue when I was on weight watchers. The weight loss is so slow that I tend to just give up. I will stay with it for another month, but if I continue to see no real drop in weight, I am just going to assume that it is the wrong diet plan for me.
I’m new to all Keto…trying desperately to loose weight…besides giving up sweets (which completely understand) need to know if hummus is okay…and what I gather from the extensive info I’m guessing like everything in life, the key is balance… too much fat? Hi calories? Do we have to worry about cholesterol in nutritional labels? Again thanks for the great information
I’m a Registered Dietitian, and I greatly appreciate your overview. I will admit, I felt the exact same as yourself, but I decided to research it further, and then go on it to test it, and I have to admit, it has changed my view of it completely. I believe as dietitians, instead of telling our clients it’s a fad, educate them on how to do it successfully as a lifestyle and not as a fad. I believe that is the key. I highly recommend “What the Fat” book written by both a Registered Dietitian and professor. Great job going into the science and research. https://whatthefatbook.com/product/what-the-fat/
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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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A: The most common ways to track your carbs is through MyFitnessPal and their mobile app. You cannot track net carbs on the app, although you can track your total carb intake and your total fiber intake. To get your net carbs, just subtract your total fiber intake from your total carb intake. I have written an article on How to Track Carbs on MyFitnessPal.

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I have been doing the Keto diet for a little over 2 weeks now. I have lost about 9lbs…7.5 in the first week. However, I now find myself weak and unable to exercise. My heart pounds with any type of fast movement. I have dark circles and bags under my eyes and my face, neck and chest have been itching for over a week now. I have a rash on my neck that itches and burns. Enough is enough.. no weight loss is worth this torment. I am going to a more balanced diet starting today. Thanks for the article.

Meanwhile, Noakes continues preaching that the right kinds of fats—the ones our bodies evolved to process, like animal fat and butter, olive and coconut oil (but not vegetable oils like corn oil and soybean oil)—are extremely healthy. Noakes titled his 2012 autobiography Challenging Beliefs, and, at age 67, he’s publicly waging a war against carbs and sugar from his Twitter account, @ProfTimNoakes, where he chimes in every few hours and has churned out more than 27,000 tweets since 2012.


Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.
Abbey, I appreciate all the work you put into this but there are a few things you missed. Not all oils are keto friendly. Vegetable oils are a huge no-no which was not mentioned. Regular mayo usually contains soybean oil which should be avoided. You also missed that foods with preservatives are a no-no which excludes some cheeses (you said enjoy all the cheese you like). Processed sliced cheese or pre-shredded cheese in a bag at the grocery store contains preservatives. Ever notice how shredded cheese in a bag never sticks to itself but when you shred your own cheese it sticks? Preservatives. Most nuts are okay but peanuts are a legume and should be consumed in very small amounts or avoided altogether. Don’t go crazy either, nuts do have carbs. I don’t eat more than a half cup a day of salted almonds. That said, you could have mentioned that getting salted nuts is ideal as you do excrete more salt and other minerals in your urine (eating keto is diuretic so attention must be paid to salt, potassium, magnesium, etc. as you did mention) so finding simple ways to add salt and other minerals is helpful. I also take a multi-vitamin daily. You mentioned you cannot do high intensity workouts. You are not supposed to do high intensity workouts as elevating your heart rate too high actually stops the fat burning process in your body. Your heart rate should be 180 beats minus your age +/- 5 beats depending on fitness level. A 40 year old obese person shouldn’t go over 135 beats/min during a workout as that is the optimal fat burning window. Higher than that and your body reverts to storing fat reserves thinking it will run out if it keeps this pace. Which bring me to metabolism. Its been long believed a high metabolism is good. A high metabolism leads to more hunger (because you’re burning glucose faster), ingesting more food, and typically gaining more weight. Slowing your metabolism down AND teaching your body to consume slow burning ketones instead of quick burning glucose puts less stress on your liver mainly and on your body in general. There’s a lot more but this is getting long so I’ll finish with this. You said this diet focuses on quantity of food and not quality. This is confusing to me….wouldn’t organic and grass-fed meats, be of better quality than non-organic and grain fed meat? (they feed animals grains to fatten them up….shouldn’t that be a huge warning sign for us?). Is food without preservatives not better quality than food with preservatives? Aren’t beverages with no sugar or artificial sweeteners of better quality than sugar/artificial sweetener-filled beverages? I’ve never seen any keto advocate advise ignoring quality foods, in fact its quite the opposite.

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Sleep enough – for most people at least seven hours per night on average – and keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss a bit. Plus they might make it harder to stick to a keto diet, and resist temptations. So while handling sleep and stress will not get you into ketosis on it’s own, it’s still worth thinking about.

Truly Dr. Colbert is also a reputable source for more thorough science and modification of previous Keto extremes. The statements about Keto diets with dairy everyday are not true…I am a 66 year old professional (University trained) and have found medical people often very unknowledgable or partially knowledgeable which may be worse. I ask you Abbey to dig deeper…meet Dr. Colbert-not a quack and more in depth than your overview. Personally I am finding switch to more green’s and low glycemic vegetables and fruits with healthy fats, occasional dairy and healthy protein; a way of life that is helping our whole family. Please watch The Magic Pill…the help for family’s caught in old thinking from poor science (ie. Alex Keys) and with autism etc. and so much modern disease is in itself, motivation to search out more truth.
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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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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A. The paleo diet mimics how our hunter-and-gatherer ancestors ate during the Paleolithic era. It avoids grains but allows high-carb foods, such as sweet potatoes and carrots, that the keto diet eschews. Another differentiator is that traditional Paleo diets don’t allow dairy whereas full-fat milk products are a part of a keto diet. However, some Paleo diets allow ghee and other dairy products.

Secondly, glucose is not the only source of energy for your body. The entire point of the Keto diet is that the body can use fat as a fuel source. Yes, you’ll still need glucose for certain things, but you eat protein and a minimal amount of carbs. The great majority of your energy needs are met by ketones. I don’t dismiss the concerns about accessing muscle for glucose, and I’d be interested in studies involving low intensity weight training on Keto to see if it helps with muscle retention. I think you’d probably have to carefully manage your protein levels as well.
Our dietary choices remain our most powerful ally in remaining healthy and combating disease. In Keto Diet, Dr. Josh Axe explores the emerging science that is converging around both the threat of carbohydrates and sugar as well as the powerfully salubrious benefits of a diet that augments our utilization of fat, and specifically ketones, to power our physiology. And beyond providing an in-depth exploration of this exciting science, Keto Diet provides the user-friendly tools that will allow every reader the chance to implement changes to regain and safeguard their health.
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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The ketogenic diet has been shown to produce beneficial metabolic changes in the short-term. Along with weight loss, health parameters associated with carrying excess weight have improved, such as insulin resistance, high blood pressure, and elevated cholesterol and triglycerides. [2,7] There is also growing interest in the use of low-carbohydrate diets, including the ketogenic diet, for type 2 diabetes. Several theories exist as to why the ketogenic diet promotes weight loss, though they have not been consistently shown in research: [2,8,9]

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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.

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