Another thing we know about diets and weight loss is that the results are not easily maintained. I’ve written about this in depth with regards to the participants on the Biggest Loser. This was evident in a study  analyzing 31 long term studies on dieting, which found 2/3 of dieters put back the weight they lost. Other research has reported the failure rate may be as high as 95%. This isn’t specific to the keto diet but rather, any diet that is restrictive and unrealistic may be nearly impossible to sustain.

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I have to thank you for presenting a more rational view of keto than I have seen presented by other dietitians. However I am a Type 1 diabetic, and ahem, also a registered dietitian and since finding keto a year ago would not have any reservation in guiding a pt, especially a diabetic, to eat keto. I find the diet far less restrictive than a vegetarian or vegan diet, and food cravings have completely been eliminated. I’m far more satiated when I eat and I have no problem adhering to this way of eating. The fact that dietitians advise eating 45-60 g CHO per meal to a diabetic (someone who essentially has a carb intolerance) is absolutely ludicrous to me. As a T1D I’m off the blood sugar roller coaster, no longer have dangerous lows and have achieved an A1c of 5.1, which means no long-term complications. I think the main fear in the mainstream media comes from that F word–fat. With the dawn of the low-fat era in the 1960s, sugar and carb consumption skyrocketed, fat consumption plummeted and what happened as a result? Yes, that’s right, rates of overweight and obesity skyrocketed. Insulin is the body’s primary fat storage hormone and carb consumption triggers insulin. The reason a keto diet works for weight loss (more than just water weight from loss of glycogen stores) is because insulin levels stay low, which allows for the mobilization of fat.
Thanks for the great article! As a fellow dietitian I think its challenging to stay on top of the fads and weight loss trends. The way I see it is that there are two types of ketogenic diets – lifestyle (for weight loss) and therapeutic for some of the medical conditions you mentioned above. Bottom line, the ketogenic diet is not a “natural” diet and there are serious associated side effects. I believe that people following the diet need to be supported by a team of medical professionals to ensure adequate monitoring.
I have never been on any kind of diet. I have never been more than 10-15lbs more than I should be. I have no health concerns. I am 55yrs. old with an enormous appetite. Almost everyone I know has been on a diet. My observation is that once you start dieting you start this yo-yo relationship with gaining and losing weight. I have counseled my children to stay away from fad diets. Moderation is enjoyable and sustainable. I love all-inclusive resorts and cruises. If I gain a bit I just cut back a bit. I don’t have a sweet tooth and I am cautious about potato chips and high fat snacks/foods. I love life, I love food in all its variety and I exercise moderately. I don’t have a gym membership. I get a little fresh air with a 30min easy jog.

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.

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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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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.

Today makes 3 months since I started Keto and I have lost 43 lbs. The way it works for me is by using a meal logging App and sticking to it daily and trying to reach the macronutrient goal percentages as closely as possible. In addition, I have found that, for me, “unlimited amounts of protein and fat” does NOT work for me. I have to carefully restrict total daily calories and mix it “intermittent fasting” with lots of hydration to get the ketosis going. I also find that if I can eat low-carb high fiber greens like arugula, celery, non-peanut no-added-sugar seven-nut butter, walnuts, avocado and lots of water and soups, it helps me avoid constipation. I am feeling so much better without the weight, my sleep apnea is gone and 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”. I have also read many articles on Keto and most are either “all in” or “no way” so I would like to thank you for the “balanced discussion” in this article. It must have taken lots of effort for a nutritionist to examine Keto in a balanced, objective style. Thanks again.

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I’m throwing in the towel but will continue working out as I LOVE it. I am going to eat sensible, keep up the weight training and see how it goes. I feel like I gave it a good run but if I haven’t seen results in 90 days I don’t feel this is the best way to eat for my body. I’m curious if anyone else has had lack luster results like mine while being diligent with a strick KETO diet.

This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.


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.

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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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Hello, I’m Abbey! I'm a Registered Dietitian (RD), an avid food and recipe writer, a TV nutrition expert and spokesperson, a YouTube host and the founder of Abbey’s Kitchen Inc. Abbey's Kitchen is a multi- faceted food and nutrition media brand developed with the goal of celebrating the pleasurable eating experience. For more information about me, check out my bio here.
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.

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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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My submission is, that a healthy body – liver, pancreas, kidneys – know how to maintain the right balance and produce or dispose of fuel, either glycogen or ketones as needed. I disagree that glucose is the favorite fuel, it is only the easy fast fuel for the body, which has one great advantage – PERFORMANCE! Both muscle and brain, fast performance is fueled by carbs. But, for ENDURANCE, it is ketones which are the best fuel, and moreover, burning ketones leaves less waste to be disposed off. I think that for athletes, the challenge is how to find the right performance-endurance balance.

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Following a very high-fat diet may be challenging to maintain. Possible symptoms of extreme carbohydrate restriction that may last days to weeks include hunger, fatigue, low mood, irritability, constipation, headaches, and brain “fog.” Though these uncomfortable feelings may subside, staying satisfied with the limited variety of foods available and being restricted from otherwise enjoyable foods like a crunchy apple or creamy sweet potato may present new challenges.
I say thank you, Abby, for the time you spent on your research of the KETO diet. I have been wondering what all that fat intake of the KETO diet would do to your liver. It can’t be healthy! But hey, it’s a matter of preference I guess. I prefer to be healthy. Okay, I’m not obese, I’m 5’1″ with 38 lbs. According to what I’ve read online and what my health insurance says, I need to lose about 15 lbs. I’m 60 years old — so, nah– probably not happening. I may be old, but active (walking 5 miles each day, doing one workout video on Grokker daily, gardening, hiking, kayaking). I want to lose enough weight to feel better (less arthritic) when I roll my butt out of bed in the morning, but I don’t want to deprive myself from the fun of eating. I don’t do fast or fat foods. I love cooking and eating healthy (like greens and everything veggie and beans and healthy grains like quinoa, freekeh, farro, black rice) and I like my beer of and on. I can do without sweets, but I do crave cheese. Take the “likes” away, and I get grouchy. I was trying to go with a low carb diet years ago, but the brain farts that came with it where just too pronounced. My body needs carbs! As long as they’re healthy carbs, I’ll be ok. I stay away from white bread and packaged, processed foods. I cook mostly low sodium and going out to eat is a special occasion. But I do count calories overall. I started logging my food intake on http://www.cronometer.com and that has helped a lot. I can create my own recipes, incorporate them into other recipes, and it gives me an overview of all the nutrients I consumed – both for the whole day or by each food item. I can tell how many calories or sodium is in each of my recipes. When I first started logging stuff on their website, I ran across the setting for “KETO diet”, but after I saw that it required to only eat 100 mg of carbs, I clicked off that one really fast. You get more than that from 1 glass of Porter! I love dark beer and good food. Real food, not pre-packaged powders or bla-tasting boxed food. I want fresh garlic, sumac, harissa. I want spice and texture. And low fat in most foods. If I want fat, I eat real cheese like goat cheddar. But that’s a treat. As long as I stick to my rule of eating at least 500 cal less than I burn, I’m ok with losing weight slowly. I want to be healthy first. So yeah, it’s a matter of preference. And patience. 🙂 To those of you who love Keto, cause it’s fast and it works for you, by all means: stay on it! It’s your body. My body runs better with a balanced diet. And that’s my 5 cents worth. 🙂

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.

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A dirty keto diet also follows the standard keto diet but with disregard to the nutrient value or quality of the food consuming. For example, you could go to a fast food restaurant and order a bunless cheeseburger chased down with a diet soda and still be keto. This works if you’re traveling and really have no better options, but is not recommended in the long run because of a host of negative effects, such as the inflammation, cravings, increased blood pressure due to the high sodium, and bloating.

Our online calculators, converters, counters, and content are provided "as is", free of charge, and without any warranty or guarantee. Each tool is carefully developed and rigorously tested, and our content is well-sourced, but despite our best effort it is possible they contain errors. We are not to be held responsible for any resulting damages from proper or improper use of the service. See our full terms of service.
I’ve lost 30 pounds in 2 months, I feel better than I ever have, energy levels are up, my skin issues have cleared up, and I am training to run a 5k with my 14 year old. This is the only diet I’ve tried that has been easy to stick to. For me I could never do a diet if I didn’t like the food. Not a chance I could go vegan. Anyone reading this I strongly suggest you do your own research. No offense to the writer but nobody should only look to one opinion as the be all and end all on any topic. Mark Sisson is an amazing resource, has been eating keto for a long time and *gasp* is a marathon runner. On Netflix check out The Magic Pill for some eye opening stuff. Just do as much research as you can before either jumping in or dismissing it. There are some amazing and delicious foods that are keto-friendly, you just gotta put in the time to find them. Keto is not just a diet, it’s a lifestyle that includes proper exercise (to avoid loss of muscle mass among many other health benefits), stress management and proper sleep. Be informed. 

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The only difficulty with some of these studies is that they tend to have small sample sizes, like this one that only has five cyclist participants and the data was largely skewed by the fact that only ONE cyclist experienced a large enhancement of exercise capacity after the keto diet. Their studies also tend to be short term. Back in 2014, Phinney and scientist Tim Noakes wrote an editorial that stated that in the past 31 years, there have only been a handful of studies measuring sports performance and low carb diets. Out of a total of 11, only 3 found exercise improvements.
I now eat healthy organic 8-10 cups of greens daily, small amounts of grass fed or organic protein and healthy fats and oils as recommended. My cravings disappeared within a few days of cutting out carbohydrates. My sugar intake was already very low. I do intermittent fasting daily without any hunger pangs. I am happily eating a main midday meal and then having a kale shake around 4pm. I am losing a healthy 1kg a week. This diet is a mood stabiliser because there are fewer insulin spikes. I do not snack and am loving the increased clarity of my mind.

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.
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.
While I admittedly struggled after going off the diet (they have some high protein, low carb,good tasting premade foods that I no longer had access to) with what to eat, I at least had better knowledges of HOW to eat and have been able to maintain my weight loss since. For the first time ever, I realized that I couldn’t eat the “food pyramid” suggested amount of carbs if I wanted to maintain a healthy weight. I even began running because I was thin enough to do so. What people who have never been fat before don’t understand is how much being fat holds us back from trying new things. If only there was a way to get people to quickly and easily lose the weight so they could be successful at dieting and discover such things (tongue in cheek).

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Another thing we know about diets and weight loss is that the results are not easily maintained. I’ve written about this in depth with regards to the participants on the Biggest Loser. This was evident in a study  analyzing 31 long term studies on dieting, which found 2/3 of dieters put back the weight they lost. Other research has reported the failure rate may be as high as 95%. This isn’t specific to the keto diet but rather, any diet that is restrictive and unrealistic may be nearly impossible to sustain.

Our online calculators, converters, counters, and content are provided "as is", free of charge, and without any warranty or guarantee. Each tool is carefully developed and rigorously tested, and our content is well-sourced, but despite our best effort it is possible they contain errors. We are not to be held responsible for any resulting damages from proper or improper use of the service. See our full terms of service.

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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.
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.
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.
And glucose is not the preferred fuel of the brain, because fat is. It is just super easy to get glucose from all the garbage carbs that are available 24/7. When you can eat a high fat diet and cause cancer to go into remission, then no it is not glucose that any part of the body prefers. It is fat. Sugar (carbs) feeds cancer and ill health. Fat improves health.
A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >

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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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