The goal of a ketogenic diet plan is to improve wellbeing through a metabolic change in which the primary cellular fuel source switches from carbohydrate based fuels (glucose) to fat fuels and fat metabolism products called ketones. This is achieved through a metabolic process called ketogenesis, and a body state called ketosis. Ketosis is simply a normal metabolic pathway in which the body cells utilize ketones to make energy, instead of relying on sugar or carbohydrate. In fact, humans developed an evolutionary ability to burn ketones as an adaptation to periods of time when food was unavailable.
A great deal of research is being done on ketosis as it relates to disease. Ketone bodies have some very beneficial effects on the human body, and elevating one’s blood levels of ketone bodies is an effective treatment for many disease conditions because it improves the function of cellular energy pathways and mitochondrial health. Ketogenic diets are now being used to treat medical conditions such as diabetes, epilepsy, autism, Alzheimer’s, cancer and others and much of the success of these treatments is rooted in these cellular effects.
This page will answer some questions you may have about a ketogenic diet plan including:
Who should NOT follow a ketogenic diet: list of medical contraindications.
How do I start a ketogenic diet plan?
Do I need to worry about the “dangers of low carb diets”?
What are the side effects of a ketogenic diet?
What are the benefits of a ketogenic diet?
But first a little legal and medical coverage: Although I have a Master’s degree in Applied Clinical Nutrition, I am not a physician. I do have extensive experience with eating the ketogenic way, and I cured my health problems with a ketogenic diet. I am not guaranteeing that this diet will work for you or cure your health problems. I am just sharing what I know about ketogenic diets. Click here for the full legal disclaimer.
Note of Caution
You should check with your physician if you have any concerns about starting a ketogenic diet plan with pre-existing health conditions, especially if those conditions involve kidney or heart problems. People with kidney disease should definitely consult with their physician about starting a ketogenic diet. Other contraindicated conditions and health issues are listed here. Make sure you check this list and rule these out before starting the diet.
However, be aware that most doctors get very little training on nutrition and don’t understand the general effect of foods on the body. They are also taught that ketosis is dangerous, and so they know even less about ketogenic diets. Hence, if you ask your physician about this diet, you may get push back and a scary “ketosis-is-dangerous” sermon.
Keep in mind that the doctor is getting nutritional ketosis confused with a much more dangerous condition called ketoacidosis. These are two different conditions. Ketoacidosis is mostly a concern for Type 1 diabetics and others whose bodies are unable to make or process insulin correctly. Ketoacidosis usually develops when a person with type 1 diabetes develops an serious infection, has a heart attack or other debilitating illness. It is accompanied by dehydration, high blood sugars and is precipitated by the inability of the sick patient to administer proper amounts of injected insulin.
Ketogenic Diet Plan Basics
There are many ways of implementing a low carbohydrate, ketogenic diet plans but most involve following a higher fat, moderate protein, low carb food plan. (The Atkins diet is one of the most famous ketogenic diets, but certainly not the only one). Many people think of ketogenic diets as high protein diets but this is not the case. There are differences in how most people view low carb diet plans and a ketogenic diet plan, and these differences center around the amount of carbohydrate and protein allowed on a daily basis:
A ketogenic diet plan requires tracking the carb amounts in the foods eaten and reducing carbohydrate intake to about 20-60 grams per day. For some people, less than 100 grams per day may work, but this level of carb intake is too high for most people to achieve ketosis. In addition, the daily protein requirement should be driven by goal or ideal body weight or lean body mass. Protein intake also depends on height, gender and the amount of exercise done. Eating too much protein can interfere with ketosis. The balance of calories after calculating carbs and protein requirements will be from fats. These ratios ensure that most people go into ketosis and stay in that state. The state of ketosis has some beneficial affects so this is an important goal, especially for those people with health issues.
The nutrient intake on a ketogenic diet typically works out to about 70-75% of calories from fat, 20-25% from protein, and 5-10% from carbohydrate on a daily basis when calories are not restricted. Although calorie counting is not required, it is important to understand how macronutrient percentages can be affected by caloric intake, so you may want to read my page on calorie counting to get more information on this subject. In short, low or very high calorie intake will skew the percentages of macronutrients, so keep this in mind.
The key to correctly implement a ketogenic diet plan is to remember that you are exchanging carbohydrate containing foods with a higher fat intake and a moderate protein consumption.
Why high fat and moderate protein? Fats have little to no effect on blood sugar and insulin levels. Protein does affect both blood sugar and insulin. If you eat too much protein for your ideal body weight or lean muscle mass (usually more than 1.5-2.0 grams/kg lean body mass), it can spark gluconeogenesis and raise blood sugar and protein will also spike blood insulin levels temporarily. Higher insulin levels will interfere with ketone body production. In addition, eating a diet that is heavy on lean protein (without enough fat) can make one sick with a condition know as “rabbit starvation”. Rabbit starvation is a form of malnutrition experienced by explorers and native Americans eating exclusively from the land during the Winter season, when food is scarce. It’s caused by a diet restricted to the lean meat of animals such as rabbits, in the absence of carbohydrate and fat. Anthropologist and wilderness explorer Vilhjalmur Stefansson wrote about it in several of his books. A diet heavy in protein and low in fat and carb can also wreck the metabolism in other ways.
How to Start A Ketogenic Diet Plan
Although this website contains all the information you need, there are also several books which explain the science behind ketogenic diets as well. They were my “go to” sources and I recommend that you get one or two and read them.
The bottom line here is to make sure to understand everything that will happen when carbohydrate intake drops. Ketogenic diets are very, very powerful, metabolically speaking and this is especially important if you take any kind of medication for blood pressure, diabetes, cholesterol or triglycerides. The amount taken of these medications will most likely need to be sharply reduced while on a ketogenic diet to avoid negative effects such as excessively low blood sugar or blood pressure.
These books are highly recommended:
The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable by Dr. Jeff Volek and Dr. Stephen Phinney
New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great. by Dr. Eric Westman, Dr. Jeff Volek and Dr. Stephen Phinney
Dr. Atkins’ New Diet Revolution, Revised Edition by Dr. Robert Atkins
The Protein Power Lifeplan by Drs. Michael and Mary Dan Eades
Once you have a good understanding and are ready to start, download the Basic Ketogenic Diet Plan (the plan is in PDF format, so you need Adobe reader to open it) and use the tips below to get prepared for success:
Get a carb counter guide (see sidebar) to help learn and remember the carb counts of the foods being eaten. Counting carbs is a critical part of the program, and it’s important to understand how to do this correctly.
Go on a carbohydrate sweep. Inspect kitchen cupboards and refrigerator, and remove all of the high carb foods. This includes any whole grain “complex carbs”.
Restock the kitchen, so that the foods on this low carb food list are available. This will help keep you on the path, grasshopper, and out of the cookies. Here’s a low carb grocery list to help with food shopping.
A ketogenic diet plan is not a “special diet” that requires special foods. There is no need to buy any “low carb” packaged foods. Ketogenic foods are essentially just real, whole foods which are close to their natural state. In other words, they are not highly processed. The only exception to this is the category of artificial sweeteners. These are highly processed. However, I think these are important to include in a low carb diet plan, because a small amount of fake sweetener has less of a negative effect on health than the standard amounts of sugar in sweetened foods. Some people may prefer more natural sugar alcohol sweeteners, but studies have shown these are “antiketogenic” and can derail the process of ketosis for some. They effect each person differently, so you’ll have to test to see if they effect your health or weight loss goals.
Be prepared to spend more time in the kitchen. This is an important point. A ketogenic diet menu involves cooking and eating real foods. If you don’t know how to cook, this would be a good time to learn about cooking in general and specifically low carb cooking.
Think about your meals, and how you will plan them. This will help in buying the right foods at the grocery store, and give a framework to follow when meal time arrives. If you know you’re supposed to have salmon and broccoli for dinner tonight, it makes it a lot easier to avoid choosing the old high carb foods you used to eat.
Replace old habits with new ones. If you’re used to hitting the coffee place for a bagel, start making coffee at home, and have it with the eggs instead.
Stay hydrated. As carb intake is lowered, the kidneys will start dumping excess water being retained as a result of the former higher carb intake. Make sure to drink enough water to replace what gets lost. The old 6-8 glasses is a good rule, I guess, although just drinking to thirst will probably do the trick. If you find yourself getting headaches and muscle cramps, you need more water, and more minerals such as salt, magnesium and potassium, because the water loss also takes minerals with it. (See my low carb diet side effects page for more info).
Avoid the foods on this list of high carb foods. These are the foods that drive up your blood sugar and insulin levels. In addition, cereal grains like wheat are toxic for more people than is widely known. I think that most people with diet related health issues have an untreated gluten intolerance.
Consider taking these natural supplements. I recommend them for the specific issues I discuss on my low carb diet side effects page.
You may also want to buy some Ketostix Reagent Strips so that you can check to see if you are in ketosis for the first few weeks. However, after the first 3-4 weeks on the plan, the goal is to become “keto-adapted”. Once adapted, the body should be burning the ketones for fuel. The stick shouldn’t register as deep purple if you are using the ketones as a fuel source. And recently, a blood ketones meter has become available to track ketosis at home. This is a much more accurate way to track your individual ketone levels. See the sidebar on my ketosis page for more information.
Find some way to track daily food intake and carb counts. Keep a spreadsheet, use one of the online food intake trackers, or simply write it down in a journal. Not only will journaling help you stay on track carb count wise, you’ll want to have a record of the foods you are eating, how you felt and the changes you make so that if you go off track, you can look back and see what worked for you. This is a good place to track ketone levels as well. I’ve created a free printable food diary for you to use. The Atkins website also has some nice tools for tracking your progress on a ketogenic diet plan. And this database is an excellent resource for food information.
Think about any social situations that will be encountered, and devise ways to handle those times when temptations to eat the “old” way will be high. You don’t want to be blind sided when someone at the office brings in a box of your favorite chocolates and puts them right under your nose. Likewise, a beer with your friends usually turns into a date with potato skins and nachos. Think salad and steak instead.
Even if you are starting a ketogenic diet plan for weight loss purposes, don’t focus on your weight. Don’t weigh yourself every day. Your weight can vary between 2-4 pounds each day because of changes in water intake and absorption. You won’t be able to track any fat loss accurately on a daily basis, and the fluctuations will make you crazy if you focus on them. Instead, weigh yourself once a week, or keep track of your body measurements to track your progress. Better yet, focus on the health benefits and the long term health changes that come with eating a low carb diet. Knowing that you are greatly improving your health is a powerful reason to stay with a ketogenic diet plan, even if you don’t lose any weight. I discuss in more depth the health benefits of a ketogenic diet in this article published in the July/August issue of the Well Being Journal.I recommend getting a health check up and a blood panel test done just before starting the diet, so that you can track the effect of the change in your eating habits on your cholesterol, blood pressure, and other health markers. Four to eight weeks later, you can get another blood test done and see if there are improvements.
Learn how to stop sugar cravings. There are supplements and techniques that can help you overcome those nagging thoughts of dessert and get your blood sugar under control. As time passes, you’ll find that ketosis is a powerful appetite suppressant, so it should get easier to abstain the longer you eat