- Keto Diet Review, Foods, Plan, Safety, Benefits & Pills
- What is the ketogenic diet?
- Is the ketogenic diet safe? What are the health benefits and risks of the ketogenic diet?
- What foods are included in the ketogenic diet?
- What are foods to avoid with the ketogenic diet?
- Should people take supplements while on the ketogenic diet?
- Who is a good candidate for the ketogenic diet?
- Ketogenic Diet
- 8 Potential Keto Diet Nutrient Deficiencies
- What to Monitor on a Keto Diet?
- 1) Calcium
- 2) Magnesium
- 3) Iron
- 4) Sodium
- 5) Potassium
- 6) Selenium
- 7) Carnitine
- 8) Lipids (Cholesterol and Triglycerides)
- Limitations and Caveats
- No, Keto Is Not Just About Eating Butter and Bacon
- 1. It's not just about eating fat
- 2. It's also not just about eating animal products
- 3. Nope, it's not a high-protein diet
- 4. Um, YES, you should be eating fruits and veggies
- 5. Nutrient deficiencies and other health issues are a concern
- 6. It's traditionally a therapeutic diet-and that has implications
- 7. Cheat meals on keto aren't a thing
- 8. Keto doesn't guarantee weight loss
Keto Diet Review, Foods, Plan, Safety, Benefits & Pills
Ketogenic is a term for a low-carb diet.
- The ketogenic diet is a high-fat diet that drastically restricts carbohydrates. It produces a reaction in the body that is similar to the fasting state.
- The low-carb, high-fat keto diet causes the metabolic state known as ketosis, in which substances known as ketones or ketone bodies accumulate in the blood. These are the same substances that accumulate during ketoacidosis in people with type 1 diabetes.
- A ketogenic diet has been shown to be effective in treating seizure disorders that have not responded to two different antiseizure medications. While this treatment is most often used in children, some adults with seizure disorders may also be helped by a ketogenic diet.
- A ketogenic diet is typically not recommended for weight control because it is not superior to other more standard weight management plans and may be associated with health risks, including nutritional deficiencies.
- Ketogenic diets have been the subject of research to determine if they have value in managing other conditions including cancer and diabetes, but there is currently no recommendation for this practice.
When you eat less than 50 grams of carbs a day, your body eventually runs fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you'll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis.
Read more about the ketogenic diet »
What is the ketogenic diet?
The ketogenic diet is a diet that produces reactions in the body similar to those that occur during fasting. This is a type of extreme low-carb diet that was first developed in 1921 due to the ability of this type of diet to reduce or suppress seizures.
As new medications to treat seizures were developed, the ketogenic diet became less popular as a way to manage seizure disorders. However, in 2008, a clinical trial showed that a ketogenic diet could help children with treatment-resistant epilepsy become seizure-free.
A ketogenic diet is often prescribed for people who have failed two mainline antiseizure drugs, with studies showing seizure-reduction rates as high as 85% after this treatment. It can be effective for patients of any age or seizure type.
The reasons why a ketogenic diet works to help reduce seizures are unclear, but it is believed to induce metabolic changes that lower the risk of seizures.
The diet itself is a low-carb, high-fat diet that involves extreme reduction of carbohydrate consumption and replacing it with fat, up to a concentration of 70%-80% of calories from fat.
There is no one standard ketogenic diet, and different ratios of nutrients have been used in so-called keto diets.
All have in common the reduction of carbohydrates and an increase in fat along with a moderate amount of protein.
The reduction in carbohydrates deprives the body of glucose and causes a metabolic state known as ketosis, due to the accumulation of molecules known as ketones in the bloodstream.
Ketones consist of acetoacetate, acetone, and beta-hydroxybutyrate and form in the liver from long- and medium-chain fatty acids when the body burns stored fat for energy after glucose is depleted or in situations in which there is inadequate insulin present for glucose to be used as energy.
In addition to seizure disorders, ketogenic diets have been tested in the management of some people with other conditions including diabetes, cancer, polycystic ovary syndrome, and Alzheimer's disease.
Further, the “keto diet” has gained attention as a potential weight loss tool. Its proponents argue that a carefully controlled ketogenic diet can avoid the dangers of ketoacidosis and be an effective way to lose weight.
According to the USDA, there is no difference between a “portion” and a “serving.” See Answer
Is the ketogenic diet safe? What are the health benefits and risks of the ketogenic diet?
The ketogenic diet has been shown in controlled studies to be effective in children and adults who have failed two lines of standard antiseizure medication. However, it is not safe for use in people with certain genetic conditions that affect the metabolism of fatty acids.
Nutritional deficiencies are a risk for any severely restricted diet, and in 2008 there was a report of two cases of sudden cardiac arrest in children who had been on the ketogenic diet for three years. Impairments in cardiac function may be due to deficiency in the mineral selenium from following the diet.
Support from a dietician or nutritionist may be required to help ensure that these and other potential nutrient deficiencies are addressed.
As a weight loss measure, while there is some evidence to suggest that a ketogenic diet can be effective for weight control, there are also definitive health risks and complications associated with this low-carb, high-fat type of diet.
Some of the positive effects of the diet that have been described in addition to weight loss include
- decreased food cravings due to the high fat content, decreases in the levels of hormones that stimulate appetite,
- fat loss, and an increase in calories burned.
In some people, short-term following of a ketogenic diet has shown improvements in
Further, the extreme carbohydrate restriction of the keto diet may cause symptoms including
- depressed mood,
- headache, and
It has also been proposed that long-term effects of this diet may include osteoporosis and an increased risk for kidney stones and gout.
Currently, it remains unknown if the potential benefits of the keto diet for weight loss outweigh the health risks.
Healthy Dieting Myths and Facts See Slideshow
What foods are included in the ketogenic diet?
As discussed previously, the ketogenic diet includes high-fat foods and proteins and restricts carbohydrates. Since there is no one approved ketogenic diet, recommended foods and meals plans may differ. Most ketogenic diets permit foods high in saturated fat, including
- processed meats,
- fatty cuts of meat, including red meat, lard, and butter.
- Unsaturated fats oily fish, nuts, seeds, and plant oils are also typically included.
What are foods to avoid with the ketogenic diet?
Since the keto diet is a low-carb diet plan, foods to avoid with the ketogenic diet include all carbohydrate sources, including both refined and unrefined products. Not only sugars but also whole-grain carbohydrates are not allowed. Foods to avoid include all breads and cereals, pasta, cookies and baked goods, rice, starchy vegetables corn and potatoes, and fruits and their juices.
Should people take supplements while on the ketogenic diet?
Since nutritional deficiencies are a risk factor with any ketogenic diet plan, it is important to work with a health care provider, including a nutritionist or dietician, to ensure that all nutritional requirements are met. In some cases, this may involve taking vitamin or mineral supplements.
Who is a good candidate for the ketogenic diet?
The ketogenic diet is a recognized medical treatment for children and some adults with seizure disorders that have not responded to two different antiseizure medications. Specific seizure disorders with multiple reports in the medical literature of benefit from the ketogenic diet include the following:
For people with certain other seizures disorders, the diet has also been suggested to be of benefit.
As a weight loss tool, there is not adequate evidence to suggest that this diet is superior to other weight-control plans and may be associated with long-term risks or nutritional deficiencies.
Medically Reviewed on 12/31/2019
Harvard T.H. Chan School of Public Health. “Diet review: ketogenic diet for weight loss.” .
Watson, John. “Ketogenic diet: Which patients benefit?” Medscape.com. Mar. 20, 2018.
Despite continuous advances in the medical world, obesity continues to remain a major worldwide health hazard with adult mortality as high as 2.8 million per year.
The majority of chronic diseases diabetes, hypertension, and heart disease are largely related to obesity which is usually a product of unhealthy lifestyle and poor dietary habits. Appropriately tailored diet regimens for weight reduction can help manage the obesity epidemic to some extent.
One diet regimen that has proven to be very effective for rapid weight loss is a very-low-carbohydrate and high-fat ketogenic diet.
A ketogenic diet primarily consists of high-fats, moderate-proteins, and very-low-carbohydrates. The dietary macronutrients are divided into approximately 55% to 60% fat, 30% to 35% protein and 5% to 10% carbohydrates. Specifically, in a 2000 kcal per day diet, carbohydrates amount up to 20 to 50 g per day.
History and Origin
Russel Wilder first used the ketogenic diet to treat epilepsy in 1921. He also coined the term “ketogenic diet.
” For almost a decade, the ketogenic diet enjoyed a place in the medical world as a therapeutic diet for pediatric epilepsy and was widely used until its popularity ceased with the introduction of antiepileptic agents.
The resurgence of the ketogenic diet as a rapid weight loss formula is a relatively new concept the has shown to be quite effective, at least in the short run.
Physiology and Biochemistry
Basically, carbohydrates are the primary source of energy production in body tissues.
When the body is deprived of carbohydrates due to reducing intake to less than 50g per day, insulin secretion is significantly reduced and the body enters a catabolic state.
Glycogen stores deplete, forcing the body to go through certain metabolic changes. Two metabolic processes come into action when there is low carbohydrate availability in body tissues: gluconeogenesis and ketogenesis.
Gluconeogenesis is the endogenous production of glucose in the body, especially in the liver primarily from lactic acid, glycerol, and the amino acids alanine and glutamine.
When glucose availability drops further, the endogenous production of glucose is not able to keep up with the needs of the body and ketogenesis begins in order to provide an alternate source of energy in the form of ketone bodies. Ketone bodies replace glucose as a primary source of energy.
During ketogenesis due to low blood glucose feedback, stimulus for insulin secretion is also low, which sharply reduces the stimulus for fat and glucose storage. Other hormonal changes may contribute to the increased breakdown of fats that result in fatty acids.
Fatty acids are metabolized to acetoacetate which is later converted to beta-hydroxybutyrate and acetone. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained. This metabolic state is referred to as “nutritional ketosis.
” As long as the body is deprived of carbohydrates, metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-threatening condition where ketone bodies are produced in extremely larger concentrations, altering blood ph to acidotic a state.
Ketone bodies synthesized in the body can be easily utilized for energy production by heart, muscle tissue, and the kidneys. Ketone bodies also can cross the blood-brain barrier to provide an alternative source of energy to the brain.
RBCs and the liver do not utilize ketones due to lack of mitochondria and enzyme diaphorase respectively. Ketone body production depends on several factors such as resting basal metabolic rate (BMR), body mass index (BMI), and body fat percentage.
Ketone bodies produce more adenosine triphosphate in comparison to glucose, sometimes aptly called a “super fuel.” One hundred grams of acetoacetate generates 9400 grams of ATP, and 100 g of beta-hydroxybutyrate yields 10,500 grams of ATP; whereas, 100 grams of glucose produces only 8,700 grams of ATP.
This allows the body to maintain efficient fuel production even during a caloric deficit. Ketone bodies also decrease free radical damage and enhance antioxidant capacity.
The short-term effects (up to 2 years) of the ketogenic diet are well reported and established. However, the long-term health implications are not well known due to limited literature.
The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu.
These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.
Cautions and Contraindications
People suffering from diabetes and taking insulin or oral hypoglycemic agents suffer severe hypoglycemia if the medications are not appropriately adjusted before initiating this diet.
The ketogenic diet is contraindicated in patients with pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. People on a ketogenic diet rarely can have a false positive breath alcohol test.
Due to ketonemia, acetone in the body can sometimes be reduced to isopropanol by hepatic alcohol dehydrogenase which can give a false positive alcohol breath test result.
The popular belief that high-fat diets cause obesity and several other diseases such as coronary heart disease, diabetes, and cancer has not been observed in recent epidemiological studies.
Studies carried out in animals that were fed high-fat diets did not show a specific causal relationship between dietary fat and obesity.
On the contrary, very-low-carbohydrate and high-fat diets such as the ketogenic diet have shown to beneficial to weight loss.
Evidence Behind The Ketogenic Diet
In relation to overall caloric intake, carbohydrates comprise around 55% of the typical American diet, ranging from 200 to 350 g/day. The vast potential of refined carbohydrates to cause harmful effects were relatively neglected until recently.
A greater intake of sugar-laden food is associated with a 44% increased prevalence of metabolic syndrome and obesity and a 26% increase in the risk of developing diabetes mellitus. In a 2012 study of all cardiometabolic deaths (heart disease, stroke, and type 2 diabetes) in the United States, an estimated 45.
4% were associated with suboptimal intakes of 10 dietary factors. The largest estimated mortality was associated with high sodium intake (9.5%), followed by low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%), low intake of omega-3 fats (7.8%), low intake of vegetables 7.
6%), low intake of fruits (7.5%), and high intake of artificially sweetened beverages (7.4%). The lowest estimated mortality was associated with low polyunsaturated fats (2.3%) and unprocessed red meats (0.4%).
In addition to this direct harm, excess consumption of low-quality carbohydrates may displace and leave no room in the diet for healthier foods nuts, unprocessed grains, fruits, and vegetables.
A recent systemic review and meta-analysis of randomized controlled trials comparing the long-term effects (greater than 1 year) of dietary interventions on weight loss showed no sound evidence for recommending low-fat diets.
In fact, low-carbohydrate diets led to significantly greater weight loss compared to low-fat interventions. It was observed that a carbohydrate-restricted diet is better than a low-fat diet for retaining an individual’s BMR. In other words, the quality of calories consumed may affect the number of calories burned.
BMR dropped by more than 400 kcal/day on a low-fat diet when compared to a very low-carb diet.
A well-formulated ketogenic diet, besides limiting carbohydrates, also limits protein intake moderately to less than 1g/lb body weight, unless individuals are performing heavy exercise involving weight training when the protein intake can be increased to 1.5g/lb body weight.
This is to prevent the endogenous production of glucose in the body via gluconeogenesis. However, it does not restrict fat or overall daily calories. People on a ketogenic diet initially experience rapid weight loss up to 10 lbs in 2 weeks or less.
This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by a fat loss. Interestingly with this diet plan, lean body muscle is largely spared.
As a nutritional ketosis state sustains, hunger pangs subside, and an overall reduction in caloric intake helps to further weight loss.
Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.
Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.
A ketogenic diet may be followed for a minimum of 2 to 3 weeks up to 6 to 12 months. Close monitoring of renal functions while on a ketogenic diet is imperative, and the transition from a ketogenic diet to a standard diet should be gradual and well controlled.
To counter the obesity epidemic, some healthcare workers do recommend the ketogenic diet. However, the primary care provider, nurse practitioner, dietitian and internist need to be aware of a few facts.
Overweight individuals with metabolic syndrome, insulin resistance, and type 2 diabetes are ly to see improvements in the clinical markers of disease risk with a well-formulated very-low-carbohydrate diet.
Glucose control improves due to less glucose introduction and improved insulin sensitivity.
In addition to reducing weight, especially truncal obesity and insulin resistance, low-carb diets also may help improve blood pressure, blood glucose regulation, triglycerides, and HDL cholesterol levels. However, LDL cholesterol may increase on this diet.
Also, in various studies, the ketogenic diet has shown promising results in a variety of neurological disorders, epilepsy, dementia, ALS, traumatic brain injury, acne, cancers, and metabolic disorders.
Due to the complexity of the mechanism and lack of long-term studies, a general recommendation of the ketogenic diet for prevention of type 2 diabetes mellitus or cardiovascular disease may seem premature but is, however, not farfetched for primary weight loss.
While in the short term the ketogenic diet may help one lose weight, this is not sustained over the long run. In addition, countless studies show that the diet is associated with many complications that often lead to emergency room visits and admissions for dehydration, electrolyte disturbances, and hypoglycemia. 
To access free multiple choice questions on this topic, click here.
1.LaFountain RA, Miller VJ, Barnhart EC, Hyde PN, Crabtree CD, McSwiney FT, Beeler MK, Buga A, Sapper TN, Short JA, Bowling ML, Kraemer WJ, Simonetti OP, Maresh CM, Volek JS. Extended Ketogenic Diet and Physical Training Intervention in Military Personnel. Mil Med. 2019 Oct 01;184(9-10):e538-e547. [PubMed: 30877806]2.Roehl K, Falco-Walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav. 2019 Apr;93:113-118. [PubMed: 30867113]3.Martin-McGill KJ, Lambert B, Whiteley VJ, Wood S, Neal EG, Simpson ZR, Schoeler NE., Ketogenic Dietitians Research Network (KDRN). Understanding the core principles of a 'modified ketogenic diet': a UK and Ireland perspective. J Hum Nutr Diet. 2019 Jun;32(3):385-390. [PubMed: 30859652]4.Jagadish S, Payne ET, Wong-Kisiel L, Nickels KC, Eckert S, Wirrell EC. The Ketogenic and Modified Atkins Diet Therapy for Children With Refractory Epilepsy of Genetic Etiology. Pediatr. Neurol. 2019 May;94:32-37. [PubMed: 30803845]5.Mohorko N, Černelič-Bizjak M, Poklar-Vatovec T, Grom G, Kenig S, Petelin A, Jenko-Pražnikar Z. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults. Nutr Res. 2019 Feb;62:64-77. [PubMed: 30803508]6.Ma S, Suzuki K. Keto-Adaptation and Endurance Exercise Capacity, Fatigue Recovery, and Exercise-Induced Muscle and Organ Damage Prevention: A Narrative Review. Sports (Basel). 2019 Feb 13;7(2) [PMC free article: PMC6410243] [PubMed: 30781824]7.Oh R, Uppaluri KR. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 3, 2020. Low Carbohydrate Diet. [PubMed: 30725769]8.Broom GM, Shaw IC, Rucklidge JJ. The ketogenic diet as a potential treatment and prevention strategy for Alzheimer's disease. Nutrition. 2019 Apr;60:118-121. [PubMed: 30554068]9.Włodarek D. Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer's Disease and Parkinson's Disease). Nutrients. 2019 Jan 15;11(1) [PMC free article: PMC6356942] [PubMed: 30650523]10.Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur. J. Paediatr. Neurol. 2019 Jan;23(1):143-151. [PubMed: 30497921]11.Armeno M, Araujo C, Sotomontesano B, Caraballo RH. [Update on the adverse effects during therapy with a ketogenic diet in paediatric refractory epilepsy]. Rev Neurol. 2018 Mar 16;66(6):193-200. [PubMed: 29537059]
8 Potential Keto Diet Nutrient Deficiencies
The ketogenic diet, or keto diet, has become one of the most popular diets in recent years for its ability to enhance fat loss, increase energy, improve athletic performance, and control appetite.
But despite these benefits, research and decades of clinical experience have found the diet to increase the risk for multiple nutrient deficiencies.
Read on to see what nutrients you should be watching to maximize your health on a ketogenic diet.
What to Monitor on a Keto Diet?
The ketogenic diet is more popular than ever. The diet is extremely low in carbohydrates (usually less than 50 g/day), moderate in protein, and very high in fat. “Ketogenic” refers to the ability of the diet to generate high levels of compounds called ketones that are used as the main energy source instead of glucose [1, 2].
The term was first coined by Dr. Russ Wilder of the Mayo Clinic in 1921, who used the diet to successfully treat epileptic children. However, with the introduction of effective anticonvulsant drugs, the ketogenic, or keto, diet fell favor with doctors. However, it was and still is used to successfully treat epileptic patients who don’t respond to drugs or surgery [1, 2].
The diet has seen a resurgence in popularity in recent decades. Reported benefits range from weight loss and improved blood sugar control to increased energy and mental clarity.
Research has backed some of these claims: the keto diet is more effective for weight loss, reducing blood sugar levels, and improvingcholesterol andtriglycerides than high-protein, calorie-restricted, and even low-fat diets (one RCT of 25 participants, one randomized crossover trial of 17 participants, three RTs of 159 participants) [3, 4, 5, 6, 7].
Beyond weight loss, the diet’s therapeutic potential has also been studied in type 2 diabetes, heart disease, brain trauma, Alzheimer’s disease, and cancer, with promising results .
While the diet may have multiple benefits, there are concerns that it can cause multiple nutrient imbalances due to its restriction of carbohydrates and its effects on how the body processes certain nutrients.
Calcium is important for bones and teeth, blood vessel function, and muscle and nerve communication .
People on long-term keto diets often lose too much calcium in the urine in addition to having acidic urine.
High-fat diets can increase the amount of acid generated by the body, which the kidneys must filter out to maintain a stable blood pH. This leads to lower urine pH. Calcium from bones is also used to buffer the increased acid production, leading to higher calcium loss in the urine and lower bone density [10, 11, 12, 13].
In addition, dietary calcium intake may be lower due to the limitation of calcium-rich foods such as fruits, vegetables, dairy, and enriched grains on the diet. Research in rats found that high-fat, low-carbohydrate diets reduced calcium absorption because fats would form indigestible soaps with calcium [14, 15].
Too much calcium in the urine and acidic urine are major risk factors for kidney stones, which is why studies suggest that 3 – 6% of people on a long-term keto diet may develop stones within two years .
If a keto diet is something you are doing long-term or often, work with your doctor to monitor your kidney health by doing a regular urinalysis. Urinalysis includes tests such as urine pH, calcium crystals, and uric acid crystals, which can tell you when you’re at risk of kidney stones.
If you’re on a long-term keto diet, your doctor will often prescribe potassium citrate, which reduces the risk of stones by increasing pH and reducing the loss of calcium in the urine [16, 17].
Keto-friendly foods high in calcium include sardines, salmon, spinach, and turnip greens .
Because blood calcium is tightly maintained within a narrow range you may need to occasionally check your bone mineral density (z-score, t-score) to determine if you are losing calcium from your bones .
Magnesium is another mineral that has been observed to decrease substantially on a long-term keto diet. This mineral is extremely important for our bodies to produce energy and is required for our nerve cells and brain to function properly. It’s not surprising that deficiency has been associated with a wide range of conditions including heart disease, and migraines [19, 20, 21, 22].
Symptoms of magnesium deficiency include muscle cramps, headaches, anxiety and nervousness, and constipation .
Decreased levels seen in people on a keto (low-carb) diet are ly due to eating fewer foods rich in magnesium such as fruits and grains [23, 24, 25, 19].
Magnesium levels can be easily tested and easily corrected. Work with your doctor to find out if your magnesium levels are adequate.
Avocados, almonds, spinach, and salmon are all high in magnesium and low in carbohydrates. Magnesium supplements can also help .
Even though keto diets usually involve eating ample quantities of meat, they also tend to reduce iron levels [27, 13, 28].
Iron is needed for energy production and making red blood cells and a deficiency can cause fatigue and trouble breathing during exercise .
Evidence suggests that iron deficiency may develop on the diet due to reduced absorption of iron caused by high amounts of fat [23, 30].
Ask your doctor to check your ferritin levels to see how well your body is storing iron.
You can increase your absorption of iron by eating more vitamin C-rich foods such as bell peppers and broccoli with iron rich-foods (or by supplementing with vitamin C).
Also, avoid drinking tea and coffee with meals as these will decrease how much iron your body absorbs [31, 32, 33, 34].
Sodium is an electrolyte mineral that helps maintain blood volume, pressure, and pH as well as fluid balance in the body .
Insulin increases the absorption of sodium by the kidneys and because the keto diet decreases insulin levels, the body expels more sodium than normal .
The most common complaints among those just starting out on a keto diet are constipation, headache, muscle cramps, diarrhea, and general weakness.
This collection of symptoms is aptly termed the “keto-flu” and is mainly caused by the increased loss of sodium, potassium, and water (low blood sugar levels also contribute).
These symptoms are temporary and usually resolve within weeks [28, 37].
You can reduce these symptoms by increasing your salt intake until your body adjusts to the increased salt loss.
sodium, potassium loss increases during the first couple of weeks on a keto diet and is partly responsible for the flu- symptoms commonly experienced by new adherents [37, 13].
Potassium helps balance fluids, maintain blood pressure, and helps nerves and muscles communicate. Because it also helps reduce calcium loss in the urine, it is especially important on a keto diet [38, 39, 17].
Spinach, cabbage, parsley, walnuts, hazelnuts, and brazil nuts can help you keep your potassium levels up without kicking you ketosis .
Selenium is a mineral that plays important roles in heart health, reproduction, making thyroid hormones, and protecting the body from oxidative stress .
Research and clinical experience in epileptic children on keto diets have found the diet to decrease selenium levels and cause deficiencies in the long run [19, 42, 43].
High-fat foods tend to be low in selenium, which is why keto diets can lead to lower selenium levels .
You can easily meet your daily selenium requirement by eating 2-3 Brazil nuts, which are high in fat and low in carbohydrates. Other selenium-rich, low-carbohydrate foods include sardines and shrimp .
Carnitine is a compound made from amino acids that are found in abundant quantities in the heart and muscles. It helps transport fatty acids to the mitochondria where they are used to make energy. The body can make carnitine, but 75% of our daily requirements comes from the diet (mainly from meat and dairy) [44, 45].
Because carnitine is needed to burn fat, it’s used up much quicker on a keto diet .
For most people on a keto diet, carnitine decreases temporarily during the first couple of months. But there is some research that shows deficiency may develop on long-term diets. If this happens, then supplementation becomes necessary to make sure you are burning fat efficiently [47, 48].
If you’ve been on the diet for more than a few months and you’re experiencing fatigue and muscle weakness, this could be a sign you’re low in carnitine. Studies suggest that even if you’re not deficient, supplementing with L-carnitine may improve how well your body burns fats for fuel .
Work with your doctor to test your blood carnitine levels to see if you’re low or deficient.
8) Lipids (Cholesterol and Triglycerides)
It’s not surprising that researchers and doctors are concerned about the effects the diet has on cholesterol and triglycerides given the high amounts of fat consumed.
However, multiple studies show that LDL-C, total cholesterol, and triglycerides decrease, and HDL-C increases in overweight and obese individuals on a long-term (> 1 year) keto diet (three RTs of 469 total participants and two pilot studies of 132 total participants) [50, 51, 52, 53, 54].
One of these trials (118 participants) found an increase in LDL-C levels .
In a 6-week pilot study in 20 healthy men with normal cholesterol levels, triglycerides decreased but cholesterol levels were unchanged .
However, longertrials (> 6 months) in epileptic children show the opposite: LDL-C, total cholesterol, and triglycerides increase on a keto diet (four pilot studies of 318 total participants) [56, 57, 58, 59].
It appears that the effect of the keto diet on lipids depends on the health and age of the individual.
Limitations and Caveats
It’s important to note that most of the research examining the effect of the keto diet on nutrient levels has been conducted in children with epilepsy. As children have different nutritional needs than adults, this research may not translate into older, healthy populations.
In addition, there are many variations of the keto diet such as the type of fats consumed (saturated vs. unsaturated), as well as the types of carbohydrates and proteins consumed.
If you’re on a long-term keto diet, it’s still smart to monitor your using blood tests. Work with your doctor to make sure your diet is healthy and discuss supplements if necessary.
No, Keto Is Not Just About Eating Butter and Bacon
The ketogenic diet is crazy popular right now. For a lot of people, it seems a manageable change in eating style that can help them look and feel better. After all, how hard can a diet be to sustain if you're allowed to eat butter, cheese, bacon, and as much avocado as your heart desires?!
But there are *so many* things people get wrong about the keto diet-not just in terms of which foods to eat, but also how much to eat, the most effective ways to implement the diet, and what the real benefits (and risks) are. And keto experts are getting tired of it. Here's what they want you to know.
1. It's not just about eating fat
Most people hear “keto” and immediately think “fat.” (If you're not familiar, keto essentially is a high-fat, very low-carb diet that puts your body into a state called ketosis, where it uses fat for fuel instead of carbs. Here's more about how the keto diet works.)
But that's not the whole story. “You can eat more fat, but the type of fat you eat does matter,” says Molly Devine, R.D., a registered dietitian and advisor to KetoLogic.
“We really are what we eat and if the animals providing your dietary fat are eating poor-quality food, guess what? Their fat is pretty poor quality, too,” she says.
“Grass-fed and free-range animals produce foods with higher nutritional quality, which is free of added hormones and other toxins that can lead to disease and metabolic dysfunction.
Including a wide variety of fats, both from animals and plants will create a more balanced and interesting diet.”
2. It's also not just about eating animal products
Butter. Bacon. Cheese. *Insert heart eyes emoji here.* These are all things you can eat on keto, maybe in larger amounts than if you were following another type of diet. But you don't have to eat them.
“This assumption that ketogenic diets require animal products is problematic because it sets up a false dichotomy between keto and vegetarianism,” says Catherine Metzgar, Ph.D., R.D.
, a registered dietitian and nutritional biochemistry expert who works with Virta Health. “It is certainly possible to eat a vegetarian or lactose-free ketogenic diet.
” In fact, plenty of her clients do it, she says-it's just a matter of some careful planning. (See: Is It Possible to Follow a Vegetarian or Vegan Keto Diet?)
(Want some ideas to get started on keto if you're plant-based? Here are 29 vegetarian keto recipes and 13 vegan keto recipes for plant-based eaters.)
3. Nope, it's not a high-protein diet
“This isn't a low-carb, high-protein way of eating,” Devine points out. Because it's so common these days to emphasize protein intake, a lot of keto dieters accidentally OD on the stuff, which takes you ketosis.
(Here, a nutritionist explains exactly why the added protein trend has gotten control.) “FAT needs to be your primary fuel source and that means finding pure-fat sources that don't include protein.
Your body will convert excess protein into glucose for fuel and this will spike insulin, preventing ketosis.”
4. Um, YES, you should be eating fruits and veggies
“A lot of people also think that they cannot eat fruits or vegetables on a ketogenic diet,” says Pegah Jalali, R.D., a registered dietitian at Middleberg Nutrition. If you take one thing away from this article, let it be this: You definitely still need to eat fruits and vegetables, no matter what kind of diet you're on.
Also, there are quite a few fruits and veggies that are keto-friendly. “You can eat many low-carbohydrate vegetables zucchini, cauliflower, mushrooms, cucumbers and more,” says Jalali.
“Fruits are a little harder to fit into a ketogenic diet, but many of my patients enjoy raspberries and other low-carbohydrate fruits in portioned amounts.
” (Here's a keto meal plan for beginners that spells everything out.)
5. Nutrient deficiencies and other health issues are a concern
There are some common health issues that occur on keto, most of which can be avoided through careful planning.
“The ketogenic diet has many side effects and this is why it's important that individuals work with a medical professional an M.D. or R.D. who has experience with the diet,” says Jalali. “Some common side effects are constipation, elevated cholesterol, kidney stones, vitamin deficiencies including zinc, copper, selenium, and vitamin D.” (Related: Is The Keto Diet Bad for You?)
Mineral and electrolyte deficiencies are also quite common in the early stages of keto. “Many people become dehydrated and deficient in electrolytes as the body sheds large amounts of water from carb restriction,” explains Devine. “Sodium, potassium, and magnesium are the big three that I supplement with at this stage.” (These hydration supplements can be added right to your water.)
Cholesterol levels are also sometimes affected by the keto diet. “It's important to ask your physician to check a fasting lipid panel before starting a ketogenic diet and three months later if you plan to continue,” says Julie Stefanski, R.D., a registered dietitian and specialist in the ketogenic diet.
“In a recent study which used a ketogenic meal plan for a year, researchers saw a rise in LDL (bad cholesterol), but the change was felt to be minimal,” she says.
“On the upside, they also documented a desirable increase in HDL (good cholesterol) and a decrease in triglyceride levels and inflammatory indicators, both of which are risk factors for heart disease.
” Still, it's a good idea to involve a dietitian or doctor in your keto diet plans so you can monitor the health impact.
Of course, this isn't an exhaustive list of everything that can go wrong on keto, but as you can see, there are some legitimate concerns here. Which leads us to…
6. It's traditionally a therapeutic diet-and that has implications
The keto diet can improve your health. But it's also not a dietary choice to make on a whim-and it's *not* just a slightly-more-intense version of other low-carb diets.
“Although ketogenic diets have recently come into vogue, it's incorrect to label this as an offshoot of Atkins,” says Metzgar. “Ketogenic diets have been therapeutically used for over a century to treat refractory epilepsy in children.
In addition, clinical trials of ketogenic diets demonstrate that they can result in profound health improvements and medication reductions for people living with type 2 diabetes. While there are many benefits to a ketogenic diet, it does change the body's metabolism.
People should consider it more a medical choice they plan to commit to rather than just something to 'try.'” (And for that matter, you need to know how to safely come off the keto diet.)
7. Cheat meals on keto aren't a thing
“To experience the full benefits of a ketogenic diet, consistency matters,” says Metzgar. That means not veering off course every week to indulge in a “cheat” meal. Each time you eat carbs, you take yourself ketosis, and you'll need to start all over again to get back into it.
“Forgoing the staple of a modern diet, carbohydrates, requires effort, sacrifice, and in many cases navigating social situations,” she adds. “Without a strong motivation or medical need, it can be hard for an individual to commit long-term to a ketogenic diet.”
8. Keto doesn't guarantee weight loss
“There's a misconception that keto automatically leads to weight loss,” Stefanski says. In reality, weight loss is not the point of the keto diet. It's possible to lose weight on keto, but it's also possible to gain it, she points out. (However, one Shape editor tried keto and lost more weight than she expected.)
“I really wish that people considering keto as an option for weight loss would meet with a licensed nutritionist first to assess the real reason for excess weight gain,” adds Stefanski. “If the cause of a person's obesity is stress eating or not enough exercise, keto isn't going to fix those issues. When a keto dieter gets bored, they'll be right back where they started.”
While keto is definitely a viable option for many people, it may also be worth it to explore other approaches before making a decision about which eating style to pursue, such as mindful eating, IIFYM or macro counting, or intuitive eating.