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What Is the Ketogenic Diet?

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The ketogenic diet is a low-carb, high-fat diet that offers many health benefits.

More than 20 studies show that this type of diet can help you lose weight and improve health (1).

Ketogenic diets may even have benefits against diabetes, cancer, epilepsy and Alzheimer's disease (2, 3, 4, 5).

This article is a detailed beginner's guide to the ketogenic diet.

It contains everything you need to know.

What is a Ketogenic Diet?

The ketogenic diet (often termed keto) is a very low-carb, high-fat diet that shares many similarities with the Atkins and low-carb diets.

It involves drastically reducing carbohydrate intake and replacing it with fat. The reduction in carbs puts your body into a metabolic state called ketosis.

When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain (6, 7).

Ketogenic diets can cause massive reductions in blood sugar and insulin levels. This, along with the increased ketones, has numerous health benefits (6, 8, 9, 10, 11).

Bottom Line: The ketogenic diet (keto) is a low-carb, high-fat diet. It lowers blood sugar and insulin levels and shifts the body's metabolism away from carbs and towards fat and ketones.

Different Types of Ketogenic Diets

There are several versions of the ketogenic diet, including:

  • Standard ketogenic diet (SKD): This is a very low-carb, moderate-protein and high-fat diet. It typically contains 75 percent fat, 20 percent protein and only 5 percent carbs (1).
  • Cyclical ketogenic diet (CKD): This diet involves periods of higher-carb refeeds, such as five ketogenic days followed by two high-carb days.
  • Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
  • High-protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60 percent fat, 35 percent protein and 5 percent carbs.

However, only the standard and high-protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.

The information in this article mostly applies to the standard ketogenic diet (SKD), although many of the same principles also apply to the other versions.

Bottom Line: There are several versions of the ketogenic diet. The standard ketogenic diet (SKD) is the most researched and most recommended.

Ketogenic Diets Can Help You Lose Weight

A ketogenic diet is an effective way to lose weight and lower risk factors for disease (8, 9, 10, 11, 12, 13).

In fact, research shows that the ketogenic diet is far superior to the recommended low-fat diet (2, 14, 15, 16).

What's more, the diet is so filling that you can lose weight without counting calories or tracking your food (16).

One study found that people on a ketogenic diet lost 2.2 times more weight than those on a calorie-restricted low-fat diet. Triglyceride and HDL cholesterol levels also improved (17).

Another study found that participants on the ketogenic diet lost three times more weight than those on the Diabetes UK's recommended diet (18).

There are several reasons why a ketogenic diet is superior to a low-fat diet. One is the increased protein intake, which provides numerous benefits (14, 19, 20).

The increased ketones, lowered blood sugar levels and improved insulin sensitivity may also play a key role (21, 22, 23, 24, 25, 26).

For more details on the weight loss effects of a ketogenic diet, read this article: A Ketogenic Diet to Lose Weight and Fight Disease.

Bottom Line: A ketogenic diet can help you lose much more weight than a low-fat diet. This often happens without hunger.

Ketogenic Diets for Diabetes and Prediabetes

Diabetes is characterized by changes in metabolism, high blood sugar and impaired insulin function (27).

The ketogenic diet can help you lose excess fat, which is closely linked to type 2 diabetes, prediabetes and metabolic syndrome (28, 29, 30).

One study found that the ketogenic diet improved insulin sensitivity by a whopping 75 percent (29).

Another study in patients with type 2 diabetes found that seven of the 21 participants were able to stop all diabetes medications (28).

In yet another study, the ketogenic group lost 24.4 lbs (11.1 kg), compared to 15.2 lbs (6.9 kg) in the higher-carb group. This is an important benefit when considering the link between weight and type 2 diabetes (2, 31).

Additionally, 95.2 percent of the ketogenic group was also able to stop or reduce diabetes medication, compared to 62 percent in the higher-carb group (2).

This article has more details about low-carb diets and diabetes.

Bottom Line: The ketogenic diet can boost insulin sensitivity and cause fat loss, leading to drastic improvement for type 2 diabetes and prediabetes.

Other Health Benefits of the Ketogenic Diet

The ketogenic diet actually originated as a tool for treating neurological diseases, such as epilepsy.

Studies have now shown that the diet can have benefits for a wide variety of different health conditions:

  • Heart disease: The ketogenic diet can improve risk factors like body fat, HDL levels, blood pressure and blood sugar (32, 33).
  • Cancer: The diet is currently being used to treat several types of cancer and slow tumor growth (4, 34, 35, 36).
  • Alzheimer's disease: The diet may reduce symptoms of Alzheimer's and slow down the disease's progression (5, 37, 38).
  • Epilepsy: Research has shown that the ketogenic diet can cause massive reductions in seizures in epileptic children (3).
  • Parkinson's disease: One study found that the diet helped improve symptoms of Parkinson's disease (39).
  • Polycystic ovary syndrome: The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome (40).
  • Brain injuries: One animal study found that the diet can reduce concussions and aid recovery after brain injury (41).

However, keep in mind that research into many of these areas is far from conclusive.

Bottom Line: A ketogenic diet may provide many health benefits, especially with metabolic, neurological or insulin-related diseases.

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Foods to Avoid

In short, any food that is high in carbs should be limited.

Here is a list of foods that need to be reduced or eliminated on a ketogenic diet:

  • Beans or legumes: Peas, kidney beans, lentils, chickpeas, etc.
  • Low-fat or diet products: These are highly processed and often high in carbs.
  • Some condiments or sauces: These often contain sugar and unhealthy fat.
  • Unhealthy fat: Limit your intake of processed vegetable oils, mayonnaise, etc.
  • Sugar-free diet foods: These are often high in sugar alcohols, which can affect ketone levels in some cases. These foods also tend to be highly processed.

Bottom Line: Avoid carb-based foods like grains, sugars, legumes, rice, potatoes, candy, juice and even most fruits.

Foods to Eat

You should base the majority of your meals around these foods:

  • Fatty fish: Such as salmon, trout, tuna and mackerel.
  • Butter and cream: Look for grass-fed when possible.
  • Cheese: Unprocessed cheese (cheddar, goat, cream, blue or mozzarella).
  • Avocados: Whole avocados or freshly made guacamole.

Bottom Line: Base the majority of your diet on foods such as meat, fish, eggs, butter, nuts, healthy oils, avocados and plenty of low-carb veggies.

A Sample Ketogenic Meal Plan For One Week

To help get you started, here is a sample ketogenic diet meal plan for one week:

Monday

  • Breakfast: Bacon, eggs and tomatoes.
  • Lunch: Chicken salad with olive oil and feta cheese.
  • Dinner: Salmon with asparagus cooked in butter.

Tuesday

  • Breakfast: Egg, tomato, basil and goat cheese omelet.
  • Dinner: Meatballs, cheddar cheese and vegetables.

Wednesday

  • Breakfast: A ketogenic milkshake (try this or this).
  • Lunch: Shrimp salad with olive oil and avocado.
  • Dinner: Pork chops with Parmesan cheese, broccoli and salad.

Thursday

  • Breakfast: Omelet with avocado, salsa, peppers, onion and spices.
  • Lunch: A handful of nuts and celery sticks with guacamole and salsa.
  • Dinner: Chicken stuffed with pesto and cream cheese, along with vegetables.

Friday

  • Breakfast: 3-cheese omelet with tomatoes.
  • Lunch: Leftover stuffed chicken from the night before.
  • Dinner: Steak, egg, mushrooms and salad.

Friday

  • Breakfast: Sugar-free yogurt with peanut butter, cocoa powder and stevia.
  • Lunch: Beef stir-fry cooked in coconut oil with vegetables.
  • Dinner: Bun-less burger with bacon, egg and cheese.

Saturday

  • Breakfast: Ham and cheese omelet with vegetables.
  • Lunch: Ham and cheese slices with nuts.
  • Dinner: White fish, egg and spinach cooked in coconut oil.

Sunday

  • Breakfast: Fried eggs with bacon and mushrooms.
  • Lunch: Burger with salsa, cheese and guacamole.
  • Dinner: Steak and eggs with a side salad.

Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefits.

For tons of recipes, check out this link: 101 Healthy Low-Carb Recipes.

Bottom Line: You can eat a wide variety of tasty and nutritious meals on a ketogenic diet.

Healthy Ketogenic Snacks

In case you get hungry between meals, here are some healthy, keto-approved snacks:

  • Fatty meat or fish.
  • Cheese.
  • A handful of nuts or seeds.
  • 1–2 hard-boiled eggs.
  • A low-carb milk shake with almond milk, cocoa powder and nut butter.
  • Full-fat yogurt mixed with nut butter and cocoa powder.
  • Strawberries and cream.
  • Celery with salsa and guacamole.
  • Smaller portions of leftover meals.

Bottom Line: Great snacks for a keto diet include pieces of meat, cheese, olives, boiled eggs, nuts and dark chocolate.

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Tips for Eating Out on a Ketogenic Diet

It is not very hard to make most restaurant meals keto-friendly when eating out.

Most restaurants offer some kind of meat or fish-based dish. Order this and replace any high-carb food with extra vegetables.

Egg-based meals are also a great option, such as an omelet or eggs and bacon.

Another favorite is bun-less burgers. You could also leave the bun and swap the fries for vegetables instead. Add extra avocado, cheese, bacon or eggs.

At Mexican restaurants, you can enjoy any type of meat with extra cheese, guacamole, salsa and sour cream.

For dessert, ask for a mixed cheese board or double cream with berries.

Bottom Line: When eating out, select a meat, fish or egg-based dish. Order extra veggies instead of carbs or starches and have cheese for dessert.

Side Effects and How to Minimize Them

Although the ketogenic diet is safe for healthy people, there may be some initial side effects while your body adapts.

This is often referred to as “keto flu"—and is usually over within a few days.

Keto flu includes poor energy and mental function, increased hunger, sleep issues, nausea, digestive discomfort and decreased exercise performance.

In order to minimize this, you can try a regular low-carb diet for the first few weeks. This may teach your body to burn more fat before you completely eliminate carbs.

A ketogenic diet can also change the water and mineral balance of your body, so adding extra salt to your meals or taking mineral supplements can help.

For minerals, try taking 3,000–4,000 mg of sodium, 1,000 mg of potassium and 300 mg of magnesium per day to minimize side effects.

At least in the beginning, it is important to eat until fullness and to avoid restricting calories too much. Usually a ketogenic diet causes weight loss without intentional calorie restriction.

Bottom Line: Many of the side effects of starting a ketogenic diet can be limited. Easing into the diet and taking mineral supplements can help.

Supplements For a Ketogenic Diet

Although no supplement is necessary, some can be useful.

  • MCT oil: Added to drinks or yogurt, this provides energy and helps increase ketone levels.
  • Minerals: Added salt and other minerals can be important when starting out, due to shifts in water and mineral balance.
  • Caffeine: Caffeine can have benefits for energy, fat loss and performance.
  • Exogenous ketones: This supplement can help raise the body's ketone levels.
  • Creatine: Creatine provides numerous benefits for health and performance. This can help if you are combining a ketogenic diet with exercise.
  • Whey: Use half a scoop of whey protein in shakes or yogurt to increase your daily protein intake.

Bottom Line: Certain supplements can be beneficial on a ketogenic diet. These include exogenous ketones, MCT oil and minerals.

Frequently Asked Questions

Here are answers to some of the most common questions about the ketogenic diet.

1. Can I ever eat carbs again?

Yes. However, it is important to eliminate them initially. After the first 2–3 months, you can eat carbs on special occasions—just return to the diet immediately after.

2. Will I lose muscle?

There is a risk of losing some muscle on any diet. However, the high protein intake and high ketone levels may help minimize muscle loss, especially if you lift weights.

3. Can you build muscle on a ketogenic diet?

Yes, but it may not work as well as on a moderate-carb diet. More details: Low-Carb/Ketogenic Diets and Exercise Performance.

4. Do I need to refeed or carb load?

No. However, a few higher-calorie days may be beneficial every now and then.

5. How much protein can I eat?

Protein should be moderate, as a very high intake can spike insulin levels and lower ketones. Around 35 percent of total calorie intake is probably the upper limit.

6. What if I am constantly tired, weak or fatigued?

You may not be in full ketosis or be utilizing fats and ketones efficiently. To counter this, lower your carb intake and re-visit the points above. A supplement like MCT oil or ketones may also help.

7. My urine smells fruity? Why is this?

Don't be alarmed. This is simply due to the excretion of byproducts created during ketosis.

8. My breath smells. What can I do?

This is a common side effect. Try drinking naturally flavored water or chewing sugar-free gum.

9. I heard ketosis was extremely dangerous. Is this true?

People often confuse ketosis with ketoacidosis. The former is natural, while the latter only occurs in uncontrolled diabetes.

Ketoacidosis is dangerous, but the ketosis on a ketogenic diet is perfectly normal and healthy.

10. I have digestion issues and diarrhea. What can I do?

This common side effect usually passes after 3–4 weeks. If it persists, try eating more high-fiber veggies. Magnesium supplements can also help with constipation.

A Ketogenic Diet is Great, But Not For Everyone

A ketogenic diet can be great for people who are overweight, diabetic or looking to improve their metabolic health.

It may be less suitable for elite athletes or those wishing to add large amounts of muscle or weight.

And, as with any diet, it will only work if you are consistent and stick with it in the long-term.

That being said, few things are as well proven in nutrition as the powerful health and weight loss benefits of a ketogenic diet.

This article was reposted from our media associate Authority Nutrition.

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By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach

The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.

When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.

We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.

Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.

What Is Guillain-Barre Syndrome?

Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.

Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.

To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.

Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.

The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.

Guillain-Barre Syndrome and Pandemics

As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.

Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.

Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?

The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.

Understanding the Association Between COVID-19 and Guillain-Barre Syndrome

While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.

It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.

Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.

Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.

Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.

Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.

Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.

Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Reposted with permission from The Conversation.