In the first month of the study, participants were put on a baseline diet, which was designed to be similar to what they reported they were eating outside the hospital, including lots of sugary carbohydrates. For the second month, the participants got the same amount of calories and protein as they did in the first month of the study, but ramped up the amount of fat in their food and ate far fewer carbs.
Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[18] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[18]

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The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[7]

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Hi Fran, There could be many reasons and unfortunately the comment area is not the place for 1:1 support, but highly recommend our support group here for questions like this. The color on keto sticks does not indicate the amount of fat you are burning, only the amount of excess ketones that are spilling into urine combined with how dehydrated you are (or not). The goal is to be in ketosis, not necessarily a darker color.
Reduced Risk of High Cholesterol and Triglycerides. (8) Many doctors originally thought that a diet high in fat might increase cholesterol and triglycerides. However, the opposite has turned out to be the case. Most people see a significant drop in their LDL and triglycerides when on a keto diet, although a small percentage of people do see the opposite effect.

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In one of the most recent studies on the question, which appeared this month in the journal Diabetes Therapy, 262 adults with Type 2 diabetes patients followed a ketogenic diet, coupled with intensive lifestyle counseling. After a year, among the 218 people who completed the study, their hemoglobin A1C (a measure of blood sugar) dropped on average to 6.3, just below the 6.5 percent threshold for Type 2 diabetes. The need for insulin was either reduced or eliminated in 94 percent of the participants who were using insulin when the study began. Their use of diabetes medications — other than metformin — also declined, from 57 percent to 30 percent, and metformin use decreased slightly, from 71 percent to 65 percent.

Thank you, Maya! That helps a lot. I’ve had a difficult time with some tracking apps, because it goes by what others put in and finding an exact match is tough. I like your idea of just tracking for the day. I thought about getting a notebook and doing it that way. I’ll ponder that. Thank you for adding the nutritional info on each recipe. That helps so much!
Since the ideal protein intake is fixed based on your lean mass and activity level and your net carbs intake is specified by you, the only macronutrient that needs adjusting is the fat intake. Your fat intake is used to adjust the calorie intake. The more fat, the more calories. Typically, you adjust fat so that you reach but not exceed your target calories.

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Thank you, Maya! That helps a lot. I’ve had a difficult time with some tracking apps, because it goes by what others put in and finding an exact match is tough. I like your idea of just tracking for the day. I thought about getting a notebook and doing it that way. I’ll ponder that. Thank you for adding the nutritional info on each recipe. That helps so much!
While the evidence behind ketogenic diets for diabetes is still preliminary and the evidence for weight loss isn’t all that convincing (more on that next), the evidence of using the diet to treat epilepsy is extremely robust. The idea for treating people with epilepsy with the keto diet came about in the 1920s, when researchers observed that people who fasted experienced fewer seizures. (Researchers still aren’t sure why the diet can work for epilepsy, but a few mechanisms have been proposed, including making neurons more resilient during seizures.)

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For the study, he confined 17 overweight and obese patients for two months to a hospital, where researchers measured their every movement and controlled what they were eating. (Diet researchers called this study the “gold standard” since it was an extremely well-controlled experiment, with all food provided, and it used the best technologies for measuring energy expenditure and body composition.)

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Hi April, Some people stick to the percentages for each meal, others just do it for the whole day. As long as you aren’t eating all your carbs for the day in one meal, in general it’s fine to just make the macros add up for the day and not necessarily at every meal. If you want to be precise, the only way to know is to enter what you are eating (with the amount) into a tracking tool so that you can get the nutrition info. If you are making low carb / keto recipes from Wholesome Yum, the nutrition info is provided on each recipe card. Hope this helps!
Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[35] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[36] However, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.[9] Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[37]
DEXA (Dual-Energy X-Ray Absorptiometry): If you can afford it, a DEXA scan will give you the most accurate results. A DEXA is an X-ray treatment that measures body composition and can detect bone mineral density, lean body mass, and fat mass with great accuracy. However, they can only be done on a health facility and a comprehensive session can cost up to $160.
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture, and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more food energy than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein, and carbohydrate is then evenly divided across the meals.[37]

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A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]

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The low glycemic index treatment (LGIT)[49] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[18] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]

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There are numerous benefits that come with being on keto: from weight loss and increased energy levels to therapeutic medical applications. Most anyone can safely benefit from eating a low-carb, high-fat diet. Below, you’ll find a short list of the benefits you can receive from a ketogenic diet. For a more comprehensive list, you can also read our in-depth article here >

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It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]

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Lots of apps and websites offer keto diet challenges—basically, a blueprint for the keto diet with a fixed starting and ending point (they typically last for a week to a month, though some may be longer). Speaking of apps, plenty of keto-centric ones are right at your fingertips (a.k.a., your smartphone), like the KetoDiet app, which can help you calculate your macros and track your keto diet effectively.

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Keto breath, on the other hand, is less of a side-effect and more of a harmless inconvenience (your breath literally smells like nail polish remover). Basically, when your body breaks down all that extra fat on the keto diet, it produces ketones—one of which is the chemical acetone, Keatley previously told WomensHealthMag.com. (Yes, the same stuff that's in nail polish remover.)
In the mid-1990s, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.[1]
”According to the insulin-carbohydrate model, we should have seen an acceleration in the rate of body fat loss when insulin secretion was cut by 50 percent,” Hall told me when the study came out. But the researchers didn’t, which Hall thinks suggests that the regulation of fat tissue storage in the body has to do with more than just insulin levels and their relationship with the carbs we eat.
Achieving ketosis is a pretty straightforward, but it can seem complicated and confusing with all of the information out there.4If you want to learn more about ketosis and the scientific process around it, you can visit a very in-depth discussion about on Dr. Peter Attia’s website. Here’s the bottom line on what you need to do, ordered in levels of importance:

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People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.

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A macronutrient (macro) is one of three main sources of daily energy supply: carbohydrates, proteins and fats. All of them are essential in maintaining a healthy life and good exercise condition, but different diets and different occasions call for different balance between them and our keto calculator is here to help you estimate how much of each you need to consume to follow a keto dietary plan.
Another common effect of the ketogenic diet is “keto flu”: fatigue, lightheadedness, and dizziness people feel when they greatly reduce their carb intake. This effect should go away after the body adjusts to the diet, but staying on keto for a long time could lead to kidney stones, high cholesterol, constipation, slowed growth (in young people), and bone fractures. We actually don’t know whether keto is safe in the long term.

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A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[20] and followed-up by a report published in 2001.[21] As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.[21][22]

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It usually takes three to four days for your body to go into ketosis because you have to use up your body's stores of glucose, i.e., sugar first, Keatley says. Any major diet change can give you some, uh, issues, and Keatley says he often sees patients who complain of IBS-like symptoms and feeling wiped out at the beginning of the diet. (The tiredness happens because you have less access to carbs, which give you quick energy, he explains.) 

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Adequate protein intake and developing ketosis are both critical for maximising fat loss and sparing muscle mass during the ketogenic diet. However, it will take up to 3 weeks before your body gets keto-adapted (in some cases even more). During the initial phase of the ketogenic diet, nitrogen losses may occur if your daily net carbs intake is very low. When your carbohydrate intake goes down, your body converts body protein into glucose. Since about 16% of protein is nitrogen, you may lose muscle mass which will cause a decrease in your metabolic rate. This could have a negative impact on fat loss. For example, if your carbs intake is close to zero, you you may have to eat more protein (aka protein sparing modified fast). Keep in mind this applies to zero carbohydrate intake which means it does not affect most people following the ketogenic diet.

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Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.1There are scientifically-backed studies that show the advantage of a low-carb, ketogenic diet over a low-fat diet. One meta-analysis of low-carbohydrate diets showed a large advantage in weight loss. The New England Journal of Medicine study resulted in almost double the weight loss in a long-term study on ketone inducing diets.

Total carbs is not a precise indicator of the carb content of a food. When you see “total carbs” on a food label, the number beside it represents the cumulative total of grams of dietary fiber, sugar, and sugar alcohol that are in that food item or beverage. Net carb content, on the other hand, relates to the carb content of the food that is digested at four calories per gram and impacts your ketones levels.

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The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[58] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[56]
But people who started following the keto diet noticed weight loss for a few reasons: When you eat carbs, your body retains fluid in order to store carbs for energy (you know, in case it needs it). But when you’re not having much in the carb department, you lose this water weight, says Warren. Also, it's easy to go overboard on carbohydrates—but if you're loading up on fat, it may help curb cravings since it keeps you satisfied.

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If you are looking to put your health on a new track, these books can help you renovate your life. Whether you are dealing with weight issues, or other health concerns such as Type-2 diabetes, autoimmune disorders, depression, Alzheimer’s, or some other gut and brain health related issues, you will be able to find value in any of these keto books on our list.

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When I recently asked Hall what his research tells us about weight loss with the ketogenic diet, he said simply: “The idea is that low-carb, ketogenic diets cause your body to burn way more calories, resulting in a lot of weight loss, even if you eat more than you were eating before. But our studies, as well as many others, demonstrate nothing of the sort.”

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Those issues can be part of what's known as the “keto flu,” Warren says. Other side effects of the keto diet, all of which are tied to carb withdrawal, can include lightheadedness, nausea, mental fog, cramps, and headaches, in addition to tiredness. Luckily, the keto flu doesn't usually last more than a week—which is coincidentally about when people start to see the number on the scale go down, says Warren.
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]

But what’s lost in the many trend articles and books about “going keto” for weight loss today is that this diet is the same one the now-late Dr. Robert Atkins and other low-carb evangelists have been selling since the 1960s. (Diet peddlers have an incredible knack for rebranding old ideas over and over, and in our eternal confusion about what to eat, we keep falling for it all.)

A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]

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The aim is to find the level best suited for you. There are two ways to count carbs - you can either count total carbs or net carbs (net carbs are total carbs minus fibre). According to Volek and Phinney, you should not eat more than 50 grams of total carbs (25-30 grams of net carbs) on a ketogenic diet. If your aim is to lose weight or maintain a healthy weight, eating 20-30 grams of net carbs (up to 50 grams of total carbs) is a great way to start. If you want to learn more about total vs net carbs, read this post.

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There are so many tricks, shortcuts, and gimmicks out there on achieving optimal ketosis – I’d suggest you don’t bother with any of that. Optimal ketosis can be accomplished through dietary nutrition alone (aka just eating food). You shouldn’t need a magic pill to do it. Just stay strict, remain vigilant, and be focused on recording what you eat (to make sure your carb and protein intake are correct).
When you approach your normal body weight, the weight loss will slow. Just remember, a “normal” body weight differs from person to person depending on our genetics and environmental exposures and may not fit what we see in the popular media. The weight loss won’t go on forever. As long as you follow the advice to eat when you are hungry, you will eventually stabilize your weight.

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First of all, don't weigh yourself more than once a week. There are natural fluctuations related to water retention and hormonal balance. If you are a woman, you will notice these fluctuations more often. If you see no movement on the scales or even if your weight goes up, it doesn't mean you are not losing fat. If you exercise, you may even see a little increase in weight, as muscles are heavier than fat. The important thing here is to concentrate on losing body fat. Don’t rely just on scales, use body tape, calipers, belts or clothes to see any changes.
Conklin's fasting therapy was adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent endocrinologist Henry Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite only having studied the patients for a short time. Further studies in the 1920s indicated that seizures generally returned after the fast. Charles P. Howland, the parent of one of Conklin's successful patients and a wealthy New York corporate lawyer, gave his brother John Elias Howland a gift of $5,000 to study "the ketosis of starvation". As professor of paediatrics at Johns Hopkins Hospital, John E. Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.[10]

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According to history, the ketogenic diet was originally designed in the 1920s to treat pediatric epilepsy. The idea has been abandoned due to the rise of a number of epilepsy and seizure medications. Seeing that it has a lot of health benefits, medical doctors modified the diet for different purposes (e.g, weight loss). It’s actually very similar to Atkin’s Diet and somewhat related to South Beach and Paleo diets.

When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).
Adequate protein intake and developing ketosis are both critical for maximising fat loss and sparing muscle mass during the ketogenic diet. However, it will take up to 3 weeks before your body gets keto-adapted (in some cases even more). During the initial phase of the ketogenic diet, nitrogen losses may occur if your daily net carbs intake is very low. When your carbohydrate intake goes down, your body converts body protein into glucose. Since about 16% of protein is nitrogen, you may lose muscle mass which will cause a decrease in your metabolic rate. This could have a negative impact on fat loss. For example, if your carbs intake is close to zero, you you may have to eat more protein (aka protein sparing modified fast). Keep in mind this applies to zero carbohydrate intake which means it does not affect most people following the ketogenic diet.

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