First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48]

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This is the purpose of this article—keto diet explained as simple as it can be. Understand the ketogenic diet, the metabolic state of ketosis, why ketones are preferred than glucose and other things associated with this diet.  It’s not ideal to follow a diet just because it’s popular. When you’re completely educated about the keto diet, you’ll be more convinced, determined and be successful with your goal.

After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]


Once ketogenesis kicks in and ketone levels are elevated, the body is in a state called “ketosis,” during which it’s burning stored fat. There are a few ways to get into ketosis. One is through fasting: When you stop eating altogether for an extended period of time, the body will ramp up fat burning for fuel and decrease its use of glucose (which is part of the reason people can survive for as long as 73 days without food).

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The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.[3]

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Keto for Women, my third paperback, delves into what the keto diet is (and is not) and how women can reap the many health benefits by using a targeted method specifically designed for their bodies. You’ll be shown why hormone imbalances cause many of the negative symptoms you experience and what keto foods and protocols will work best to remedy those. By showing you how to understand your body, you will be empowered to find solutions that are right for you as an individual and stay in control each step of the way.

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The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[18]

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In the 1960s, medium-chain triglycerides (MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides).[15] MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system.[16] The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[15] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[10]
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!
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[46]
If you stick to g of carbs, g protein, and g fat, you will eat kcal and lose kg (lbs) in the first month. Keep in mind that your body weight can fluctuate by ±2kg (±4lbs) on any given day from water weight and what's in your stomach. Recalculate your macro ratio once a month! Changes in body composition have a large influence on the recommendations and weight loss.

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The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]

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Here’s what we do know: The keto diet may be useful in treating symptoms of epilepsy, a seizure disorder. “The use of keto in treating epilepsy has the most evidence,” Angelone says. One study conducted by Johns Hopkins Medicine, for example, followed epileptic patients on the keto diet and found that 36 percent of them had a 50 percent reduction in seizures after three months on the diet, and 16 percent were seizure-free. However, experts aren't entirely sure why the keto diet has this affect, she adds.

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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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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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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 a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.[3]

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.
Here’s what we do know: The keto diet may be useful in treating symptoms of epilepsy, a seizure disorder. “The use of keto in treating epilepsy has the most evidence,” Angelone says. One study conducted by Johns Hopkins Medicine, for example, followed epileptic patients on the keto diet and found that 36 percent of them had a 50 percent reduction in seizures after three months on the diet, and 16 percent were seizure-free. However, experts aren't entirely sure why the keto diet has this affect, she adds.
You didn’t convert grams to calories. You must convert the grams of fat and protein to calories and then calculate your macronutrient percentages. Calorie percentages, not gram percentages, are what the recommended keto percentages are based on. Usually, once you account for the fact that one gram of fat has five more calories than one gram of protein the calorie percentages will end up being what you expect from a typical keto diet.

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There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[7]

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If you select Gain Muscle as your goal, then you can select the Gain (surplus). The macro calculator will then recommend that you eat this percentage more calories than you need. Eating more calories than you need will result in weight gain, which will be in the form of muscle if you do weight training. For example, if you select 10% as the gain, the calculator will output 10% more calories than your body needs for maintenance.

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NOTICE: The information contained or presented on this website is for educational purposes only. Information on this site is NOT intended to serve as a substitute for diagnosis, treatment, or advice from a qualified, licensed medical professional. The facts presented are offered as information only - not medical advice - and in no way should anyone infer that we or anyone appearing in any content on this website are practicing medicine. Any diet, health, or nutritional program you undertake should be discussed with your doctor or other licensed medical professional. Seek the advice of a medical professional for proper application of ANY material on this site to your specific situation.


During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. This changed in 1938 when H. Houston Merritt, Jr. and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox–Gastaut syndrome, declined further.[10]
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This is the purpose of this article—keto diet explained as simple as it can be. Understand the ketogenic diet, the metabolic state of ketosis, why ketones are preferred than glucose and other things associated with this diet.  It’s not ideal to follow a diet just because it’s popular. When you’re completely educated about the keto diet, you’ll be more convinced, determined and be successful with your goal.

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Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose).[19] Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.[56]

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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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Get Plenty of Sodium. This might sound counter to what you’ve been told before, but your body really needs sodium. It’s one of the ways that your cells transport nutrients in and out of cells. And when you stop eating processed grains and sugar, you often get much less sodium. So when you go keto, just be sure that you’re eating salt or sodium-rich foods. If not, you will often experience fatigue.

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

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Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][31][32] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.[9][33]

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