A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians who are needed to administer a ketogenic diet programme.[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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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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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.

The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]

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Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]

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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]
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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Our bodies need energy to function properly. We usually get energy from carbohydrates found in rice, bread, pasta, whole grains, sweets, etc.  The body then converts carbohydrates to glucose. Glucose becomes the body’s primary source of energy. We also get energy from fats. However, since the body makes use of glucose as its main source of energy, fats consumed are not needed as energy and, therefore are stored in different parts of our body.

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A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >

Hi Michelle, You don’t necessarily have to “hit” macros to get into ketosis. Ketosis is achieved by restricting carbohydrates, that’s it. Fat is needed for satiety and protein is needed to prevent muscle loss. So make protein a goal and carbs a limit, then eat enough fat to stay satisfied and don’t go over your macros. You can get more individual help in our support group.

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Jeremy Hendon grew up in Georgia, studied at Emory and UC Berkeley, and practiced law for 6 years in LA and NYC. For much of his life, Jeremy was overweight and unable to consistently find a way to get healthy. That’s a big part of the reason why he co-founded Louise’s foods, 2 health magazines, KetoSummit.com, and now CoBionic.com. He’s also co-authored multiple books, had his products featured on national TV, and has lived in 9 different countries over the last 5 years. You can find him on Facebook or LinkedIn.
A computer program such as KetoCalculator may be used to help generate recipes.[47] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[37]

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In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.
Another way to get into ketosis is by eating less than 20 grams of carbs — or a slice of bread — per day. So people on a ketogenic diet get about 5 percent of their calories from carbohydrates, 15 percent from protein, and 80 percent from fat. Note that that’s a much lower ratio of protein and a lot more fat than you’d get on other low-carb diets, but it’s this ratio that will force the body to derive much of its energy from ketones. If you eat too much protein, or too many carbs, your body will be thrown out of ketosis.

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On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.
Hi Megan, Sorry about that – there was an issue with that section and you should now see it in the FAQ above, explaining how it’s determined. The weight loss per week will depend on how much weight you have to lose, as weight loss happens more rapidly the more overweight you are. But in general, between 0.5 and 2 pounds loss per week is reasonable. 

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Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions.[19] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[18]
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!

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In the first week, many people report headaches, mental fogginess, dizziness, and aggravation. Most of the time, this is the result of your electrolytes being flushed out, as ketosis has a diuretic effect. Make sure you drink plenty of water and keep your sodium intake up.6One of the fathers of keto, Dr. Phinney, shows that electrolyte levels (especially sodium) can become unbalanced with low carb intake.

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In ketogenesis, our livers start to break down fat into a usable energy source called ketone bodies, or ketones for short. “Organs like the brain that normally rely primarily on glucose for fuel can begin to use a substantial amount of ketones,” said Kevin Hall, a National Institutes of Health senior investigator who has studied the ketogenic diet. So ketones can stand in for glucose as fuel for the body when there’s a glucose shortage. “It’s an amazing physiological adaption to starvation that allows tissues like the brain to survive,” Hall added.

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The ketogenic diet has recently become very popular, and many food companies want to cash in by putting a “ketogenic” or “low carb” label on a new product. Be very cautious of special “keto” or “low-carb” products, such as pastas, chocolate bars, energy bars, protein powders, snack foods, cakes, cookies and other “low carb” or “ketogenic” treats. Read all labels carefully for natural low carb ingredients. The fewer ingredients the better.


The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]

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In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]

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This seminal randomized trial, published in JAMA in 2007, involved 300 women and measured their weight loss on the Atkins diet compared to the Zone, Learn, and Ornish diets. The researchers found that while women on Atkins shed a few more pounds, the weight loss on low-carb diets was “likely to be at least as large as for any other dietary pattern” and “the magnitude of weight loss [on Atkins] was modest, with a mean 12-month weight loss of only 4.7 kg.” In other words, long-term weight loss on Atkins wasn’t meaningfully different from the other diets.

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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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A cyclical keto diet follows the standard keto diet of 50 grams or fewer of carbs a day, with the exception of a “carb refeed” day on the seventh day of the week when you can up your carb intake to 150 grams. For some people, a standard keto diet can lead to burnout, thyroid problems, and dry eyes. Using carb cycling will help avoid these potential problems.

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Meat – Unprocessed meats are low carb and keto-friendly, and organic and grass-fed meat might be even healthier. But remember that keto is a high-fat diet, not high protein, so you don’t need huge amounts of meat. Excess protein (more than your body needs) is converted to glucose, making it harder to get into ketosis. A normal amount of meat is enough.

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Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]

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Make things yourself. While it’s extremely convenient to buy most things pre-made or pre-cooked, it always adds to the price per pound on items. Try prepping veggies ahead of time instead of buying pre-cut ones. Try making your stew meat from a chuck roast. Or, simply try to make your mayo and salad dressings at home. The simplest of things can work to cut down on your overall grocery shopping.
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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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]
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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In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10]

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Let's find out your body fat percentage. Based on your height and weight, your body fat percentage might be around %. The most accurate measurement would be a DEXA. Skin fold measurement with a good caliper is also pretty accurate. The easiest way is to just estimate it from some comparison pictures. More: 1, 2, 3, 4. You can also try this calculator but that can be inaccurate.
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]

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With Type 2 diabetes, the body either doesn’t produce enough insulin or becomes insulin-resistant, so it can’t move glucose from the blood into the cells for energy. Eating carbs results in an increase in blood glucose — so if you vastly cut down your carbs, your blood glucose levels won’t go up as much, and you won’t need as much insulin to manage blood sugars. It’s not surprising that researchers have been finding that people who follow a ketogenic diet can better manage their blood sugar by cutting down their carbs.

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Depending on the info that you enter into our keto calculator, you will get different ratios of fat, protein, and carbs. In general, carbs should remain low because they will prevent you from entering into ketosis and getting all of the benefits of the keto diet. By limiting carb consumption to this degree, many people will lose a considerable amount of water weight as well.
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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