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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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). MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system. 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. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
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The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy. It is approved by national clinical guidelines in Scotland, England, and Wales and reimbursed by nearly all US insurance companies. Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet. About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults. A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.
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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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, leading to more food choices and larger portion sizes. The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil. 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. 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.
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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.
A dirty keto diet also follows the standard keto diet but with disregard to the nutrient value or quality of the food consuming. For example, you could go to a fast food restaurant and order a bunless cheeseburger chased down with a diet soda and still be keto. This works if you’re traveling and really have no better options, but is not recommended in the long run because of a host of negative effects, such as the inflammation, cravings, increased blood pressure due to the high sodium, and bloating.
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The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted. It involves a consultation with the patient and their caregivers and, later, a short hospital admission. Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.
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.
The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.