The ketogenic diet is not a benign, holistic or natural treatment for epilepsy; as with any serious medical therapy, there may be complications.[27] These are generally less severe and less frequent than with anticonvulsant medication or surgery.[27] Common but easily treatable short-term side effects include constipation, low-grade acidosis and hypoglycaemia if there is an initial fast. Raised levels of lipids in the blood affect up to 60% of children[37] and cholesterol levels may increase by around 30%.[27] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and, if persistent, by lowering the ketogenic ratio.[37] Supplements are necessary to counter the dietary deficiency of many micronutrients.[3]
This is highly unlikely to occur in normal circumstances because for most people it’s a challenge to get into optimal ranges for ketosis so getting into the range where you need medical intervention isn’t likely.
MCTs are a type of fat that can be readily used for energy by your body and do not have to be broken down before use. They are precursors to ketones and help your body burn fat instead of burning carbs. The primary whole food source of MCTs are coconuts.
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures and kidney stones.[3] 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.[37] About 1 in 20 children on the ketogenic diet will 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.[38] The stones are treatable and do not justify discontinuation of the diet.[38] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in a sevenfold decrease in the incidence of kidney stones.[39] 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:[38]
Achieving optimal ketosis hinges on finding the right balance of macronutrients (or “macros” in keto-speak); these are the elements in your diet that account for the majority of your calories, a.k.a. energy—namely, fat, protein, and carbohydrates. By the way, it’s often “net grams” of carbohydrates that are counted toward your daily intake; “net” deducts the amount of fiber in a food from its carbohydrate total.
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]
Planning is your key to success on the ketogenic diet. Knowing which foods to eat (and which to avoid), meal prepping and following a keto meal plan will help you reach your macro goals and stay in ketosis.
Hi Dr. Jockers. Your article is very thorough, thank you. I’ve been moving slowly into the keto diet and so far everything is good except for my stools now float. Is the higher increase in fats to blame? I’m taking digestive enzymes before each meal and I still have my gallbladder.
Take a multivitamin. “Because you are removing grains, the majority of fruit, some vegetables, and a significant amount of dairy from your menu, a multivitamin is good insurance against any micronutrient deficiencies,” says Jadin. Depending on what your individual overall diet looks like, Jadin says you might also need to add a calcium, vitamin D, and potassium supplement.
The last thing I suggest doing is buying the speciality items prior to needing them. Normally some of these items you can only find online, and by the time you need them, you’ll actually have them. There are no speciality items used in Week 1 for that reason. Make sure you order what you need and have it by the time you need it.
Many workout programs have you consuming a large number of carbs to fuel your workouts. While on keto you don’t need to bulk up on the carbs but you can fill up your glycogen stores so that you have glucose ready for a workout.
As I briefly mentioned already, hypoglycemia is the first underlying cause to contribute to side effects during keto-adaptation. This is because the body simply doesn’t know how to burn fat for energy yet.
Keto flu is a very common experience that some people go through when transitioning over to keto. It usually goes away in just a few days but if you don’t take active measures to find against it, it can stay around for much longer.
Coconut oil coffee probably sounds tasty, especially if you’re a coconut fan. But, you may be nervous to add things like butter, collagen and gelatin to your morning joe. Please don’t be scared. Collagen powder and gelatin are actually very neutral in their flavor profiles. Meanwhile, grass-fed butter adds a creamy richness that makes additional dairy like milk or cream unnecessary.
If you want to slam a protein shake post-workout, that’s probably fine as long as you’ve got room for it in your macros. But shoot for one that is very low—like, zero—in carbohydrates. If you struggle to fit fat in during the day, toss a tablespoon of olive oil in with your shake. You won’t taste it, and it gives a quick 13-14 grams of fat.
Can ketone production in the body get too high? Yes, it’s called ketoacidosis. Is it likely under normal circumstances? Not at all. For most people, it’s a challenge just to get into optimal ranges for ketosis. Getting into territory where you need medical intervention is just not likely.
Most people end up driving themselves crazy measuring and testing. It’s much better to focus on the nutritional aspect, making sure that you’re in taking proper foods and staying within your macro ranges (read below).
Keep it straightforward and strict. You usually see better results in people who restrict their carb intake further. Try to keep your carbs as low as possible for the first month of keto. Keep it strict by cutting out excess sweets and artificial sweeteners altogether (like diet soda). Cutting these out dramatically decreases sugar cravings.
Your glycogen stores can still be refilled while on a ketogenic diet. A keto diet is an excellent way to build muscle, but protein intake is crucial here. It’s suggested that if you are looking to gain mass, you should be taking in about 1.0 – 1.2g protein per lean pound of body mass. Putting muscle on may be slower on a ketogenic diet, but that’s because your total body fat is not increasing as much.

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A: This is likely an electrolyte problem. It’s necessary to get your sodium, potassium and magnesium in. This also helps prevent keto flu when you start out. I normally get enough from my food but if you don’t, you may want to add some supplements. Don’t rely on sports drinks like Gatorade as they only have like 5% of your recommended daily amount. Do salt your food generously – as your body is holding onto less water without carbs and you’re getting in much less sodium without a lot of the processed stuff, your sodium levels may get too low.
In the 1960s, it was discovered that medium-chain triglycerides (MCTs) 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 twelve 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]
Vegetarians and vegans are used to eating more healthy grains and carbs than fat. We know vegetarians and vegans who struggled to give up and replace their usual meals of sandwiches, pastas and starchy vegetables.
Crack egg into each jar. Heat oven to 400 degrees F. Transfer jars to deep baking dish and pour enough boiling water into baking pan to come halfway up the sides of the jars. Cover entire pan with aluminum foil and bake for 18-20 minutes.
Although egg yolks are high in cholesterol, consuming them doesn’t raise blood cholesterol levels in most people. In fact, eggs appear to modify the shape of LDL in a way that reduces the risk of heart disease (37).
Coconut butter isn’t anything like dairy butter. If you used coconut butter in your coffee, it would just be grainy and weird. Just use the coconut oil. It’s the same thing, only without the fiber the coconut “butter” has.
About four years ago I realized I was addicted to food. Putting that together and understanding the seriousness of what I was dealing with helped focus me. I set out to lose 100 lbs in a year. I started by counting calories and then eventually transitioned into basically a paleo, clean eating diet along with regular exercise and training. I accomplished my goal. I went from 325 to 225.
A business that doesn’t take a regular inventory usually goes broke – and it’s no different with us and the way we eat. Starting up on the ketogenic diet basically means we have to check in on what we need to start, what we need to stop and what we need to continue to make progress! It may be in the,
Experts on the ketogenic diet recommend it be strongly considered for children with uncontrolled epilepsy who have tried and failed two or three anticonvulsant drugs;[9] most children who start the ketogenic diet have failed at least three times this number.[24]
With HPA axis dysfunction you are likely to experience a disruption in sleep. This is because cortisol is antagonistic to melatonin (meaning it opposes its function). When the HPA axis is thrown off, cortisol levels begin to fluctuate and interfere with the release of melatonin that occurs at night-time.
“Keto diets should only be used under clinical supervision and only for brief periods,” Francine Blinten, R.D., a certified clinical nutritionist and public health consultant in Old Greenwich, Connecticut, told Healthline. “They have worked successfully on some cancer patients in conjunction with chemotherapy to shrink tumors and to reduce seizures among people suffering from epilepsy.”
The only real time where ketosis can give performance loss is in exercises that need an explosive action. If you need a little boost in your performance during these, you can “carb-up” by eating 25-50g of carbs about 30 minutes before you train.
Typically not Shelley. You could try incorporating a low-carb, high-fat diet while using a high quality MCT oil to assist with ketone production but if you feel very sluggish for longer than a week you should use more carbs from low glycemic sources along with strategies to support the adrenals and balance blood sugar.
All leafy greens, including dandelion or beet greens, collards, mustard, turnip, arugula, chicory, endive, escarole, fennel, radicchio, romaine, sorrel, spinach, kale, chard, etc. — range from 0.5–5 net carbs per 1 cup
Positive science on ketosis coupled with personal successes passed by word-of-mouth have driven more people to explore the ketogenic diet, says Volek. More recently, the keto diet hints at having a promising therapeutic role in cancer, Alzheimer’s, Parkinson’s and polycystic ovary syndrome (PCOS). Research is still early in many areas, but Volek suspects there will more definitive answers on the wider scope of the diet’s benefits within the next decade.
A: Although desirable, there’s no requirement to eat organic or grass fed. Just get whatever cheap meat and veggies and eggs you can find. Frozen is usually cheaper and wait till something’s on sale and stock up. You don’t need to buy all the fancy things like nut flours, MCT oil, psyllium husk, xantham gum etc. Just keep meals simple and it can all be easy and cheap.
Keto Connection Facebook Group – This is a great community of like minded people working together to help everyone succeed. Make use of this group for accountability, motivation, or even just for sharing recipes and asking questions.
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