¢ Athletic Performance Impediments: For those people who train heavy and hard, going keto might cramp your style. As important as protein is for muscle growth, carbs also play an equally critical role by releasing insulin to drive that protein into muscles faster. It also helps us build up glycogen stores for longer training sessions, runs or hikes. One comprehensive review of the literature in sports nutrition found that while research is lacking on the long-term impacts of the keto diet, in the short term, the keto diet is inferior to other diet protocols on anaerobic, aerobic and in some cases even strength performance measures.

One of the most common side effects of starting the ketogenic diet is the œketo flu. This term describes the often unpleasant, fatigue-inducing symptoms that occur as the body adjusts from a high-carbohydrate to a low-carbohydrate diet. During the keto flu, the body's stored glucose begins depleting, and the body starts adapting to producing and utilizing ketones as energy. (2)


When you're first getting started, it can be helpful to use a blood or breath ketone meter. What these meters do is measure the amount of ketones (the energy source your body is switching to) in your blood or your breath. Knowing those amounts and seeing how they increase or decrease depending on what you're eating daily can often be a motivating and helpful indicator of the transition occurring in your body.
¢Sodium: Believe it or not, depending on your diet, you may be low on salt. When carb intake is low and insulin isn't being excreted, the kidneys absorb less sodium and potassium and excrete more as waste, leaving you feeling dizzy, fatigued and grumpy. Rather than reaching for more processed food, try seasoning your food a little more liberally with sea salt.
The ketogenic diet is based on the principle that by depleting the body of carbohydrates, which are its primary source of energy, you can force the body to burn fat for fuel, thereby maximizing weight loss. When you consume foods that contain carbohydrates, the body converts those carbohydrates into glucose, or blood sugar, which it then uses for energy. (1)
Some people also experience a change in bathroom habits. Moving your bowels can be difficult with a dramatic change in diet, and can be helped by choosing specific foods over others. Cheese is well known to stop up the works, so reducing cheese can help. Making sure to include plenty of fibrous vegetables can also keep things moving, so make sure to get lots of leafy greens, celery, and other veggies. In addition, make sure to drink enough water. Water not only keeps you hydrated, but also helps keep the bowels moving.
Exogenous ketones, or ketones that are produced in a lab and then consumed, have been compared to jet fuel, both as a fuel for the brain and body, and as a flavor comparison. It's like kick-starting ketosis, or enhancing it, since you wind up with vastly more ketone bodies in circulation with a concurrent drop in blood glucose. The best, most effective, and safest version of exogenous ketones currently available are ketone salts. They can potentially get you into ketosis faster, and help you reap the benefits of a low carb diet, but they're still relatively new to the market (12).
Experts are split on whether the keto diet is a good idea. On the one hand, Lori Chang, registered dietitian and a supervisor at the Center for Healthy Living at Kaiser Permanente West Los Angeles, says using a œcleaner source of energy”ketones rather than quick-burning carbohydrates”can improve mood and energy levels. When you eat refined carbohydrates or just too many carbs in general, the blood is flooded with excess insulin, Chang says. "This can lead to a blood sugar rollercoaster that stresses the body and negatively impacts energy levels and mood. When you're in a state of ketosis, however, ketone bodies don't require insulin to cross the blood-brain barrier, which wards off unfavorable blood sugar levels."
If you do try the diet outside of medical supervision, Kizer says it's important to test your urine with urinalysis ketone test strips to ensure your ketone levels don't become dangerously high. Ketone urine test strips are also used by people with diabetes to determine if they're at risk for ketoacidosis (DKA), a life-threatening complication that occurs when an individual doesn't have enough insulin in their body. (Healthy ketosis is considered 0.5 to 3.0 mM blood ketones.)
¢ Type 2 Diabetes: This population has been studied heavily with the keto diet since it's technically as low-carb as you can get. While the research to date has been conducted in very small sample sizes, evidence suggests that an ultra-low-carb diet (like the keto diet) may help reduce A1C and improve insulin sensitivity by as much as 75 percent. In fact, a 2017 review found that a keto diet was associated with better glucose control and a reduction in medication use. Having said that, the authors cautioned that it was unclear whether the results were due to weight loss in general, or higher ketone levels.
If you start at 20g of carbohydrates a day, you should slowly move to 50 as you reach your goal. Once you reach your goal, you can up your carbs as you see how they effect your weight. If you eat fruit for a week and gain weight, cut back. You have to figure out what works best for you. Ketosis is usually reached by only consuming 50g of carbs or less each day so that should be your starting range. I would not move past this until you have reached your goal weight and started to exercise daily (more about exercise is at the bottom of this post).
Most alcoholic beverages don't list the ingredients or nutritional information on the label, so be prepared and check your favorite drinks online so you know your limits beforehand. Most apps and trackers list many types of alcohol in their database, and this is the easiest way to be sure of what you're drinking. Be warned, when you're in ketosis your alcohol tolerance will go down, so you might not want to drink as much as you might be used to.
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:

There are several medical studies ” such as two conducted by the Department of Radiation Oncology at the Holden Comprehensive Cancer Center for the University of Iowa, and the National Institutes of Health's National Institute of Neurological Disorders and Stroke, for example ” that show the ketogenic diet is an effective treatment for cancer and other serious health problems. (12)
There are so many vegetables that you can use, and so many ways to prepare them, that an entire book could be written on the topic. Most vegetables that grow above the ground are high in fiber, vitamins, minerals, and antioxidants. They can be added to meat dishes, cooked on their own, or eaten as a salad. Vegetables are inexpensive, easy to prepare, and can be part of every meal. Most of them are quite low in carbohydrates, so it's hard to overindulge in this food group.
Y. Wady Aude, MD; Arthur S. Agatston, MD; Francisco Lopez-Jimenez, MD, MSc; Eric H. Lieberman, MD; Marie Almon, MS, RD; Melinda Hansen, ARNP; Gerardo Rojas, MD; Gervasio A. Lamas, MD; Charles H. Hennekens, MD, DrPH, œThe National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat, Arch Intern Med. 2004;164(19):2141-2146. http://archinte.jamanetwork.com/article.aspx?articleid=217514.
In a state of ketosis, your body breaks fat down in the liver and converts it into ketones to be used for energy. Fat doesn't generate an insulin response, so insulin levels remain stable. This makes it much harder to store excess fat, and easier to tap into body fat stores for energy. Not only will this allow you to maintain your weight, but it will greatly encourage weight loss.
In some ways, it's similar to the Atkins diet, which similarly boosts the body's fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto diet and the Atkins diet is ketogenic emphasizes healthier fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.

Thanks for the very informative article. This was the push I needed to at least try it. Starting next weekend, my partner and I will be trying keto for 30 days. I'm all for small changes, in theory, but what I sometimes discover is that sweeping changes can have their place, too, if they produce positive results. Often, what will work for me is trying a big change, and even if I then throw out 80% of it, at least the remaining 20% sticks. By contrast, any backsliding from a small change can often mean just throwing it out entirely.

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Medical Disclaimer: The material on this site is provided for informational purposes only and is not medical advice. Always consult your physician before beginning any diet or exercise program.

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