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 that 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 (EEG) 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 it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[45]
After increasing water intake and replacing electrolytes, it should relieve most all symptoms of Keto Flu. For an average person that is starting a ketogenic diet, eating 20-30g of net carbs a day, the entire adaptation process will take about 4-5 days. My advice is to cut your carbs to fewer than 15g to ensure that you are well on your way into ketosis within one week. If you are experiencing any more keto flu symptoms, double check your electrolyte intake and adjust.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
On average it takes most people about three days to get into ketosis.The sticks will confirm that ketones are being excreted through your urine. That’s all. They won’t change color at all for no ketones, then there is trace (light pink) and it goes up from there to dark purple. The darkness of the stick doesn’t matter. As long as you are showing even trace amounts, then you are in ketosis and good to go. In fact, if you are showing really dark on the stick, you may be dehydrated and need to drink more water (see #4.)
For any individual with diabetes, discussing dietary changes — especially those as dramatic as the ones the ketogenic diet requires — with your healthcare team is essential. Because carbohydrates are broken down into glucose in the blood, cutting carbohydrates from your diet could cause levels to crash rapidly depending on your current medication regimen. Such a change may require significant adjustments to medication and insulin to prevent dangerous side effects such as low blood sugar, called hypoglycemia. (8)
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]
The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[42] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[18] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]
After increasing water intake and replacing electrolytes, it should relieve most all symptoms of Keto Flu. For an average person that is starting a ketogenic diet, eating 20-30g of net carbs a day, the entire adaptation process will take about 4-5 days. My advice is to cut your carbs to fewer than 15g to ensure that you are well on your way into ketosis within one week. If you are experiencing any more keto flu symptoms, double check your electrolyte intake and adjust.
Miss Mellissa…. I was doing *so well* with keto eating last summer and dropped some weight, but all the old (bad, bad) habits started sneaking in and I’m in one heck of a pickle. Just wanted to say “thanks” for this jump-start… Hopefully this will help me remember what I’m SUPPOSED to be doing. Got a long slog ahead of me, but I have hope I can make it. Your site is so, so helpful, and I really appreciate all you do. Thank you.
Still, it can be hard to get enough fat when you first start this diet. Butter, nuts, coconut and olive oils, and fatty cuts of meat are all on the menu. However, don't go overboard with polyunsaturated fats like soybean, corn, or sunflower oil. Keto dieters who increase their intake of those fats often end up with gastrointestinal distress that causes them to jump ship.
“The cleaner, the better when it comes to the keto diet,” says Jadin. Focus on “whole” and “unprocessed.” Also, strive for a mix of saturated and unsaturated fats for balance. Note: Tipping the scale toward too much protein is a common pitfall many people make on the keto diet. Mind your protein intake, since too much can kick you out of ketosis, says Jadin.

The Keto diet emphasizes weight loss through fat-burning. The goal is to quickly lose weight and ultimately feel fuller with fewer cravings, while boosting your mood, mental focus and energy. According to Keto proponents, by slashing the carbs you consume and instead filling up on fats, you safely enter a state of ketosis. That’s when the body breaks down both dietary and stored body fat into substances called ketones. Your fat-burning system now relies mainly on fat – instead of sugar – for energy. While similar in some ways to familiar low-carb diets, the Keto diet’s extreme carb restrictions – about 20 net carbs a day or less, depending on the version – and the deliberate shift into ketosis are what set this increasingly popular diet apart.


In its 2016 report “Healthy Eating Guidelines & Weight Loss Advice,” the Public Health Collaboration, a U.K. nonprofit, evaluated evidence on low-carbohydrate, high-fat diets. (The Keto diet falls under the LCHF umbrella.) Among 53 randomized clinical trials comparing LCHF diets to calorie-counting, low-fat diets, a majority of studies showed greater weight loss for the Keto-type diets, along with more beneficial health outcomes. The collaboration recommends weight-loss guidelines that include a low-carbohydrate, high-fat diet of real (rather than processed) foods as an acceptable, effective and safe approach.
I love this! I am an amateur powerlifter and I have recently started using the keto diet as there is only so much gained by being a fat powerlifter but working out my macros was driving me nuts as I also work as a disability support worker and need to take meals and so on to work with me. Thanks to this I can now have better control of the macros to bring my weight down without doing to much harm to my lifts! Thank you for this!
I’d like to add to your last point because my uterus hated me for a week! I have the IUD (Mirena) and I honestly don’t remember when my last period was, guesstimating I’d say 8 months ago. Since having the IUD I only spot and rarely have a period (I’ve had it since 2014), but OMG my hormones must’ve been all over the place because I not only got a heavy period but I had it for 9 days straight!
For athletes, research on the keto diet highlights potential improvements in athletic performance, especially when it comes to endurance activities. An article suggests ketogenic-type diets may allow endurance athletes to rely mostly on stored fat for energy during exercise rather than having to refuel with simple carbohydrates during endurance training and competition while additionally improving recovery times. (10)
Hi, before finding your AMAZING website (THANK YOU), I had been dipping my toe in the low carb diet thing. In the past two weeks, I did the 3 day induction and have made things from the week one meal plan. Although I have only lost 3-4 pounds (had a trip this past weekend where I was a bit lax), I have lost an inch on my waist!!! Crazy stuff!! Also, even though I was a bit lax, I felt the self control was really good, versus times in the past on other typical low fat/low cal diets. I truly want to THANK YOU for your time, energy, and patience with this wonderful work you provide.
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. Pure isolates, such as Signature 100% Whey Isolate, are extremely low in carbohydrate. 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.
the biggest challenge most people have is sticking that first week at less than 20 net carbs but this is crucial not only to start losing but to keep losing. Most people don’t really start to notice weight loss till a good week in even then. If you want to jump start you can try a three day fast but then stick to that 20 net carbs and like was stated, know the nutrition facts of what you are eating. Onions for instance have quite a bit of sugar/net carbs. Even if it takes a bit for your body to rev up it definitely will as long as you stick to the carb numbers and fat ratio of 40% total calories
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. There are several possible explanations for this gap between evidence and clinical practice.[33] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[30]
Dinner: In a small sauce pan bring 2-3 cups of water to the boil. Cook a large egg in rolling boil for 5 minutes, then transfer to ice bath (a bowl with cold water and ice cubes in it). Wash and spin dry butter lettuce, top with sliced avocado and hemp seed. Serve soft boiled egg with cherry tomatoes, butter lettuce salad and mayonnaise as dressing.
When a person goes off the ketogenic diet and regains much of their original weight, it’s often not in the same proportions, says Kizer: Instead of regaining lean muscle, you’re likely to regain fat. “Now you’re back to your starting weight, but you no longer have the muscle mass to burn the calories that you did before,” she says. “That can have lasting effects on your resting metabolic rate, and on your weight long-term.”
The first month or two on keto you may experience some strange periods (aka. Shark Week.) Don’t be alarmed. When you lose weight and your body detoxes from sugar and excess carbs, all kinds of hormonal changes (for the better) occur. Initially though, you may experience heavier periods than normal, more extreme PMS symptoms, etc. This is normal, and while it’s inconvenient it shouldn’t last more than a few months at the most.If your weight loss is rapid on keto (let’s hope), you may also lose more hair than normal for a month or two. It can be disconcerting, but it’s not permanent and will stop when your hormones regulate.
Keeping your tastebuds entertained while following a keto diet does not have to be a struggle.  Some low-carb, high-fat dieters find that they have the most success with their diet when they eat consistent meals on a regular basis and do not deviate from their plan.  Others find that if their diet has too much repetition it will get boring and difficult to stick to.  Whether you choose to stick to a set of staple meals that you eat every week or you’d rather spice things up, there are plenty of amazing food choices on the ketogenic diet.

First off I just want to say thank you for the 3 day meal plan to get started. I stumbled across Keto about a week ago and I have been reading and reading and reading and then essentially got super confused and though that this was not for me! But then I came across your website and my my you break it down for people like me who are just looking for guidance to get started. I am hoping to start soon as I do go on a business trip begging of next week and I am afraid to start and then boom off the band wagon. My goal is to start next Thursday…..(fingers crossed this works) everything else has failed and dieting has been a struggle since I had a hysterectomy due to cancer. Now my weight is out of control and I am the biggest I have ever been! 251 pounds and I am 5′ 2″ and none of my clothes fit!! Makes it hard to get excited in the morning when getting ready to endure the day!
Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D., “A Randomized Trial of a Low-Carbohydrate Diet for Obesity — NEJM,” N Engl J Med 2003; 348:2082- 2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207.
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Symptoms of the keto flu include headache, fatigue, dizziness, sleep problems, heart palpitations, cramps, and diarrhea. These side effects usually lessen and eventually resolve in about two weeks. (2) But to lessen the effects of any discomfort, simply consider slowly transitioning onto a ketogenic diet rather than rushing to change your eating habits. By slowly lowering your carbohydrate intake, while gradually increasing your intake of dietary fat over time, you can transition with less of a negative impact and potentially prevent the keto flu.
I see your point – but at the same time some people are squeamish about the normal terms and when I first heard shark week I laughed out loud so I thought it might be fun to inject some humor into a sometimes totally humorless subject, especially for people who have really painful and debilitating cycles every month. Glad you’re enjoying the site though and thanks for letting me know! :)
It’s important to remember that the goal of any dietary change is to promote a healthy lifestyle, so make sure to select a meal plan you can envision yourself following long term. If you know you will not be able to comply with such stringent carbohydrate restrictions for years to come, the ketogenic diet is most likely not the right choice for you.
I have one more question. You stress salt in this diet but I was wondering why you don’t recommend salted nuts. Is there a reason? I will just replace the almonds with string cheese if that is the case but I just can’t handle raw unsalted nuts. To me they taste like dirt! But I love salted ones so I was curious if we need the salt can I eat my salted almonds or pistachios? Just trying to figure out where the salt can be utilized. Thanks for all you help! Day 3 and going strong!

Bear in mind that those macronutrient ratios refer to calories from fat, protein, and carbohydrate, not actual grams of each. Protein and carbs have 4 calories per gram and fat has 9 calories per gram, so it’s actually a relatively easy task to let your fat calories pile up to keto-appropriate proportions if you consume fattier proteins and embellish your food with an extra bit of pure fat. To illustrate, if a portion of a particular food has 10 grams of protein, 10 grams of fat, and 0 grams of carbohydrate, that portion contains 130 calories, 90 from fat and 40 from protein, and is about 69.2% fat and 30.7% protein (allowing for rounding).
Funny story, I didn’t mean to start the keto diet. My best friend has been doing it for a few months, and I was not really paying close attention to her journey. I assumed it was too restrictive for me, and I love food, so conversely hate “restrictive”. I’ve been lowering calories, eating more protein/vegetables, fewer carbs and working out. I feel great, but I’m not really losing weight, which is frustrating. But, being 44, i was beginning to accept it as part of my metabolic process. The funny thing is, one day I felt like total, deep-fried dog crap. It was right before going on vacation: body aches, dizziness, irritability, I was sure I caught the flu. IN SUMMER!! Awful. However, the next day I woke up, feeling mildly better, and a conversation with my bestie came back to me. Could this be keto flu???? I loaded up on electrolytes that day, WHAM it was gone. I went on vacation and just limited my carbs because I wanted to eat all the good stuff (fatty, hot cheesy, meaty scrumptiousness), but not get gluten bloat. I LOST WEIGHT. YEAAHHHH!!!!!! So I did some research and realized that keto was definitely for me because it really is all my favorite foods. I love to cook, so I had been creating clean, gluten free recipes for quite some time. So now I’m here with you because I loved the name of your blog, just about every recipe appeals to me, as does your writing style. So relatable. I just wanted to share how excited I am to be here, at ground zero of what is to me, a life changing experience. Starting a diet is usually done with grim determination, but today, I’ve never been more excited to start a diet! Looking forward to exploring this gem of a site!

hello, i am interested in trying the ketogenic diet. i have hypothyroidism and cannot seem to lose any weight no matter what i do or eat. i need to lose about 20 pounds. do you think this diet can help me to lose weight and would it be good for my low thyroid? also, i am not a very active person…i have herniated disc in my lower back and have to be careful how i move, bend, or stretch, etc. however, i can get on my indoor exercise bike and ride it for about 10 min. per day.

What a great post. I thought i would add about the selection of food you eat on keto and that everyone is different. Some food gives you energy and some doesnt, this varies person to person. I started and quit keto 3 times before i managed to find my balance. The first few times it made be poorly, from the shock of diet change. However, you can wean yourself into the diet which i did the last time when i had the most success.
Your three day kick start seems to me to be almost zero carbs? Am I wrong? I have been doing 20g net carb where you can still get in quite a few veggies for 20g net carbs. Am I missing something? In the day one for instance the only veggies are celery (1g or carb) and then rommaine leaves? I suppose you are getting 2 g in cheese string, a bit in the eggs, etc? I have been tracking and getting to 20g net with veggies, fats and meats (measuring every single thing). So As long as you are at 20g no matter how you get there it should be ok?
Question 1: Sugar substitutes – I like Stevia and want to use it if that is the best choice. If another is better, please let me know. I have tried Erythritol & Xylitol and one or both affected us like a laxative. I have heard that can be the case and I’m not sure if that side effect subsides but Stevia does not have that affect so that is another reason I would like to stay with Stevia. Just wondering your thoughts….. And if you have already addressed this topic, please just point me in the right direction and I will educate myself.
A review of multiple studies in the journal Nutrients found that ketogenic diets are connected to significant reductions in total cholesterol, increases in “good” HDL cholesterol levels, dips in triglycerides levels and decreases in “bad” LDL cholesterol; there are questions as to whether diets high in saturated fat negate these benefits. The same paper reports that a ketogenic may slightly reduce blood pressure, but science is still very scant on this point.
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.
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