Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often there is no initial fast (fasting increases the risk of acidosis and hypoglycaemia and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size but alter the ketogenic ratio from 2:1 to 4:1.[9]

Fairly recently, the diet was introduced as a weight-loss diet by an Italian professor of surgery, Dr. Gianfranco Cappello of Sapienza University in Rome. In his 2012 study, about 19,000 dieters received a high-fat liquid diet via a feeding tube inserted down the nose. The study showed an average weight loss of more than 20 pounds in participants, most of whom kept it off for at least a year. The researchers reported a few minor side effects, like fatigue.
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]
Chasing blood Ketones instead of focusing on hormone signals: "The higher the number means you have more Ketones circulating in your bloodstream, but that does not mean that you are better at burning fat for fuel," Mavridis points out. "You must be in nutritional Ketosis, which is described as being between 1.5 - 3.0 mol/L on the blood Ketone meter. You will know once you are fat-adapted from hormonal signals, and not from higher Ketones on the blood meter," she adds.
Many ketogenic dieters also swear by MCT oil. (MCT simply stands for medium chain triglycerides.) MCT's energy-sustaining powers can be explained as follows: When MCT oil is metabolized in the body, it behaves more like a carbohydrate than a fat. Unlike other fats, MCT oil does not go through the lymphatic system. Instead, it is transported directly to the liver where it is metabolized so it releases energy like a carbohydrate and creates lots of ketones (which can be used for fuel) in the process.
Epilepsy is one of the most common neurological disorders after stroke,[7] and affects at least 50 million people worldwide.[8] It is diagnosed in a person having recurrent unprovoked seizures. These occur when cortical neurons fire excessively, hypersynchronously, or both, leading to temporary disruption of normal brain function. This might affect, for example, the muscles, the senses, consciousness, or a combination. A seizure can be focal (confined to one part of the brain) or generalised (spread widely throughout the brain and leading to a loss of consciousness). Epilepsy may occur for a variety of reasons; some forms have been classified into epileptic syndromes, most of which begin in childhood. Epilepsy is considered refractory (not yielding to treatment) when two or three anticonvulsant drugs have failed to control it. About 60% of patients will achieve control of their epilepsy with the first drug they use, whereas about 30% do not achieve control with drugs. When drugs fail, other options include epilepsy surgery, vagus nerve stimulation and the ketogenic diet.[7]

"My suggestion is to start with changing your mindset first and foremost around three very important facts: this is not just another diet, you don’t have to live in Ketosis forever, and you will not be depriving yourself. Having said that, if you are used to eating highly-processed sugary food and refined carbohydrates you’ll need to ease into it," she explains.


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.[22] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[3]
For breakfast, we are going to change it up a bit. Here’s where we introduce ketoproof coffee. Now, don’t get me wrong – I know some of you won’t like it. If you’re not a fan of coffee, then try it with tea. If you’re not a fan of the taste (which is very rare), then try making a mixture of the ingredients by themselves and eating it like that. So, why ketoproof coffee?
Along the same vein, some of my recipes on the blog include hemp seeds, coconut flour, almond flour, and other not so easy to find ingredients – IGNORE THOSE RECIPES (for now). The focus here is, again, simplicity. You will likely be irritable, fatigued, and not feeling awesome during the first three days to a week. Trust me on this – the last thing you are going to want to do is make complicated meals.
Started the kickstart yesterday and stuck to it all day. Was so easy and the dishes were good! I did bacon and eggs, tuna with Romaine, buffalo chicken…even made the mousse! I dont want to use bottled dressings so I made this one…. the BEST! https://lowcarbyum.com/creamy-blue-cheese-dressing/ I already hit ketosis this morning! I have been trying to cut down on carbs for the last month or more so maybe that’s why I hit it so quickly. Im excited to stick with this! Thank you for the recipes and the humor!
"I recommend only 5 percent of calories coming from carbs, which usually averages out to less than 30 grams," he says. "I understand why people get nervous and panic, thinking 'Can I even eat a salad?' This is why I recommend tracking only 'net carbs', which are total carbs minus fiber. For example, an avocado has 12 grams of carbs but 10 grams of fiber, which means it has 2 grams of net carbs. Also, green leafy vegetables are very nutritious and contain a lot of fiber, so you can almost eat them as much as you want and stay below your limit.
UPDATE: Hi! It’s been 4 weeks already. I am still cooking keto and enjoying many delicious dessert too! I have finally convinced my husband to totally convert to keto food. It’s only been one week since he stopped using diet package food. He is very happy with the food he get to eat and still losing weight but much slower pace this week. That’s because I have been giving him larger portions as this is the first week for him. Since he was already on low carb diet prior to this, keto flue may be not as bad but still want to keep him happy and better transition experience. Meanwhile, I get to cook keto for the whole family and really enjoying the new way of eating and cooking. I have lost total of 6 lb but that was enough to prove to my husband eating bacon and butter is ok as long as we are on keto diet. I was only doing this to convert my husband since he doesn’t have any interest in nutrition or theory behind it, so what he sees is what he believes. 6 lb may not sounds a lot for 4 weeks but I was already below average weight , so it was a lot of loss for me. I think it’s a science 5-30-65 combination works on everyone. Now I just eat more portions of everything ,so we can still eat same food. Today, he had a once a week appointment with his ideal protein dietitian. Seems like they are not convinced that he can still continue to lose weight unless he eat their packaged food. I plan to continue sending him there for once a week appointment , so he sill have something to be accountable for. Next few weeks, I’m hoping he won’t be as hungry so I can start portion control his food without his knowledge, LOL.

Use fat as a lever.  We’ve been taught to fear fat, but don’t! Both keto and low carb are high fat diets. Fat is our source of energy as well as satiety. The key to understand, though, is that fat is a lever on a low carb or keto diet. Carbs and protein stay constant, and fat is the one you increase or decrease (push the lever up or down) to gain or lose weight, respectively. So if your goal is weight loss, eat enough fat to be satisfied, but there’s no need to “get your fats in” once you’re satisfied.
Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[55]
Love this! So glad I found you! Your menus are great, you make it easy with the shopping lists, (now if I could just find someone to do the shopping for me ;-)) I usually fall off the wagon to easy, my usual excuse not knowing what to make, but with your menus and lists it gives me no excuse. I just started and am anxious to see how it goes. I have also started my exercise again!
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]
Keto breath, on the other hand, is less of a side-effect and more of a major (not harmful) inconvenience (your breath literally smells like nail polish remover). Basically, when your body breaks down all that extra fat on the keto diet, it produces ketones—one of which is the chemical acetone (yes, the same stuff that's in nail polish remover), Keatley previously told WomensHealthMag.com.
The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[7]
But it’s worth noting that, as yet, there hasn’t been enough research into the ketogenic diet to support its use in some medical conditions – so people using the diet to treat diabetes or polycystic ovarian syndrome, should consult their doctor before trying it, as it can affect blood sugar levels. People with pancreatic or liver problems, or problems with fat metabolism should also avoid the ketogenic diet. This is because the diet is so high in fat that it puts added pressure on both organs, which are essential for fat metabolism .

Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[55]

Thank you. Needed this. Going to try. Been doing almost this. However on good days. I eat much less food. W maybe 40 to 60 carbs tops. But cant lose anymore. And go up 6 down7 or 8. Back up. Need to go down. 12. This is my 5th time losing over 100lbs. My last time. Its been off for over a year. I know this works. But u r right. Ppl will hate it. But suck it up. It sucks. Ive done it.
8. All brands are not created equal. Sometimes (but not always) you have to pony up for the name brand over the generic because the carbs are less – this is generally true with cream cheese for example. When buying heavy cream, go organic if you can find it because some brands use thickeners that add carbs. Buy your cheese in blocks or slices rather than in shreds – the shredded cheese is coated with food starch to avoid clumping and that adds carbs.
Made this for the first time tonight, excellent! I read the comments before I started so I knew to beat the eggs well and drain the beef. Thank you to everyone who commented! I didn’t use pickles, instead I put a few dots of sweet relish on top of the beef/bacon layer then spread them out a bit. Not so keto friendly but there isn’t much in a portion and it’s much quicker than dealing with pickles. Hubby asked me what I thought of it as he went for seconds. I quite enjoyed this and he did too! I had much more beef than called for, I used all 3 eggs and beat them well before the whipping cream and yellow mustard went in.There was no eggy taste. I will definitely make this again!
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.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[3] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[47] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[3]

As a note, you do need to check the carbohydrate content of everything you eat, especially processed foods such as sausages, cheeses and sauces. There could be hidden carbs in the products used to preserve or “pad out” these foods, so make sure you are buying the lowest carb options and counting the carbs they do contain to ensure you don’t go over your daily limit.
When you eat foods high in carbohydrates and fat, your body naturally produces glucose. Carbohydrates are the easiest thing for the body to process, and therefore it will use them first – resulting in the excess fats to be stored immediately. In turn, this causes weight gain and health problems that are associated with high fat, high carbohydrate diets (NOT keto).

Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >


There are ways around the vitamin K issue and that would be eating the veggies that vit k are found in on a regular, consistant basis then getting your PT/INR levels checkeed every few days until you can reach therapeutic level. Only problem would be if you deviated from how much vit k containing food you ate – if you ate more than usual your blood would be thick and if you ate less than usual your blood would get to thin. So, the key here is establishing the amt of veggies you eat in a day and sticking to that amouth every day :)
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]
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?
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
Hello. I’m a kept newbie. Started 6 days ago today. By day 4 I was down 10lbs. I’m following the 20 or less carbs a day, altho I more like less than 10 on most days. I have only wanted to harm someone for a cookie twice, and my bf for his fried potatoes once. I’m honestly shocked at how much food I really can eat with no carbs. And then on some days, shocked at how many carbs are in other things. Headaches and lack of energy are the only thing that I find bothersome, but i am pushing thru it. Thank u for a very detailed site. It’s helped me, and a coworker.
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.
okay so i am very new at this…starting this tomorrow with my mom. i know it says in the 3 day blog not to be concerned with portion size at first, but when that’s over with how do i know how much to eat? for instance, how many of the cream cheese pancakes are a normal portion size and how much ham and cheese am i supposed to put in them? sorry if any of these questions were answered previously, i just have read like every blog and i am confused.
I too started Atkins years ago- back in the ‘80’s. I did well as long as i stuck to it. But, it’s a tough road and restaurants and snack food companies are not very low carb friendly. It’s all too easy for me to grab something quick & the donuts in the break room do me in everytime!!! I read your post this morning & It inspired me. I also am 57 and have been discouraged lately with my weight and lack of ability to stay away from carbs. But, I am going at it again – and this time with a vengeance. Thanks again for your post – very inspiring & appreciated. By the way – I found that Mellissa’s website the best for keto. Her recipes are simply delicious and not over complicated or time consuming. She also has a great sense of humor. It’s nice to know she goes through the same trials we do – and what it’s like to mess up !! !!. Thank you Mellissa for your articles, recipes, humor and your perseverance!!
A ketogenic diet helps control blood sugar levels. It is excellent for managing type 2 diabetes, sometimes even leading to complete reversal of the disease. This has been proven in studies. It makes perfect sense since keto lowers blood-sugar levels, reduces the need of medications and reduces the potentially negative impact of high insulin levels.
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