A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[19] and followed-up by a report published in 2001.[20] As with most studies of the ketogenic diet, there was no control group (patients who did not receive the treatment). The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction and 3% were seizure-free.[Note 7] At twelve months, 55% were still on the diet, 23% had a good response, 20% had an excellent response and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three and four years was 39%, 20% and 12% respectively. During this period the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free but had had an excellent response.[20][21]
Thank you, thank you, thank you! Thank you for taking the guesswork out of putting a plan together. Thank you for putting in the time, your dedication and commitment helping people you don’t even know. I get overwhelmed putting a plan together. What I think is healthy is not! I am starting the 3 day kickstart this week. I am putting my shopping list together. While doing so, I find myself asking- are these ingredients enough for 1 person or more? Should I increase the quantity of items to feed the family? I have a family of 5 and we all need to eat healthier. More specifically, my husband and I will be doing Keto. The kids (14, 18 & 20’year olds) will most likely do the dinners and snacks. Thank you for your help with this. Sorry in advance if you already answered these questions. I went through other comments and didn’t notice if it had been addressed. Thanks again!
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).
Natural fat, high-fat sauces – Most of the calories on a keto diet should come from fat. You’ll likely get much of it from natural sources like meat, fish, eggs etc. But also use fat in cooking, like butter or coconut fat, and add plenty of olive oil to salads etc. You can also eat delicious high-fat sauces including Bearnaise sauce etc., or garlic butter (recipes).
Articles and information on this website may only be copied, reprinted, or redistributed with written permission (but please ask, we like to give written permission!) The purpose of this Blog is to encourage the free exchange of ideas. The entire contents of this website is based upon the opinions of Dave Asprey, unless otherwise noted. Individual articles are based upon the opinions of the respective authors, who may retain copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the personal research and experience of Dave Asprey and the community. We will attempt to keep all objectionable messages off this site; however, it is impossible to review all messages immediately. All messages expressed on The Bulletproof Forum or the Blog, including comments posted to Blog entries, represent the views of the author exclusively and we are not responsible for the content of any message.
I just made this keto bread, and it is amazing! It’s better than most bread I’ve tasted! I made mine with bacon, American cheese, Brie, and Camembert (because I wanted to be extra). If you use bacon, cook it to how you normally like it in a seperate pan, as the bacon doesn’t cook much extra while baking. I think I used a little too much butter, but, oh boy, was it nice and moist!
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:
I have a question on sugar since I see it’s not allowed. Is splenda or any other sugar subsitute ok? What if one of the ingredients that is required for a keto recipe contains sugar, does it matter? I haven’t really seen any discussion on how some things may already contain sugar (even if in low doses) may affect the keto diet. Should they be avoided altogether?

Hi Patricia, you can replace the avocado with any of the other snack options. I would omit the dessert rather than trying to sub for the avocado in it – or you can have 2 squares of Lindt 90% chocolate in place of it. Just be aware that there are a few grams of carbs in them so don’t overindulge and keep your carbs under 20g per day and you should be good to go!
The keto diet does provide short-term benefits, but the long-term benefits are still unknown. Researchers caution that a very low  carb diet can be difficult to maintain long term, leading to “yo-yo” dieting and increased weight gain. Researchers suggest that the keto diet can be used to kick start weight loss, but should be followed up with healthy eating plans that can be sustained long term.

I’m thinking about trying Keto for the very first time in order to help my hormone levels and lose some weight. As I scrolled through your menu plan, I clicked on some recipes. I noticed that they included fruits/veggies that weren’t included in the menu. For example, there are strawberries with your cream cheese pancakes and chocolate mousse. There is also red pepper with the chilli and lettuce with another item (maybe the chilli or the tuna?) Are these items calculated in the carb count for the plan? I have NO CLUE how to calculate net carbs or even calculate carbs using fresh fruits/veggies. Are there any fresh fruits/veggies that are freebies like lettuce or cucumbers? I really don’t want to botch this and feel even worse or lengthen the keto flu. Finally, do I need to factor in vitamins that I’m taking (Magnesium, B complex, and D3? Do they have any carbs that I wouldn’t expect? TIA for any insight you can provide.
For people with diabetes, rapidly rising ketone levels can signal a health crisis that requires immediate medical attention. When there is an absence or not enough of the hormone insulin (or the body is too resistant to insulin to allow it to drive glucose into the cells for energy), the body cannot use glucose for fuel. Insulin helps ferry glucose to our cells and muscles for energy. Instead, in this case, the body resorts to burning stored fat for energy through the process of ketosis, leading to a buildup of ketones in the body.

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).
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!
A systematic review in 2018 looked at sixteen studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein (LDL), high total cholesterol, and weight loss.[23]
To prevent side effects such as the keto flu, begin transitioning your meal plan gradually. Start by understanding how many carbohydrates you take in most days. Then begin slowly reducing your carbohydrate intake over a period of a few weeks while gradually increasing your intake of dietary fat to keep your calories the same. You should also make sure to seek guidance from a professional to make sure this plan works best for you and your health goals. “See a dietitian and adapt the diet to fit your long-term needs,” Spano recommends.

Natural fat, high-fat sauces – Most of the calories on a keto diet should come from fat. You’ll likely get much of it from natural sources like meat, fish, eggs etc. But also use fat in cooking, like butter or coconut fat, and add plenty of olive oil to salads etc. You can also eat delicious high-fat sauces including Bearnaise sauce etc., or garlic butter (recipes).


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.
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.
Hi Mellissa. I am starting your 3 day kick start menu today (again) and was wondering, how do you calculate the carbs in sugar free syrup (with the LC pancakes)? Do you subtract the sugar alcohols the same as you do fiber? I’ve added about 1 Tbsp. to the pancakes but if I don’t subtract the sugar alcohols, it would be around 14 carbs! Help? Thank you!
He is convinced that carbohydrate-heavy, low-fat diets are a major reason we're seeing high rates of diabetes, high blood pressure, obesity, and cancer. That's because a diet high in sugar can quickly raise insulin levels in the body. Over time, those spikes can lead to insulin resistance and eventually to long-term health issues like high blood pressure, Type 2 diabetes, inflammation, and obesity.
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.
When you’re eating the foods that get you there (more on that in a minute), your body can enter a state of ketosis in one to three days, she adds. During the diet, the majority of calories you consume come from fat, with a little protein and very little carbohydrates. Ketosis also happens if you eat a very low-calorie diet — think doctor-supervised, only when medically recommended diets of 600 to 800 total calories.
×