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Ketogenic Diet: How Does It Work and Is It Effective?

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The keto diet has been around since 1921 and was originally used by Russell Wilder to treat epilepsy. It was used frequently until 1940 when an antiepileptic drug treatment became regularly available. However, in 1998, it exploded in popularity again, this time for weight loss. 

The keto diet starts with measuring your macros, or macronutrients. These are fat, protein and carbohydrates. There are nine calories per gram of fat and four calories per gram of protein and carbohydrates. Start with a 4:1 ratio of fat to combined protein and carbohydrates to keep you satiated and reduce cravings, improve your self-control, increase your physical activity and decrease your caloric intake.

What Is a Ketogenic Diet?

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The ketogenic, or keto diet, is a high-fat, low-carb diet which decreases blood sugar levels and increases insulin sensitivity. Over a period of time, this trains the body to consume fat and ketones for fuel rather than carbohydrates. There are four types of ways to practice the ketogenic diet. They are the standard ketogenic diet, the cyclical ketogenic diet, the targeted ketogenic diet and the high-protein ketogenic diet.    The standard keto diet has macronutrient ratios of 75% fat, 20% protein and 5% carbs. The cyclical ketogenic diet involves five ketogenic days and two high-carb days which allow you to maintain this lifestyle, if you have trouble giving up carbs. The targeted ketogenic diet allows you to eat higher levels of carbs on days which contain strenuous workouts. Finally, the high-protein ketogenic diet involves 60% of your calories coming from fat, 35% of your calories coming from protein and 5% of your calories coming from carbohydrates. This is useful because protein keeps you more satiated than fat. The cyclical and targeted ketogenic diets are useful for athletes, such as bodybuilders who lift very heavy weights. 

Keto-Friendly Foods

The hardest part of the keto diet is determining which foods to eat. The majority of your meals should be centered around: 

  • Meat
  • Fatty fish
  • Eggs
  • Butter and cream
  • Cheese
  • Nuts and seeds
  • Healthy oils
  • Avocados
  • Low-carb veggies
  • Condiments

Meat includes red meat, steak, ham, sausage, bacon, chicken and turkey legs. Good fish includes tuna, trout, mackerel and salmon, although tuna is much leaner than salmon. Look for omega-3 or pastured whole eggs and grass-fed butter and cream. Cheese should be unprocessed, such as cheddar, goat, cream, blue or mozzarella. Nuts and seeds include chia, pumpkin and flax seeds and walnuts and almonds.

Search for healthy oils, such as avocado, coconut and extra virgin olive oil. Make fresh guacamole out of avocado, or slice one on top of your toast for breakfast, in your oatmeal or on an open-faced grilled chicken sandwich. Low-carb veggies include most green veggies, tomatoes, onions and peppers. Keto-friendly condiments include salt, pepper and healthy herbs and spices.

Food to Avoid

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Here is a list of food types to reduce or eliminate from your keto diet: 

  • Sugary foods
  • Grains or starches
  • Fruit
  • Beans or legumes
  • Root vegetables and tubers
  • Low-fat or diet products
  • Some condiments and sauces
  • Unhealthy fats
  • Alcohol
  • Sugar-free diet foods

Sugary foods include candy, ice cream, cake, smoothies, fruit juice and soda. Grains and starches include cereal, pasta, rice and wheat-based products. Fruits include all fruits except for small portions of high-fiber, low-carb fruits, like blackberries and raspberries. Beans and legumes include chickpeas, lentils, kidney beans and peas. Root vegetables and tubers include parsnips, carrots, sweet potatoes and red potatoes.

Low-fat and diet products are frequently very processed and high in carbohydrates. Aim for unprocessed, whole natural food whenever possible. Avoid condiments and sauces which are high in unhealthy fat and sugar. Minimize processed, unhealthy fats in your diet, such as mayonnaise and vegetable oils.

Minimize alcohol containing carbohydrates, such as beer, wine and cocktails, as they may throw you out of ketosis. Look for carb-free alcohol, such as whiskey, but remember to keep it within your daily caloric allowance. Alcohol has seven calories per gram, so a shot of whiskey will have 96 calories. Alcohol also reduces your inhibitions, so you may binge on foods which are not keto diet-friendly. Avoid sugar-free diet foods and gum as these can affect ketone levels with their high-sugar alcohol content. They are also often highly-processed.

Healthy Keto Snacks

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Great snacks for between meals on the keto diet include:

  • Small portions of leftover meals
  • Celery with salsa and guacamole
  • Strawberries and cream
  • Full-fat yogurt mixed with nut butter and cocoa powder
  • A low-carb milkshake with nut butter, cocoa powder and almond milk
  • 90% dark chocolate
  • 1 or 2 hard-boiled eggs
  • Cheese with olives
  • A handful of seeds or nuts
  • Cheese 
  • Fatty meat or fish

Eating Out

If your friends invite you to a restaurant while you’re on the keto diet, it is easy to find a keto-friendly meal. At Mexican restaurants, enjoy any type of meat with extra cheese, sour cream, salsa and guacamole. Just skip the tortilla. At your local burger joint, opt for a bunless burger with avocado and nut butter, eggs, bacon or extra cheese. Swap out french fries for low-carb vegetables. At breakfast restaurants, get an omelet with avocado, bacon and sausage. At a steakhouse or seafood restaurant, you can get a meat or fish-based dish with high-carb food replaced with extra vegetables. For dessert, you can get berries and cream or a mixed cheese board.

How the Keto Diet Works

The keto diet works by getting your body to burn fat for fuel rather than carbs. Normally, we eat a high-carb meal, and our body converts those carbs into glucose for fuel. We then make insulin to move that glucose into the bloodstream. Our body then uses that glucose as its primary fuel source. When there is a minimal presence of carbs, our body must use another fuel source. Our liver takes fatty acids and converts them into ketone bodies called ketones. The process is called ketosis, and the goal of the ketogenic diet is to keep your body in a state of ketosis. When your liver breaks down fatty acids, three ketones are created: 

  • Acetoacetate (AcAc) – created first during ketosis
  • Beta-hydroxybutyric acid (BHB) – formed from acetoacetate
  • Acetone – created spontaneously as a byproduct of acetoacetate

Testing Ketosis

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There are a few methods to test the ketone levels in your body. These are blood, breath and urine testing. Testing is important in the beginning to ensure you have entered and are staying in ketosis so you can reap the full benefits. Urine test strips may be purchased at your local pharmacy at a very low cost and indicate your ketone level by color. When you first start testing your ketones, use the urine sample method with the blood testing method to confirm the accuracy of your urine tests. When you have been in ketosis for a while, your body is more efficient at using ketones so this may show up as lower ketone levels in your urine test. Levels of hydration and electrolytes in your body also affect test results.

Using a breath meter, you can test the levels of acetone in your breath. The benefit of this testing method is it only consists of one upfront cost. The disadvantage is it is not as reliable as blood testing. If you can afford it, use a blood glucose meter to test your ketone levels with a blood strip. This method can get a little pricey, if you use it frequently, but it is your best bet while you are still learning what portion of carbohydrates you can eat to keep your body in ketosis. After 21 days, your new way of eating will become a habit, and you will not need to test anymore.

Is It Effective?

The keto diet is effective for weight loss, but it is also used to improve a variety of other health conditions. These include: 

  • Heart disease
  • Cancer
  • Alzheimer’s disease
  • Epilepsy
  • Parkinson’s disease
  • Polycystic ovary syndrome
  • Brain injuries, like concussions
  • Acne 
  • Hypertension
  • Hyperglycemia
  • Excess triglycerides
  • High cholesterol

Excess carbohydrates, particularly fructose, increase your triglyceride levels, so reducing these easy-to-store carbs in your diet decreases the fat in your bloodstream. It also lowers blood pressure and eliminates Type 2 diabetes. If you have hypotension, talk to your general health practitioner about adding salt to your diet to keep your blood pressure high enough. The keto diet also increases the levels of good cholesterol and lowers the levels of bad cholesterol in your bloodstream.

This diet is effective in reducing inflammation which eliminates pain and reduces the frequency of skin conditions, such as eczema and acne. By increasing the amount of BHB in your bloodstream, you also fight inflammatory diseases, such as psoriasis, arthritis and irritable bowel disease. There are over 43 health conditions the keto diet is effective in treating, and all it takes to reap the benefits is a simple change in diet.


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The keto diet is the best diet you can go on if you suffer from inflammatory diseases or health conditions compounded by excess weight. It is effective for weight loss, improves your mood, increases your energy levels and improves many markers of good health. The macronutrient ratios are different depending on your needs, and you can have a registered dietician help you make meal plans while you start this transition. As long as your breath, blood or urine tests indicate an adequate level of ketones in your body, you will reap the benefits of this highly-effective, healthy diet. Always talk to your doctor before starting a new diet.       

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