This document provides an overview of the ketogenic diet, including what it is, its potential benefits, how to implement it, and some concerns. The key points are: - The keto diet is very low in carbs (5-10% of calories), moderate in protein (10-15%), and high in fat (70-80%). This induces a metabolic state called ketosis where the body burns fat for fuel instead of carbs. - Potential benefits include weight loss, lower blood sugar/risk of diabetes, reduced inflammation and cancer risk, increased energy and brain health. - Implementation involves restricting net carbs to 20-50g per day, getting protein based on lean body mass,

1. Are You Right For The Keto Diet?

3. These days,itseemslike everyoneistalkingaboutthe ketogenic(inshort,keto) diet - the verylow-
carbohydrate,moderate protein,high-fateatingplanthattransformsyourbodyintoa fat-burning
machine.Hollywood starsandprofessionalathleteshave publiclytoutedthisdiet'sbenefits,fromlosing
weight,loweringbloodsugar,fightinginflammation,reducingcancerrisk,increasingenergy,toslowing
downaging.So isketosomethingthatyoushouldconsidertaking on?The followingwill explainwhat
thisdietisall about,the pros and cons,as well asthe problemstolookout for.
What Is Keto?
Normally,the bodyusesglucose asthe mainsource of fuel forenergy.Whenyouare on a ketodietand
youare eatingveryfewcarbswithonlymoderate amountsof protein(excessproteincanbe converted
to carbs),your bodyswitchesitsfuel supplytorunmostlyonfat. The liverproducesketones(atype of
fattyacid) from fat.These ketonesbecome afuel source forthe body,especiallythe brainwhich
consumesplentyof energyandcanrun on eitherglucose orketones.
Whenthe bodyproducesketones,itentersametabolicstate calledketosis.Fastingisthe easiestwayto
achieve ketosis.Whenyouare fastingoreating veryfew carbsand onlymoderate amountsof protein,
your bodyturnsto burningstoredfatfor fuel.Thatiswhypeople tendtolose more weightonthe keto
diet.
https://www.youtube.com/watch?v=nlsSPvL5sRU
BenefitsOf The KetoDiet
The ketodietisnot new.It startedbeingusedinthe 1920s as a medical therapytotreatepilepsyin
children,butwhenanti-epilepticdrugscame to the market,the dietfell intoobscurityuntilrecently.
Givenitssuccessinreducingthe numberof seizuresinepilepticpatients,more andmore researchis
beingdone onthe abilityof the diettotreat a range of neurologicdisordersandothertypesof chronic
illnesses.

4. Neurodegenerativediseases.New researchindicatesthe benefitsof ketoinAlzheimer's,Parkinson's,
autism,andmultiple sclerosis(MS).Itmayalsobe protective intraumaticbraininjuryandstroke.One
theoryforketo'sneuroprotective effectsisthatthe ketonesproducedduringketosisprovide additional
fuel tobraincells,whichmayhelpthose cellsresistthe damage frominflammationcausedbythese
diseases.
Obesityandweightloss.If youare tryingto lose weight,the ketodietisveryeffectiveasithelpsto
access andshedyour bodyfat.Constanthungeristhe biggestissue whenyoutryto lose weight.The
ketodiethelpsavoidthisproblembecause reducingcarbconsumptionandincreasingfatintake
promote satiety,makingiteasierforpeople toadhere tothe diet.Ina study,obese testsubjectslost
double the amountof weightwithin24weeksgoingona low-carbdiet(20.7 lbs) comparedtothe group
on a low-fatdiet(10.5lbs).
Type 2 diabetes.Apartfromweightloss,the ketodietalsohelpsenhance insulinsensitivity,whichis
ideal foranyone withtype 2 diabetes.InastudypublishedinNutrition&Metabolism, researchersnoted
that diabeticswhoate low-carbketodietswere abletosignificantlyreduce theirdependence on
diabetesmedicationandmayevenreverseiteventually.Additionally,itimprovesotherhealthmarkers
such as loweringtriglyceride andLDL(bad) cholesterol andraisingHDL(good) cholesterol.
Cancer.Most people are notaware that cancercells'mainfuel isglucose.Thatmeanseatingthe right
dietmayhelpsuppresscancergrowth.Since the ketodietisverylow incarbs, itdeprivesthe cancer
cellsof theirprimarysource of fuel,whichissugar.Whenthe bodyproducesketones,the healthycells
can use that as energybutnot the cancer cells,sotheyare effectivelybeingstarvedtodeath.Asearlyas
1987, studieson ketodietshave alreadydemonstratedreducedtumorgrowthandimprovedsurvival for
a numberof cancers.
ComparingStandardAmerican,Paleo,&KetoDiets
(Asa % of total caloricintake)
__________________________Carbs__________Protein_________Fat
StandardAmericanDiet_____40-60%_________15-30%_________15-40%
PaleoDiet_________________20-40%_________20-35%_________25-50%
KeoDiet________________ __5-10%__________10-15%_________70-80%

5. The keydistinctionbetweenthe ketodietandthe standardAmericanorPaleodietsisthatit containsfar
fewercarbsand much more fat.The ketodietresultsinketosiswithcirculatingketonesrangingfrom
0.5-5.0 mM. This can be measuredusingahome bloodketone monitorwithketone teststrips.(Please
knowthat testingketonesinurine isnotaccurate.)
How To Formulate A KetoDiet
1. Carbohydrates
For mostpeople,toachieve ketosis(gettingketonesabove 0.5mM) requiresthemtorestrictcarbs to
somewhere between20-50grams (g)/day.The actual amountof carbs will varyfrompersontoperson.
Generally,the more insulinresistantapersonis,the more resistanttheyare toketosis.Some insulin
sensitiveathletesexercisingvigorouslycanconsume more than50 g/dayand remaininketosis,whereas
individualswithtype 2diabetesandinsulinresistance mayneedtobe closerto20-30 g/day.
Whencalculatingcarbs,one isallowedtouse netcarbs, meaningtotal carbsminusfiberandsugar
alcohols.The conceptof netcarbs is to incorporate onlycarbsthat increase bloodsugarandinsulin.
Fiberdoesnothave any metabolicorhormonal impactandso do mostsugar alcohols.The exceptionis
maltitol,whichcanhave a non-trivial impactonbloodsugarand insulin.Therefore,if maltitol isonthe
ingredientlist, sugaralcohol shouldnotbe deductedfromtotal carbs.
The level of carbsone can consume andremaininketosismayalsochange overtime dependingonketo
adaptation,weightloss,exercise habits,medications,etc.Therefore,one shouldmeasure his/her
ketone levelsonaroutine basis.
In termsof the overall diet,carb-densefoodslikepastas,cereals,potatoes,rice,beans,sugarysweets,
sodas,juices,andbeerare not suitable.
Most dairyproducts containcarbs inthe form of lactose (milksugar).However,some have lesscarbs
and can be usedregularly.These include hardcheeses(Parmesan,cheddar),soft,high-fatcheeses(Brie),
full-fatcreamcheese,heavywhippingcream, andsourcream.

6. A carb level lessthan50 g/daygenerallybreaksdowntothe following:
5-10 g carbs from protein-basedfoods.Eggs,cheese,andshellfishwillcarrya few residual gramsof
carbs fromnatural sourcesandaddedmarinadesandspices.
10-15 g carbs fromnon-starchyvegetables.
5-10 g carbs from nuts/seeds.Mostnutscontain5-6 g carbs perounce.
5-10 g carbs from fruitssuchas berries,olives,tomatoes,andavocados.
5-10 g carbs from miscellaneoussourcessuchaslow-carbdesserts,high-fatdressings,ordrinkswith
verysmall amountsof sugar.
Beverages
Most people require atleasthalf agallonof total fluidperday.The bestsourcesare filteredwater,
organiccoffee andtea (regularanddecaf,unsweetened),andunsweetenedalmondandcoconutmilk.
Dietsodasand drinksare bestavoidedastheycontainartificial sweeteners.If youdrinkredorwhite
wine,limitto1-2 glasses,the dryerthe better.If youdrinkspirits,avoidthe sweetenedmixeddrinks.
2. Protein
A ketodietisnota highproteindiet.The reasonisthatproteinincreasesinsulinandcan be convertedto
glucose througha processcalledgluconeogenesis,hence,inhibitingketosis.However,aketodietshould
not be too lowinproteineitherasitcan leadto lossof muscle tissue andfunction.
The average adultrequiresabout0.8-1.5 g per kilogram(kg) of leanbodymassperday. It isimportantto
make the calculationbasedonleanbodymass,not total bodyweight.The reasonisbecause fatmass
doesnotrequire proteintomaintain,onlythe leanmusclemass.
For example,if anindividual weighs150 lbs(or150/2.2 = 68.18 kg) and has a bodyfat contentof 20%
(or leanbodymassof 80% = 68.18 kg x 0.8 = 54.55 kg),the proteinrequirementmayrange from44 (=
54.55 x 0.8) to 82 (= 54.55 x 1.5) g/day.

7. Those whoare insulinresistantordoingthe ketodietfortherapeuticreasons(cancer,epilepsy,etc.)
shouldaimto be closerto the lowerproteinlimit.The higherlimitisforthose whoare veryactive or
athletic.Foreveryone else whoisusingthe ketodietforweightlossorotherhealthbenefits,the
amountof dailyproteincanbe somewhere inbetween.
Bestsourcesof highqualityproteininclude:
Organic,pasturedeggs(6-8 g of protein/egg)
Grass-fedmeats(6-9g of protein/oz)
Animal-basedsourcesof omega-3fats,suchaswild-caughtAlaskansalmon,sardines,andanchovies,
and herrings.(6-9g of protein/oz)
Nutsand seeds,suchasmacadamia,almonds,pecans,flax,hemp,andsesameseeds.(4-8g of
protein/quartercup)
Vegetables(1-2g of protein/oz)
3. Fat
Havingfiguredoutthe exactamountsof carbs andproteintoeat, the restof the dietcomesfromfat. A
ketodietisnecessarilyhighinfat.If sufficientfatiseaten,bodyweightismaintained.If weighlossis
desired,one shouldconsume lessdietaryfatandrelyonstored bodyfat forenergyexpenditureinstead.
(Asa % of total caloricintake)
_________________________Maintain Weight_______Lose Weight
Carbs____________________5-10%________________5-10%
Protein__________________10-15%_______________10-15%

8. Fat fromdiet_____________70-80%_______________35-40%
Fat fromstoredbodyfat___0%___________________35-40%
For individualswhoconsume 2,000caloriesa day to maintaintheirweight,dailyfatintakesrange from
about156-178 g/day.For large or veryactive individualswithhighenergyrequirementswhoare
maintainingweight,fatintakesmayevenexceed300 g/day.
Most people cantolerate highintakesof fat,butcertainconditionssuchasgallbladderremoval may
affectthe amountof fatthat can be consumedat a single meal.Inwhichcase,more frequentmealsor
use of bile saltsorpancreaticenzymeshighinlipase maybe helpful.
Avoideatingundesirablefatssuchastrans fat, highlyrefinedpolyunsaturatedvegetableoils,aswell as
highamountsof omega-6polyunsaturatedfats.
Bestfoodsto obtainhighqualityfatsinclude:
Avocadosandavocado oil
Coconutsand coconutoil
Grass-fedbutter,ghee,andbeef fat
Organic,pasturedheavycream
Olive oil
Lard from pasturedpigs
Mediumchaintriglycerides(MCTs)
MCT ölisa specifictype of fatthatis metabolizeddifferentlyfromregularlong-chainfattyacids.The liver
can use MCTs to rapidlyproduce energy,evenbefore glucose,thusallowinganincreasedproductionof
ketones.

9. Concentratedsourcesof MCT oil are available assupplements.Manypeopleuse themtohelpachieve
ketosis.The onlyfoodthatisuniquelyhighinMCTsiscoconut oil.Abouttwo-thirdsof the coconutfatis
derivedfromMCT(mctpulveröl).
Who ShouldBe CautiousWithA KetoDiet?
For mostpeople,aketodietisverysafe.However, there are certainindividualswhoneedtotake special
care and discusswiththeirdoctorsbefore goingonsucha diet.
Those takingmedicationsfordiabetes.Dosage mayneedtobe adjustedasbloodsugargoesdownwith
a low-carbdiet.
Those takingmedicationsforhighbloodpressure.Dosage mayneedtobe adjustedasbloodpressure
goesdownwitha low-carbdiet.
Those whoare breastfeedingshouldnotgoon a verystrictlow-carbdietas the bodycan lose about30 g
of carbs perday viathe milk.Therefore,have atleast50 g of carbs perday while breastfeeding.
Those withkidneydisease shouldconsultwiththeirdoctorsbefore doingaketodiet.
CommonConcernsWithA KetoDiet
Notbeingable toreach ketosis.Make sure youare not eatingtoomuch proteinandthere isno hidden
carbs in the packagedfoodsthatyou consume.
Eatingthe wrongkindsof fat suchas the highlyrefinedpolyunsaturatedcornandsoybeanoils.
Symptomsof a "keto-flu",suchasfeelinglight-headed,dizziness,headaches,fatigue,brainfog,and
constipation.Wheninketosis,the bodytendstoexcrete more sodium.If one isnotgettingenough
sodiumfromthe diet,symptomsof aketo-flumayappear.Thisiseasilyremediedbydrinking2cupsof
broth (withaddedsalt) perday.If youexercise vigorouslyorthe sweatrate is high,youmayneedto add
back evenmore sodium.
Dawn effect.Normal fastingbloodsugarsare lessthan100 mg/dl and mostpeople inketosiswill
achieve thislevelif theyare notdiabetic.However,insome people fastingbloodsugarstendto
increase,especiallyinthe morning,while onaketodiet.Thisiscalledthe "dawneffect"andisdue to
the normal circadianrise in morningcortisol (stresshormone) thatstimulatesthe livertomake more
glucose.If thishappens,make sure youare notconsumingexcessive proteinatdinnerandnottoo close

10. to bedtime.Stressandpoorsleepcanalsoleadtohighercortisol levels.If youare insulinresistant,you
may alsoneedmore time toachieve ketosis.
Low athleticperformance.Keto-adaptationusuallytakesabout4 weeks.Duringwhich,insteadof doing
intense workoutsortraining,switchtosomethingthatislessvigorous.Afterthe adaptationperiod,
athleticperformance usuallyreturnstonormal orevenbetter,especiallyforendurancesports.
Keto-rashisnota common side effectof the diet.Probable causesinclude productionof acetone (a
formof ketone) inthe sweatthatirritatesthe skinornutrientdeficienciesincludingproteinorminerals.
Showerimmediatelyafterexerciseandmake sure youeatnutrientdense wholefoods.
Ketoacidosis.Thisisa veryrare conditionthatoccurs whenbloodketone levelsgoabove 15 mM. A well -
formulatedketodietdoesnotcause ketoacidosis.Certainconditionssuchastype 1 diabetes,beingon
medicationswithSGLT-2inhibitorsfortype 2 diabetes,orbreastfeedingrequire extracaution.
Symptomsinclude lethargy,nausea,vomiting,andrapidshallowbreathing.Mildcasescanbe resolved
usingsodiumbicarbonate mixedwithdilutedorange orapple juice.Severe symptomsrequire prompt
medical attention.
Is KetoSafe ForLong-Term?
Thisis an area of some controversy.Thoughthere have notbeenanystudiesindicatinganyadverse
long-termeffectsof beingonaketodiet,manyexpertsnow believethatthe bodymaydevelopa
"resistance"tothe benefitsof ketosisunlessone regularlycyclesinandoutof it.In addition,eatinga
veryhigh-fatdietinthe long-termmaynotbe suitable forall bodytypes.
Cyclical ketodiet
Once you are able to generate over0.5 mM of ketonesinthe bloodona consistentbasis,itistime to
start reintroducingcarbsbackintothe diet.Insteadof eatingmerely20-50 g of carbs/day,you maywant
to increase itto 100-150 g on those carb-feedingdays.Typically,2-3timesaweekwill be sufficient.
Ideally,thisisalsodone onstrengthtrainingdaysonwhichyouactuallyincrease yourproteinintake.
Thisapproach of cyclingmay make the dietplanmore acceptable tosome people whoare reluctantto
permanentlyeliminatesome of theirfavoritefoods.However,itmayalsolowerresolve and
commitmenttothe ketodietor triggerbingesinsusceptibleindividuals.

11. Carol Chuang isa CertifiedNutritionSpecialist.She hasa Mastersdegree inNutritionandisa Certified
GlutenPractitioner.She specializesinMetabolicTypingandFunctional DiagnosticNutrition.
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