Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, 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]
In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[54]
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!
Nina, this is a brilliant article, thank you. I have shared it with my Low Carb & Keto Facebook US & UK groups, many of whom are new to this way of eating for weight loss, reversing Diabetes, preventing Diabetes and improving their health. My members receive regular low carb recipes and support but articles like this, really do reinforce their reasons for staying low carb and helps them justify their lifestyle to family, friends and some Medics!
You won’t miss dirty keto add-ins like heavy cream or peanut butter with this recipe. Ripe strawberries and coconut milk blend into a sweet pastel shake perfect for dessert (or breakfast). Choose full-fat canned coconut milk for your dairy and get fresh, organic strawberries to make it more Bulletproof. (And enjoy chia seeds in moderation, since they can irritate your stomach.)
Most people have probably heard of the Atkins diet, which is a pretty general take on ketogenic eating. Wildly popular in the 70s and again in the 90s, Atkins and the low-carb diet are one of the best ways to lose weight. In fact, one of the biggest benefits to low carb eating is that it is a very efficient way to lose weight without much effort. The combination of filling meals that reduce overeating and the fact that, when you’re in ketosis your body burns stored fat for energy makes this an ideal diet for people whose primary goal is fat loss.

Even in endurance sports that don’t require sprinting, ketogenic-style diets are disadvantageous according to a ketogenic diet and exercise article published in Sports Medicine[5]: “a high-fat, low-carbohydrate ketogenic diet may impair exercise performance via reducing the capacity to utilize carbohydrates, which forms a key fuel source for skeletal muscle during intense endurance-type exercise.” The article concluded, “At present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.”

The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals, and calcium-rich foods. In particular, the B vitamins, calcium, and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[18] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises three small meals and three small snacks:[28]
No human population has ever lived in a permanent state of ketosis. Ketogenic diets are dangerous for pregnant women and developing fetuses, and the only human population that has ever subsisted on this dietary pattern advocated by keto diet proponents could only do so because of a genetic mutation that prevents them from going into ketosis. Unfortunately, it has the unintended but unavoidable consequence of reducing the survival prospects of their infants.
Insulin is a hormone that lets your body use or store sugar as fuel. Ketogenic diets make you burn through this fuel quickly, so you don’t need to store it. This means your body needs -- and makes -- less insulin. Those lower levels may help protect you against some kinds of cancer or even slow the growth of cancer cells. More research is needed on this, though.
The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
Our human ancestors did not consume high-fat, low-carbohydrate diets and therefore would not have been in diet-induced ketosis. Even the most successful early hunters could not possibly have consumed enough fat to enter ketosis since african wildlife such as wildebeests, warthogs and impalas all have low body fat – well under 10%, and as low as 0.3%[6] in the dry season.
While many health care providers aren’t comfortable recommending the keto diet for people with diabetes, there’s a substantial body of research indicating that it can help with weight loss, reduce the need for medication, and even lower A1C into the non-diabetes range. It’s so effective that when researchers assigned 349 volunteers with type 2 diabetes to follow either a keto diet or a traditional diabetes eating plan (the makeup of that plan wasn’t defined in the study) for one year, they observed some powerful results. While the people on the “diabetes diet” didn’t experience any positive movement in their A1C, body weight, or medication requirements, those on the keto plan reduced their A1C from 7.6 to 6.3 percent, shed 12 percent of their body weight, eliminated their need for sulfonylurea medication, and lowered or reduced their need for insulin by 94 percent. The results were published in 2018 in the journal Diabetes Therapy.

While there is no such thing as a one-size-fits-all diet, diets with varying macronutrient compositions can help in supporting different health goals. The ketogenic diet, with its high fat, low carbohydrate, and moderate protein intake, has been solidly researched for a number of health applications since the 1920s and has been growing in popularity in recent years. Additional science and the potential for the ketogenic diet in various applications is emerging.
For both keto and Bulletproof diets, opt for full-fat, grass-fed, raw, and organic dairy to reap the anti-inflammatory benefits of omega-3s and CLA. Dairy is a great source of fat on a ketogenic diet, but be mindful not over-do the protein. Although milk (yep, even raw, full-fat, or goat milk) is too high in lactose sugars, you can stay in ketosis with foods like butter, ghee, and colostrum. Avoid sweetened or low-fat dairy, evaporated or condensed milk, and buttermilk to keep your fat intake high.
Inpatient stay: Within one month of the first appointment, your child will be initiated on the diet. They will be admitted as inpatients for four days and given a schedule of activities, and our dietitians will guide your child and whole family through about 10 hours of education about the diet. Everyone who will take care of the child, including babysitters, grandparents, nannies, etc., is taught the specifics of the diet. The inpatient stay is also used to adjust the diet to your child’s palate.
When you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis. It's important to note that the ketogenic diet is a short term diet that's focussed on weight loss rather than the pursuit of health benefits. 
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
Meanwhile, more than 70 trials have examined the health effects of a low-carb diet. They attest to the benefits64 associated with ketosis and low-carb diets, including a reduction in body weight and body mass index, improved cardiovascular risk factors including blood pressure, and the reversal of Type 2 diabetes. It is virtually impossible to imagine that a diet with so many health improvements in the ‘near term’ (2 years) could ultimately shorten life—and the study authors offer no possible mechanism to explain how this might happen.
The only issue with keto, is really that I’m afraid that it might be hard to up my calories to a maintenance weight now that I’ve gotten a taste preference for the rich assortment of foods with no carbs in them. I’m satisfied with less calories than I will need after my excess fat is burned off… but , maybe I bet my body will send more hunger signs once there isn’t anymore body fat in the cupboard to use instead of what goes down my throat.
A ketogenic diet could be an interesting alternative to treat certain conditions, and may accelerate weight loss. But it is hard to follow and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time. It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.
What about fruits and vegetables? All fruits are rich in carbs, but you can have certain fruits (usually berries) in small portions. Vegetables (also rich in carbs) are restricted to leafy greens (such as kale, Swiss chard, spinach), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber, celery, and summer squashes. A cup of chopped broccoli has about six carbs.
Epilepsy is one of the most common neurological disorders after stroke,[7] and affects around 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 can 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 achieve control of their epilepsy with the first drug they use, whereas around 30% do not achieve control with drugs. When drugs fail, other options include epilepsy surgery, vagus nerve stimulation, and the ketogenic diet.[7]

Alison Moodie is a health reporter based in Los Angeles. She has written for numerous outlets including Newsweek, Agence France-Presse, The Daily Mail and HuffPost. For years she covered sustainable business for The Guardian. She holds a master’s degree from Columbia University’s Graduate School of Journalism, where she majored in TV news. When she's not working she's doting on her two kids and whipping up Bulletproof-inspired dishes in her kitchen.
If you’re wondering about the difference between ketosis and diabetic ketoacidosis, you’re not alone. “The word ketone is scary for most people with type 1 diabetes because they relate ketones to diabetic ketoacidosis,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “But with the ketogenic diet, we’re talking about a much lower level of ketones.”
Alison Moodie is a health reporter based in Los Angeles. She has written for numerous outlets including Newsweek, Agence France-Presse, The Daily Mail and HuffPost. For years she covered sustainable business for The Guardian. She holds a master’s degree from Columbia University’s Graduate School of Journalism, where she majored in TV news. When she's not working she's doting on her two kids and whipping up Bulletproof-inspired dishes in her kitchen.
Like weeknight dinners. It goes without saying that weeknight dinners should be the easiest of them all because you have neither the time nor the inclination to spend a bunch of time in the kitchen. But you still need to eat! That’s why I’ve done the work for you. These are the best and easiest low carb dinner recipes you could hope for. You’re welcome!

Look, the good doctor is right – he only forgot to stress “portion control” which is why many fanatical dieters are so kee-jerk reactive to any discussion – odds are you over ate like a hog before your keto diet, and are weak and insecure in your diet plans. Eat EVERYTHING in small amounts, and you will live long and prosper. The only thing to avoid are processed foods. Cook your meals from scratch using quality ingredients.
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.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]
“If someone with diabetes is [taking insulin or oral type 2 meds in the sulfonylurea or meglitinide class and is] following this diet, they need to know that their blood sugar can drop really quickly, so it’s critical that they check it more frequently,” says Toby Smithson, MS, RDN, CDE, author of Diabetes Meal Planning & Nutrition for Dummies. “Don’t wait for it to happen. Meet with your doctor or diabetes educator in advance so that you can troubleshoot exactly what to do if your blood sugar drops.” If it’s an infrequent occurrence, you may be advised to treat with fast-acting glucose. But frequent lows may require medication adjustments or the addition of more carbs to your eating plan.
Furthermore, humans develop a condition dubbed ‘rabbit starvation’[7] when they eat a diet that is low in fat and carbohydrates, and high in protein (> 35% of total daily energy intake). This is due to the inability of the human liver to sufficiently upregulate urea synthesis to meet excessive loads of protein. Consequently, hyperaminoacidemia, hyperammonemia, hyperinsulinemia, nausea, diarrhea, and even death can ensue within 2 to 3 weeks. These effects were recognized historically through the excess consumption of lean wild meat by early American explorers.[8]
Our Clinical Services Team - staffed by clinicians and other nutritional experts - answer technical questions about our nutritional formulas and the most effective ways to recommend them in a variety of protocols. And our product representatives help practitioners grow their business in many more ways than suggesting practice-appropriate nutritional products.
Despite its explosive popularity, there’s a lot of confusion about what the ketogenic (keto) diet really is. “Many people think they’re following a keto diet when they’re really just consuming a low-carbohydrate diet,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “So one person’s ‘keto diet’ may look very different than another’s.”
Thanks for this post, I am always on the look out for new blogs I haven’t discovered yet and you have provided a couple. I am also on the look out for new dinner recipes ( this is not to say I don’t appreciate your dessert recipes cause boy do I ) but my husband cannot eat red meat of any kind so this makes it even harder to make a low carb dinner for us. I have gotten used to subbing ground turkey for beef and have discovered that using broth from dried porcinis gives it a very beefy flavor. Now I have a few more recipes to try, Thanks for that.

The ketogenic diet may seem like the latest weight-loss craze, but it’s actually been around for nearly a century. Developed in the 1920s, this ultra-low-carb, high-fat eating plan was originally used to treat seizures in people with epilepsy. Today, it’s getting some serious attention for an entirely different reason. “There’s growing research showing that the ketogenic diet is effective for managing blood sugar in people with diabetes,” says William Yancy, MD, program director at the Duke Diet and Fitness Center in Durham, North Carolina. “However, because we don’t have studies [lasting] longer than two or three years, we don’t know what can happen with regard to complications over longer periods of time.”


“If someone with diabetes is [taking insulin or oral type 2 meds in the sulfonylurea or meglitinide class and is] following this diet, they need to know that their blood sugar can drop really quickly, so it’s critical that they check it more frequently,” says Toby Smithson, MS, RDN, CDE, author of Diabetes Meal Planning & Nutrition for Dummies. “Don’t wait for it to happen. Meet with your doctor or diabetes educator in advance so that you can troubleshoot exactly what to do if your blood sugar drops.” If it’s an infrequent occurrence, you may be advised to treat with fast-acting glucose. But frequent lows may require medication adjustments or the addition of more carbs to your eating plan.
Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.
×