Missing Nutrients. One of the biggest concerns for dietitians is the keto diet’s lack of key foods. Many question the eating plan’s impact on the development of certain chronic diseases. Without milk, for example, getting enough calcium and vitamin D for sturdy bones becomes a challenge. Take away whole grains, fruit, beans, and potatoes, and it’s nearly impossible to consume enough potassium for healthy blood pressure or enough fiber to stay regular. And unless you’re eating lots of low-carb, leafy green vegetables, you miss out on vitamins A, C, K, and folate, too. 
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 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]


A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
Bread probably isn’t the first thing that comes to mind when you think about the ketogenic diet because it’s generally full of carbs. But, if you replace your store-bought bread with a homemade keto bread recipe, it can fit seamlessly into your keto low-carb, high-fat diet. How does bread even become keto-friendly? With almond flour, a lot of eggs, cream of tartar, butter, baking soda and apple cider vinegar.
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]
Professional guidance is important in deciding whether or not the ketogenic diet is the right path based on the individual’s health history and goals, and it's also necessary to routinely monitor ketone levels in the body while on the diet. At Metagenics, we offer a number of resources to help support the ketogenic journey along with several convenient ketogenic supplementation options to help bring convenience and variety to ketogenic living.
A systematic review in 2018 looked at 16 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, high total cholesterol, and weight loss.[24]
Note the emphasis on ketosis as a temporary adaptive state. Our ancestors could not be in fasting-induced ketosis permanently because they would eventually exhaust their fat reserves (which were presumably far more limited than ours, owing to the simple fact that they ate less and moved more than we do). They would then progress from fasting to starving, and subsequently die.
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.
Missing Nutrients. One of the biggest concerns for dietitians is the keto diet’s lack of key foods. Many question the eating plan’s impact on the development of certain chronic diseases. Without milk, for example, getting enough calcium and vitamin D for sturdy bones becomes a challenge. Take away whole grains, fruit, beans, and potatoes, and it’s nearly impossible to consume enough potassium for healthy blood pressure or enough fiber to stay regular. And unless you’re eating lots of low-carb, leafy green vegetables, you miss out on vitamins A, C, K, and folate, too. 
But even if you’re not trying to lose weight, the keto meal plans might appeal to you. By limiting sugars and processed grains, you lower your risk of type 2 diabetes. Eating an array of heart-healthy fats, like nuts, olive oil and fish, can decrease your risk of heart disease. And while some people stick to a super strict keto diet, with 75 percent of their diet coming from fat, 20 percent from protein and just five from carbs, even a less intense, modified version can help you reap the keto diet’s benefits.

First appointment: Your first meeting with our team will be a one-hour new patient appointment. You’ll meet our nurse practitioners, social worker and dietitians to discuss the diet’s daily requirements, the initiation process, the length of time your child will be on the diet, how the diet may affect your family and any other questions your family may have. If the ketogenic diet team and your family both agree the diet will be manageable for your family, an initiation is scheduled.

My principal hope in this article is to provide journalists with a resource to do what basic journalism demands, namely to ensure that stories are scientifically balanced and accurate. At the end of this post I provide contacts for some of the credentialed experts who helped me compile this research. Reporters, please seek out these or other low-carb diet experts so you can provide accurate, up-to-date information for your readers.
Some keto cookies or a keto brownie can certainly be delicious, but if you’re looking for a dessert that’s a little more interesting, then you have to try this chocolate chia pudding! I love chia seeds for a number of reasons. They’re high in antioxidants, vitamins such as calcium, potassium and magnesium, Omega-3 ALA, dietary fiber and even protein. So, while this dish feels like a dessert, you’re receiving plenty of necessary nutrients. Enjoy guilty-free!
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]
A ketogenic diet is a very low-carbohydrate way of eating that delivers moderate amounts of high-quality dietary protein and high amounts of healthy dietary fat. This reduction in carbohydrate intake helps the body shift toward a state that promotes the breakdown of fats (from the diet and your body) to produce ketone bodies and enter a state known as “ketosis.”

Some keto cookies or a keto brownie can certainly be delicious, but if you’re looking for a dessert that’s a little more interesting, then you have to try this chocolate chia pudding! I love chia seeds for a number of reasons. They’re high in antioxidants, vitamins such as calcium, potassium and magnesium, Omega-3 ALA, dietary fiber and even protein. So, while this dish feels like a dessert, you’re receiving plenty of necessary nutrients. Enjoy guilty-free!


Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
Even after irradiation (the industry standard sterilization process that also destroys any antioxidants and health benefits), spices and herbs can spoil in your home, and often harbor aggressive mold toxins. To spice up your dishes the Bulletproof way, use high-quality, fresh or recently opened herbs and spices. Spices with especially high mold toxin risk include black pepper, powdered garlic, nutmeg, and paprika. Apple cider vinegar is the only vinegar permitted in the Bulletproof diet, as other vinegars and yeasts introduce toxins, and promote yeast growth in your gut.
A ketogenic diet is high in fat and low in carbohydrates. It’s called “ketogenic” because people on this diet shift from using glucose (a type of sugar) as their main fuel source to ketone bodies, which are derived from fat. In other words, people on the ketogenic diet can use their bodies’ fat stores as fuel—and this is why many studies show that this diet is superior for sustainable weight loss.
A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more controversy when we consider the effect on cholesterol levels. A few studies show some patients have increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.
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.
Some sugar-free candy may seem safe (especially on dirty keto), but can contain the wrong sugar alcohols that could spike your blood glucose. This recipe uses stevia, which ranks much lower on the glycemic index, combined with lemon juice and gelatin for a chewy 3-ingredient gummy candy that still satisfies your sugar cravings. Make sure your gelatin comes from a pastured source to keep this one Bulletproof.

A systematic review in 2018 looked at 16 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, high total cholesterol, and weight loss.[24]


Thanks for this article. I just started a Keto diet so found it appropriate to my current lifestyle. Though I don’t believe your bottom line is strong enough since you simply stating that the diet is “hard to follow” and food is “notoriously unhealthy” without evidence going deeper into why those “notoriously unhealthy” foods are worse than keeping carbohydrate-heavy food that are addictive and give the body a quick sugar high for energy. I believe “hard to follow” is your opinion only, since acceptable Keto foods are found at all restaurants easily and also all grocery stores. All the foods you mention: “rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water” are all Keto-friendly. Many people have been on a Keto-diet for years. A healthy lifestyle is a healthy mindset change and making right choices – it’s not going to be easy.


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.[56]

Modern-day ketogenic diet promoters such as Pete Evans advocate low-carbohydrate diets for babies and children. However, the Inuit practiced exclusive breastfeeding until their children reached 2 years of age,[11] at which time meat was introduced in their diets. In other words, at the time of most rapid brain growth, the low-carb eating Inuit provided their children with the only carbohydrate-rich food available to them – human milk.
When you’ve eaten all of the crustless spinach quiche and keto frittata recipes that you can, these keto everything bagels are another great breakfast staple. With their help, you don’t have to cut out your favorite breakfast sandwiches. You can also try a bread-less keto breakfast sandwich with chicken sausage patties as the “buns” when you’re craving a keto-approved breakfast option.
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:
Metagenics offers a wide range of educational opportunities including webinars, group meetings, and seminars as part of our commitment to continuing functional medicine education. Our goal is to give our practitioners further insight to help address their patients’ unique health needs for a higher level of personalized, lifetime wellness care. We have been sharing this ever-growing body of nutritional and lifestyle research for over 25 years.
Our bodies are incredibly adaptive to what you put into it – when you overload it with fats and take away carbohydrates, it will begin to burn ketones as the primary energy source. Optimal ketone levels offer many health, weight loss, physical and mental performance benefits.1There are scientifically-backed studies that show the advantage of a low-carb, ketogenic diet over a low-fat diet. One meta-analysis of low-carbohydrate diets showed a large advantage in weight loss. The New England Journal of Medicine study resulted in almost double the weight loss in a long-term study on ketone inducing diets.
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]

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]
This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
Please note that I am not a medical or nutritional professional. I am simply recounting and sharing my own experiences on this blog. Nothing I express here should be taken as medical advice and you should consult with your doctor before starting any diet or exercise program. I provide nutritional information for my recipes simply as a courtesy to my readers. It is calculated using MacGourmet software and I remove erythritol from the final carb count and net carb count, as it does not affect my own blood glucose levels. I do my best to be as accurate as possible but you should independently calculate nutritional information on your own before relying on them. I expressly disclaim any and all liability of any kind with respect to any act or omission wholly or in part in reliance on anything contained in this website.

There are three essential components of all food: fats, carbohydrates and protein. The ketogenic diet is a carefully prescribed ratio of fats to carbohydrates and protein. This ratio causes the body to convert fat into substances called ketone bodies (thus the name). These ketones are then used for fuel in many cells of the body, including the brain. When this happens, the brain goes into a higher energy state and is better able to protect itself against seizures.


There are numerous benefits that come with being on keto: from weight loss and increased energy levels to therapeutic medical applications. Most anyone can safely benefit from eating a low-carb, high-fat diet. Below, you’ll find a short list of the benefits you can receive from a ketogenic diet. For a more comprehensive list, you can also read our in-depth article here >

^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
If you’re looking to get a jump start on your health and fitness goals this year, you may be thinking about trying the ketogenic diet. Maybe you’ve heard the phrase before — it’s a huge diet buzzword — but aren’t sure what it means. Here’s a primer: The ketogenic diet is an eating plan that drives your body into ketosis, a state where the body uses fat as a primary fuel source (instead of carbohydrates), says Stacey Mattinson, RDN, who is based in Austin, Texas.
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