What is Keto Diet

The keto diet is a regimen high in fat, moderate in protein, and very-low in carbohydrate. The diet consists of 75% fat, 20% proteins, and only 5% carbohydrates. In some types of the diet, carbohydrates consumption can go to as low as 2% only.

Meanwhile, a standard modern diet AMDR (Acceptable Macronutrients Distribution Ranges) allows for a daily caloric intake of carbs: 45% - 65%, fat: 25% - 35%, and proteins: 10% - 35%. 

Accordingly, based on the standard diet, most of the calories we burn come from carbohydrates. These carbs are metabolized by the liver and converted into glucose that is used as the primary source of energy for the body.    

Now given that the keto diet restricts carbohydrates, the body will become depleted from carbs in few days. Subsequently, glucose that is produced from metabolizing carbohydrates by the liver, will not be available anymore. 

However, glucose is the main source of energy for the body. Hence, in order to survive, the body needs to find an alternative source of energy. 

Since fats are the only nutrient now available in abundance, the body becomes forced to shift from burning carbohydrates for energy to start burning fat for energy. This metabolic shift that takes place in the body is known by the name of “ketosis”. Hence, the name of the diet “Keto”.

During this “ketosis” metabolic state, the liver starts converting fat into ketones instead of glucose that was previously produced from metabolizing carbohydrates. 
Subsequently, ketones become now the new alternative source of energy. These ketones are an extremely strong source of energy and will be providing the body and the mind with the necessary nutrients to function properly.
Ketones are also believed to have tremendous health benefits, and can provide the body with long lasting energy.

Keto Diet history

The ketogenic diet is a very famous diet nowadays and very commonly used for weight loss. However, this diet was originally created to treat epilepsy. So how did it all started?

Since ancient times, fasting was considered an important cure for many diseases and a healthy way of living. Greek physicians restricted patient’s diets in order to treat various health conditions. And for more than two thousand years, fasting was the only treatment used for managing epilepsy around most of the world. 

Back in 1911 in France, a research was conducted to better understand the role of fasting in treating epilepsy. The results of the study found that patients who consumed low-caloric diets in addition to fasting for longer periods had fewer seizures and fewer symptoms caused by this condition.

Around the same time, Hugh Conklin, an American osteopathic physician, was recommending fasting to his epileptic patients in order to control their seizures. There was a 50 percent success rate among adults and 90 percent for children. In 1916, the fasting therapy was adopted for treating epilepsy. 

It was in 1921 when endocrinologist Rollin Woodyatt noted that the body starvation created three water-soluble compounds: acetone, β-hydroxybutyrate, and acetoacetate; known as ketone bodies. It was also noted that the same bodies were produced when people followed a diet rich in fats and low in carbohydrates.

In this same year, Dr. Russel Wilder, a pioneering researcher in diabetes and nutrition from the Mayo Clinic, called this diet the “ketogenic diet”. This diet was recognized for its ability to imitate the effect of fasting and producing body ketones. 

The keto diet consisted of fat, protein, and carbohydrates at a ratio of 4 to 1 for fat to combined protein and carbohydrates. This percentage split of each macronutrient incorporated in this diet was seen to force the body use fat instead of carbohydrates as an energy source. When this happened, the body started creating ketones that are used as an alternative source of energy. This metabolic shift known as “ketosis” was proven to be quite effective in helping treating seizures caused by epilepsy. 

Soon after, in the 1920’s, the keto diet became commonly used for treating epilepsy. With time, the diet proved to be very successful also in treating many other medical conditions as well.

Almost after one century, the keto diet started to gain much more popularity but this time for its ability to reduce weight. In the 2010’s, the diet became one of the most famous diets across the world used for weight loss. 

Millions of people tried it so far. Many success stories are available all over the internet. “Before and after” pictures are posted across all social media, clearly showing how effective this diet was for losing weight. 

Standard Keto diet (SKD)

This type is the most common version of the diet. It is mostly used for weight loss. This diet is very-low carb (5%), moderate protein (20%), and high fat (75%).

Cyclical Keto diet (CKD)

This diet rotates between a ketogenic and high carbohydrate diet. For example, people can follow a keto diet for five days then high carbohydrate diet for two days.

This diet is usually for individuals who have hard time following the ketogenic diet or for athletes who need to fuel with carbohydrates between workouts or competitions.

High Protein Keto diet

This diet is comparable to the standard ketogenic diet (SKD) diet; however, it incorporates more proteins. Fats consist of 60%, proteins 35%, and carbohydrates 5%.

This diet is recommended for those who need to stay lean and protect their muscle mass such as body builders.

Targeted Keto diet (TKD)

This diet adds carbohydrates during the workouts period. The ketogenic diet is normally followed until 30 to 45 minutes before the workout. Then, 25 g of carbohydrates can be consumed before training.

This diet is advised for high-intensity workouts that last around couple of hours.

Keto diet misconceptions: 

1- Fat in Keto Diet is bad for health: 

There’s a misconception revolving around the false belief that following a keto diet is bad for health since the diet promotes eating “high fat foods”. And this can lead to various health conditions.

In this regard, it is important to understand that the keto diet suggests consuming “good fat” food such as avocados and olive oil among others. These foods are known to be beneficial for health as they increase good cholesterol levels.

By the same token, the keto diet recommends avoiding the saturated and unhealthy fats known as “bad fats” such as bacon and mayonnaise. 
Accordingly, it is crucial to know exactly what “high fat” food products to eat and understand the difference between them.

However, there's another version known as "dirty keto" that suggests allowing bad fat as long as we keep carbs consumption very low. This diet can still be effective for weight loss, however it can have negative long-term effects such as nutritional deficiencies and increased risks of diseases.

2- Keto diet increases cholesterol and is bad for the heart:

There's also another myth about the keto diet and heart disease as people always hear that 1- Keto diet increases cholesterol; and 2- keto diet promotes heart disease.

While it is true that the keto diet increases cholesterol level, however it is important to note that the diet actually increases the HDL (good cholesterol) and lowers the LDL (bad cholesterol). So, on the contrary, this increase in cholesterol is a very good thing for the heart health. 

The second misconception suggests that keto diet can cause heart diseases. This is also based on the previous false claim stating that keto diet increases cholesterol.

Furthermore, it has been long believed that cholesterol plays a major role in blocking the heart arteries and causing a heart attack or a stroke. Currently, this claim is thought to be false and is being highly challenged.

Accordingly, current researches suggest that inflammation is the primary cause of atherosclerosis and increasing the risks of heart diseases, not high cholesterol as it was wrongly assumed.

How Keto diet works in the Body

The Keto diet is a regimen that restricts the consumption of carbohydrates to only 5% of daily caloric intake (less than 50 grams per day), and increases fat up to 75%, with moderate protein around 20%.

Accordingly, carbohydrates will be drastically reduced in the body, and glucose which is the primary source of energy produced from carbohydrates, will become depleted.

Faced by this situation, the body needs to look for an alternative source of energy in order to survive. The main alternative source of energy that is available is fat. Accordingly, the body will be forced to turn to fat and starts breaking it down for energy.

This state is known as “ketosis”. It is a normal metabolic process in which the body starts burning fats instead of carbs, and the liver metabolizing fat into acids called “ketones”. These ketones will be used as the alternative source of energy, and hence replacing glucose that was previously produced by the liver from burning carbohydrates.

However, given that our bodies are not used to burning fat and they are not quite good at it, it will take the body some time to get used to processing fat before it becomes efficient.

Once this phase is reached, the body will start producing ketones in proper quantities to provide necessary energy and nutrients for the body, and hence keep the system functioning properly. 

Accordingly, ketones are sent into the blood stream so that muscles and other tissues can use them for fuel. It is also believed that these ketones can provide tremendous health benefits for the body and brain cells compared to glucose.

There is not one standard ketogenic diet to follow but it is rather a ratio of carbohydrates, protein and fat that is applied. The diet plan of the ketogenic diet is to consume high fat foods such as healthy oils, meats, fish, eggs, avocados, high fat-dairy, some nuts and non-starchy vegetables while avoiding sugar, high carbohydrate foods, and most fruits and low-fat products. 

Keto Diet program guidelines:

The ketogenic diet suggests consuming 70% to 80% of fat, 10% to 20% of protein and around 5% of carbohydrates only (less than 50 grams per day). 

There are no specific guidelines about the duration of the diet. However, it is generally recommended to follow it for at least three months.

Currently, there’s not enough data related to the long-term effects of the keto diet. Accordingly, it is not agreed yet whether this diet can be adapted as a lifelong eating plan or it should be applied only for specific durations.

It is recommended also to consume enough proteins to preserve the tissues and muscles. However, it is important to maintain the protein amounts within moderate limits of 20%. Any excess of protein can be converted into glucose in the body. Hence, this would push the body out of ketosis.

What are macros

It is very common to encounter the word “macros” while reading about the ketogenic diet. This term is short for macronutrients that include carbohydrates, fat and protein. These three substances provide our body with energy (calories) when we eat. 

Accordingly, if you wish to follow a ketogenic diet and make sure to maintain the “state of ketosis”, it is imperative for you to understand what are these macronutrients, and what you should do to balance them properly. 

Below is a brief explanation about each macronutrient and its main functions:

Carbohydrates:

Carbohydrates are made up of sugar and starches, and they are the body’s first source of energy. However, it is possible to survive on minimal quantities since fat and protein become the sources of energy when carbohydrates are not available. 

It is important to count net carbs as the total carbohydrate intake. Net carbs or impact carbs are common terms used in the ketogenic diet. It is the amount of carbs directly absorbed by the body that will contribute to calories, while indigestible (unabsorbed) carbohydrates that we know as dietary fiber, are subtracted from this amount.  In other words, the amount of net carbs is the total amount of carbohydrates minus the dietary fiber.

1 g of carbohydrates = 4 calories

Proteins: 

Proteins have many important functions in the body since they play different roles as antibodies, enzymes and hormones. They are needed for immunity, growth, tissue repair and to preserve lean body mass.

Amino acids are what makes proteins and they are known to be the building blocks of proteins. There are twenty amino acids, nine out of them are considered to be the essential ones. These are not produced by the body, instead they come from the food we eat. 

Any deficiency in proteins intake may lead to several health conditions. That’s why the ketogenic diet requires to consume enough protein in order to preserve lean body mass. 

The general requirements are 0.8 grams per kilogram of body weight to preserve muscle mass and 0.8-1.2 grams per kilogram of body weight in order to gain muscle mass. It is important to note 0.8 g/kg is the minimal requirement to maintain good health.

1 g of protein = 4 calories

Fat:

Fats provide energy for the body and support cells growth. They help the body absorb fat-soluble vitamins (vitamin A, D, E, K) and nutrients. They also help protect the organs and keep the body warm.

Fats are made up of fatty acids and glycerol. There are two essential fatty acids called linoleic acid and linolenic acid (omega 3 and 6) that the body cannot produce. Accordingly, these should come from the food we eat. 

Consuming fats is also known to influence satiety as it gives a feeling of being full for longer.

1 g of fat = 9 calories

Keto diet Macro Calculator:

1- Calculate your BMR (Basal Metabolic Rate): The Mifflin equation

The number of calories required by the body per day is called the Total Daily Energy Expenditure (TEE). This is equal to the sum of the Basal Metabolic Rate (BMR), which is the number of calories the body needs to function at rest, plus the amount of physical activity achieved daily.

To maintain your current weight, you should fulfill your TEE needs. In order to lose weight, you should subtract calories from your calculated TEE. Make sure to always check with a health professional regarding the number of calories you can reduce from your diet.

The Mifflin equation is used to calculate the BMR. It works as such:

Women

BMR (Basal Metabolic Rate) = (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) -161

Men

BMR (Basal Metabolic Rate) = (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) +5

2- Calculate the TEE (Total Daily Energy Expenditure):

To calculate the TEE, the activity level should multiply the BMR.

3- Calculate your macros: how many calories you should eat per day

Once the TEE (total daily energy expenditure) is determined, the macronutrients can be calculated accurately.

Example of macronutrients calculation: 

TEE = 1,600 for a woman.

Fat = 75 % = 1,200 cal = 133.3 g (each gram of fat is 9 calories)

Protein = 20% = 320 cal = 80 g (each gram of protein is 4 calories)

Carbohydrate = 5% = 80 cal = 20 g (each gram of carbohydrate is 4 calories)

This is a typical example of how many grams should be consumed daily depending on the TEE and percentage requirement of each macronutrient. The goal is to be able to choose foods properly that meet these needs.

Keto Diet foods: what you can eat

The various food types incorporated in the keto diet are high in good fat and very low in carbohydrates. Maintaining the proper proportions is critical to maintain the state of ketosis. Proportions should be done as per the macro calculation provided in the diet structure section.

Below is a list of the various food types for Keto diet: 

- Healthy fats: incorporate healthy high fat foods daily such as some oils (coconut, olive), avocadoes, nuts (macadamia, walnuts, almonds, pecans), and seeds (sunflower, pumpkin, sesame, flax). 

- Meat: it is suggested to consume grass-fed beef instead of grain-fed, and free-range poultry because they contain higher amounts of omega-3. Pork, bacon and organ meats can be consumed in moderation.

However, it is important to avoid eating too much meat in order to maintain the protein restrictions. It is also important to note that processed meats like sausages and cold cuts contain added carbohydrates. You should avoid them.

- Dairy: some dairy products are allowed such as butter, high fat cheese, and high fat yogurt, because of their low lactose content. Low fat dairy products should not be consumed as they tend to be higher in carbohydrates.

- Fish: it is suggested to consume fatty fish like salmon, wild-caught fish being the best option. Avoid breaded fish because it contains carbohydrates. 

- Non-starchy vegetables: non-starchy vegetables (low carb) include leafy greens (kale, Swiss chard, spinach, lettuce), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber and celery. Mostly, all vegetables that grow above the ground are lower in carbohydrates, and hence can be consumed.

- Fruits: fruits that are low in net carbs such as berries are allowed. 

- Nuts: nuts can be consumed in moderation as a snack. Avoid cashews and peanuts since they are high in carbohydrates.

- Dark chocolate: 90% dark chocolate and cocoa powder are allowed. Only higher than 70% dark chocolate can be consumed. For example, one ounce (28 grams) of unsweetened chocolate (100% cocoa) has 3 grams of net carbs.

- Drinks: water is the best choice in order to stay hydrated since it has no carbohydrates. Unsweetened coffee and tea can also be consumed. It is critical not to add any sugar. For example, 1 teaspoon of sugar is equivalent to 4 grams of carbohydrates. Hence, this will make it so difficult to remain within the recommended carbohydrates amount if you add any sugar.

Keto Diet recommendations

- Always check food labels: some hidden carbs may be present in spices, vegetables, and drinks. Always read food labels carefully before you buy any product.

- Always stay hydrated: make sure you always drink enough water to stay hydrated. Carbohydrates retain water in the body, so a low-carb diet can lead to dehydration and constipation.

- Consume enough salt, electrolytes, and magnesium: minerals can be lost along with water while following a keto diet. It is important to consume enough salt and take electrolytes or magnesium if necessary.

- Restrict your calories consumption: always restrict your diet within the allowed daily calories requirements. Do not exceed the recommended calories, otherwise this will result in weight gain.

Keto Diet: What you should Avoid

- Limit grains and starches: avoid wheat-based products like rice, pasta and cereals since they are high carbohydrate sources. 

- Limit sugary foods: avoid soda, beverages and juices with added sugars, smoothies, cake, and candies.

- Limit fruits: avoid fruits that are not considered low net carbs and all fruit juices because they are high carbohydrate sources.

- Limit beans and legumes: avoid eating beans, lentils and peanuts because they have high carbohydrate content.

- Limit root vegetables: avoid potatoes, sweet potatoes, carrots and parsnips because they are high in carbohydrates.

- Limit high lactose dairy: while dairy can be high in fat, most are also high in lactose sugar. Be aware of the amounts of carbohydrates present in the dairy products consumed. Avoid highly processed dairy such as ice cream because they are higher in sugar content.

- Avoid low fat or diet products: pay attention to low fat products because they are usually high in carbohydrates.

- Limit unhealthy fats: while a high fat diet is recommended, avoid consuming too much bad fat found in processed vegetable oils and mayonnaise.

- Limit alcohol: avoid full carbohydrates wine, beers, and cocktails with added sugars.

- Avoid processed food: processed foods should be avoided even if they are low in carbohydrates. They are composed of bad fats and increase the risk of several diseases.

- Be aware of sweeteners and sugar: sugar is naturally present in fruits and dairy, and hence these should be consumed in limited amounts. Watch out for sweeteners as well, and go instead for keto-friendly sweeteners or Stevia.

- Avoid eating farmed fish: While eating fish is great for keto but you should avoid eating farmed fish because of the fewer benefits they might have and the chemical additives they might contain. Check out this video about farmed fish.

Keto Diet benefits

The ketogenic diet includes many benefits as it can reduce weight, control blood sugar, increase mental performance, increase energy, reduce blood pressure, and reduce cholesterol. The diet can also help in epilepsy treatment, Alzheimer, type 2 diabetes, and solving acne problems. 

Below is a list of the keto diet various benefits:

- Weight loss: the diet is quite effective for reducing weight as it increases the amount of fat burned in the body which contributes to weight loss. Plus, the diet triggers satiety much quicker. Hence, fewer calories are consumed, resulting in additional weight loss.

- Improve physical performance: the body has large amounts of fat stores that are not used effectively. However, when the body starts burning fat efficiently for energy instead of carbs, it can benefit from large fat fuel reserves available. Hence, a long-lasting energy burning process. Accordingly, this diet can sustain improved energy and physical performance.

- Diabetes: the diet is beneficial for diabetes because it reduces carbohydrate intake and control levels of glucose in the blood.

- Heart disease: the diet can protect against heart diseases by reducing the risks factors associated with heart diseases such as overweight, triglycerides, hypertension, and blood sugar levels. The diet can also increase the good cholesterol (HDL) in the body and lower the bad cholesterol level (LDL). This would balance the cholesterol ratio in the body and help further in reducing the risks of heart disease. 

- Triglycerides: the diet reduces drastically the triglyceride levels found in the blood. High levels of triglycerides are associated with heart disease.

- Cholesterol: the diet increases the level of good cholesterol called HDL and reduces bad cholesterol. High levels of HDL cholesterol lower the risk of heart diseases, because it helps in balancing the cholesterol ratio. 

- Blood pressure: the diet may also decrease blood pressure levels. Hypertension is associated with many diseases such as heart disease and kidney failure.

- Alzheimer’s disease: the diet can reduce symptoms and slow down the progression of the disease. This is mainly due to the ketones that can be used as an alternative source of energy and nutrition for the brain.

- Epilepsy: the diet reduces significantly seizures in epileptic patients, especially children. Studies have shown that a keto diet can reduce epilepsy, 50% among adults, and 90% among children.

Other conditions: following a keto diet has also shown to have beneficial effects for other conditions such as cancer, Parkinson’s disease, acne, and polycystic ovary syndrome (PCOS). However, more research and findings are needed in order to support these statements further. 

Keto Diet precautions

Before you start your keto diet, it is important to take some precautions in case you are taking some medication or if you have any medical condition. Always consult with a health expert especially if you have any of the following conditions or you are taking any medication.

- Blood-pressure: a combination of blood pressure medication and a low carb diet is risky because there’s a possibility of decreased blood pressure from the diet. Low blood pressure may occur within the first days and sometimes might take months to happen. If low blow pressure occurs, it is important to contact a doctor.

- Diabetes: the keto diet will reduce blood sugar levels due to the reduced carbohydrate intake. If you are taking any diabetes medication such as insulin to reduce blood sugar levels as well, it is important to discuss this with your doctor before starting the diet to avoid any possible complications.

- Pregnancy / breast feeding: it is not advised to restrict any food groups if you are pregnant or breast feeding. A balanced diet is highly required for developing babies. Since the keto diet eliminates completely some food groups, this can be risky for them. Always make sure to discuss this with a specialized nutritionist before starting any diet to make sure you avoid any sort of nutrient deficiencies. 

- Nutritional deficiencies: it is important to watch out for any possible nutritional deficiencies since the keto diet does not include all food groups. Other reasons that may lead to deficiencies are fewer calories that are consumed because they are subtracted from the TEE in order to promote weight loss or because less food is consumed due to increased satiety. Always make sure to follow up with a nutrition expert before starting this diet.

Keto Diet side effects

The ketogenic diet is mainly safe, however there are some side effects that need to be taken into consideration:

- Keto flu: the keto flu is a series of symptoms such as fatigue, headache, nausea and cramps that are experienced by some people following the keto diet. These symptoms are quite common especially at the beginning of the diet.

However, this problem will be resolved in few days by the time the body starts adapting to lower carbohydrate intake and starts burning fat properly. To avoid these symptoms, it is recommended to reduce carbohydrates gradually out of the diet so that the body gets used to this gradually.

- Cramps:  leg cramps are common with the keto diet. It’s an indication of mineral deficiency, mainly magnesium. This is because carbohydrates retain water in the body. Hence, less carbs mean less water retention, resulting in fewer electrolytes as well. It is important to stay hydrated and consume enough salt as this helps retain magnesium in the body.

- Constipation:  the main cause behind constipation is dehydration, due to less water retention from the reduced carbohydrates intake. It is important to drink enough water while making sure the vegetables consumed contain some fiber.

- Heart palpitations:  during the transition period, the heart may beat faster and harder. This is quite common especially because of dehydration and lack of salt. Accordingly, you should always make sure to have enough water and salt. This should usually solve this problem. However, if this situation continues, you should immediately seek medical assistance. 

- Fatigue: at the initial stages of ketosis while the body is shifting to using fat for energy instead of carbohydrates, people would feel tired. Their physical performance might be affected as well. However, this should be resolved once the body adapts to the new process and starts burning fat properly to produce the required energy.

- Ketoacidosis: this happens when the buildup of ketones results in higher levels of acids in the blood (byproduct of burning ketones). Ketoacidosis can affect the livers, kidneys, and the brain.

Ketoacidosis can occur for people following a low carbohydrates diet, though it is very rare. However, this can be a more common problem for people that suffer from diabetes. Accordingly, if you have diabetes, it is important to contact your doctor before starting the keto diet.

- Hypoglycemia: this is when glucose levels become very low in the blood. Accordingly, people might experience blurred vision, headaches, and confusion. This might become dangerous if left untreated as it can cause seizures. In some cases, it can even be fatal. Hypoglycemia happens mainly because our bodies are not used to run on ketones from fat instead of glucose from carbohydrates, this might lead in some cases to hypoglycemia.