The ketogenic diet became popular as a therapy for epilepsy in the 1920s and 30s. It was developed to provide an alternative to non-mainstream fasting, which had demonstrated success as an epilepsy therapy. However, the diet was eventually largely abandoned due to the introduction of new anticonvulsant therapies. Although it emerged that most cases of epilepsy could be effectively controlled using these medications, they still failed to achieve epileptic control in around 20% to 30% of epileptics. For these individuals, and particularly children with epilepsy, the diet was re-introduced as a technique for managing the condition.
The role of fasting in the treatment of disease has been known to mankind for thousands of years and was studied in detail by ancient Greek physicians and ancient Indian physicians. An early treatise in the Hippocratic Corpus, “On the Sacred Disease,” describes how alterations in diet played a role in epilepsy management. The same author also describes in “Epidemics” from the collection, how a man was cured of epilepsy when he abstained completely from consuming food or drink.
The first modern scientific study into fasting as a cure for epilepsy was conducted in France, in 1911. At the time, potassium bromide was used to treat epileptics, but this agent slowed patients’ mental capabilities.. Instead, twenty epilepsy patients followed a low-calorie, vegetarian food plan that was combined with fasting. Two patients showed significant improvements, although most could not adhere to the dietary restrictions. However, the diet was found to improve the patient’s mental abilities compared with the effects of taking potassium bromide.
Also during the early 20th Century, an American called Bernarr Macfadden, popularised the idea of fasting as a means of restoring health. His student osteopath, Hugh Conklin, introduced fasting as a treatment method for controlling epilepsy. Coklin proposed that epileptic seizures were caused by a toxin secreted in the intestine and suggested that fasting for 18 to 25 days could cause the toxin to dissipate. His epileptic patients were put on a “water diet,” which he reported cured 90% of children with the condition and 50% of adults. Analysis of the study that was performed later showed that, in fact, 20% of Coklin’s patients became seizure-free, while 50% demonstrated some improvement. The fasting therapy was soon adopted as part of mainstream therapy for epilepsy and in 1916, Dr McMurray reported to the New York Medical Journal that he had successfully treated epileptic patients by prescribing a fast, followed by a diet free of starch and sugar since 1912.
It was in 1921 that endocrinologist Rollin Woodyatt noted that three water-soluble compounds, acetone, β-hydroxybutyrate and acetoacetate (together called ketone bodies) were produced by the liver as a result of starvation or if they followed a diet rich in fat and low in carbohydrates. Russel Wilder from the Mayo Clinic called this the “ketogenic diet” and used it as a treatment for epilepsy, also in 1921.
Further research in the 1960s showed that more ketones are produced by medium-chain triglycerides (MCTs) per unit of energy because they are transported quickly to the liver via the hepatic portal vein, as opposed to the lymphatic system. In 1971, Peter Huttenlocher devised a ketogenic diet where 60% of the calories came from MCT oil, which allowed more protein and carbohydrates to be included compared with the original ketogenic diet, meaning parents could prepare more enjoyable meals for their children with epilepsy. Many hospitals also adopted the MCT diet in place of the original ketogenic diet, although some used a combination of the two.
The Ketogenic Diet: A Detailed Beginner’s Guide to Keto
The ketogenic diet (or keto diet, for short) is a low-carb, high-fat diet that offers many health benefits.
In fact, over 20 studies show that this type of diet can help you lose weight and improve your health.
Ketogenic diets may even have benefits against diabetes, cancer, epilepsy and Alzheimer’s disease.
Here is a detailed beginner’s guide to the keto diet.
What Is a Ketogenic Diet?
The ketogenic diet is a very low-carb, high-fat diet that shares many similarities with the Atkins and low-carb diets.
It involves drastically reducing carbohydrate intake and replacing it with fat. This reduction in carbs puts your body into a metabolic state called ketosis.
When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain.
Ketogenic diets can cause massive reductions in blood sugar and insulin levels. This, along with the increased ketones, has numerous health benefits.
SUMMARYThe keto diet is a low-carb, high-fat diet. It lowers blood sugar and insulin levels, and shifts the body’s metabolism away from carbs and towards fat and ketones.
Different Types of Ketogenic Diets
There are several versions of the ketogenic diet, including:
- Standard ketogenic diet (SKD): This is a very low-carb, moderate-protein and high-fat diet. It typically contains 75% fat, 20% protein and only 5% carbs.
- Cyclical ketogenic diet (CKD): This diet involves periods of higher-carb refeeds, such as 5 ketogenic days followed by 2 high-carb days.
- Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
- High-protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein and 5% carbs.
However, only the standard and high-protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.
The information in this article mostly applies to the standard ketogenic diet (SKD), although many of the same principles also apply to the other versions.
SUMMARYThere are several versions of the keto diet. The standard (SKD) version is the most researched and most recommended.
Ketogenic Diets Can Help You Lose Weight
A ketogenic diet is an effective way to lose weight and lower risk factors for disease.
In fact, research shows that the ketogenic diet is far superior to the often recommended low-fat diet.
What’s more, the diet is so filling that you can lose weight without counting calories or tracking your food intake.
One study found that people on a ketogenic diet lost 2.2 times more weight than those on a calorie-restricted low-fat diet. Triglyceride and HDL cholesterol levels also improved.
Another study found that people on the ketogenic diet lost 3 times more weight than those on the diet recommended by Diabetes UK.
There are several reasons why a ketogenic diet is superior to a low-fat diet, including the increased protein intake, which provides numerous benefits.
The increased ketones, lower blood sugar levels and improved insulin sensitivity may also play a key role.
SUMMARYA ketogenic diet can help you lose much more weight than a low-fat diet. This often happens without hunger.
Ketogenic Diets for Diabetes and Prediabetes
Diabetes is characterized by changes in metabolism, high blood sugar and impaired insulin function.
The ketogenic diet can help you lose excess fat, which is closely linked to type 2 diabetes, prediabetes and metabolic syndrome.
One study found that the ketogenic diet improved insulin sensitivity by a whopping 75%.
Another study in people with type 2 diabetes found that 7 of the 21 participants were able to stop using all diabetes medications.
In yet another study, the ketogenic group lost 24.4 pounds (11.1 kg), compared to 15.2 pounds (6.9 kg) in the higher-carb group. This is an important benefit when considering the link between weight and type 2 diabetes.
Additionally, 95.2% of the ketogenic group were also able to stop or reduce diabetes medication, compared to 62% in the higher-carb group.
SUMMARYThe ketogenic diet can boost insulin sensitivity and cause fat loss, leading to significant health benefits for people with type 2 diabetes or prediabetes.
Other Health Benefits of Keto
The ketogenic diet actually originated as a tool for treating neurological diseases such as epilepsy.
Studies have now shown that the diet can have benefits for a wide variety of different health conditions:
- Heart disease: The ketogenic diet can improve risk factors like body fat, HDL cholesterol levels, blood pressure and blood sugar.
- Cancer: The diet is currently being used to treat several types of cancer and slow tumor growth.
- Alzheimer’s disease: The keto diet may reduce symptoms of Alzheimer’s disease and slow its progression.
- Epilepsy: Research has shown that the ketogenic diet can cause massive reductions in seizures in epileptic children.
- Parkinson’s disease: One study found that the diet helped improve symptoms of Parkinson’s disease.
- Polycystic ovary syndrome: The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome.
- Brain injuries: One animal study found that the diet can reduce concussions and aid recovery after brain injury.
- Acne: Lower insulin levels and eating less sugar or processed foods may help improve acne.
However, keep in mind that research into many of these areas is far from conclusive.
SUMMARYA ketogenic diet may provide many health benefits, especially with metabolic, neurological or insulin-related diseases.
Foods to Avoid
Any food that is high in carbs should be limited.
Here is a list of foods that need to be reduced or eliminated on a ketogenic diet:
- Sugary foods: Soda, fruit juice, smoothies, cake, ice cream, candy, etc.
- Grains or starches: Wheat-based products, rice, pasta, cereal, etc.
- Fruit: All fruit, except small portions of berries like strawberries.
- Beans or legumes: Peas, kidney beans, lentils, chickpeas, etc.
- Root vegetables and tubers: Potatoes, sweet potatoes, carrots, parsnips, etc.
- Low-fat or diet products: These are highly processed and often high in carbs.
- Some condiments or sauces: These often contain sugar and unhealthy fat.
- Unhealthy fats: Limit your intake of processed vegetable oils, mayonnaise, etc.
- Alcohol: Due to their carb content, many alcoholic beverages can throw you out of ketosis.
- Sugar-free diet foods: These are often high in sugar alcohols, which can affect ketone levels in some cases. These foods also tend to be highly processed.
SUMMARYAvoid carb-based foods like grains, sugars, legumes, rice, potatoes, candy, juice and even most fruits.
Foods to Eat
You should base the majority of your meals around these foods:
- Meat: Red meat, steak, ham, sausage, bacon, chicken and turkey.
- Fatty fish: Such as salmon, trout, tuna and mackerel.
- Eggs: Look for pastured or omega-3 whole eggs.
- Butter and cream: Look for grass-fed when possible.
- Cheese: Unprocessed cheese (cheddar, goat, cream, blue or mozzarella).
- Nuts and seeds: Almonds, walnuts, flax seeds, pumpkin seeds, chia seeds, etc.
- Healthy oils: Primarily extra virgin olive oil, coconut oil and avocado oil.
- Avocados: Whole avocados or freshly made guacamole.
- Low-carb veggies: Most green veggies, tomatoes, onions, peppers, etc.
- Condiments: You can use salt, pepper and various healthy herbs and spices.
SUMMARYBase the majority of your diet on foods such as meat, fish, eggs, butter, nuts, healthy oils, avocados and plenty of low-carb veggies.
A Sample Keto Meal Plan For 1 Week
To help get you started, here is a sample ketogenic diet meal plan for one week:
- Breakfast: Bacon, eggs and tomatoes.
- Lunch: Chicken salad with olive oil and feta cheese.
- Dinner: Salmon with asparagus cooked in butter.
- Breakfast: Egg, tomato, basil and goat cheese omelet.
- Lunch: Almond milk, peanut butter, cocoa powder and stevia milkshake.
- Dinner: Meatballs, cheddar cheese and vegetables.
- Breakfast: A ketogenic milkshake.
- Lunch: Shrimp salad with olive oil and avocado.
- Dinner: Pork chops with Parmesan cheese, broccoli and salad.
- Breakfast: Omelet with avocado, salsa, peppers, onion and spices.
- Lunch: A handful of nuts and celery sticks with guacamole and salsa.
- Dinner: Chicken stuffed with pesto and cream cheese, along with vegetables.
- Breakfast: Sugar-free yogurt with peanut butter, cocoa powder and stevia.
- Lunch: Beef stir-fry cooked in coconut oil with vegetables.
- Dinner: Bun-less burger with bacon, egg and cheese.
- Breakfast: Ham and cheese omelet with vegetables.
- Lunch: Ham and cheese slices with nuts.
- Dinner: White fish, egg and spinach cooked in coconut oil.
- Breakfast: Fried eggs with bacon and mushrooms.
- Lunch: Burger with salsa, cheese and guacamole.
- Dinner: Steak and eggs with a side salad.
Always try to rotate the vegetables and meat over the long term, as each type provides different nutrients and health benefits.
SUMMARYYou can eat a wide variety of tasty and nutritious meals on a ketogenic diet.
Healthy Keto Snacks
In case you get hungry between meals, here are some healthy, keto-approved snacks:
- Fatty meat or fish
- A handful of nuts or seeds
- Cheese with olives
- 1–2 hard-boiled eggs
- 90% dark chocolate
- A low-carb milkshake with almond milk, cocoa powder and nut butter
- Full-fat yogurt mixed with nut butter and cocoa powder
- Strawberries and cream
- Celery with salsa and guacamole
- Smaller portions of leftover meals
SUMMARYGreat snacks for a keto diet include pieces of meat, cheese, olives, boiled eggs, nuts and dark chocolate.
Tips for Eating Out on a Ketogenic Diet
It is not very hard to make most restaurant meals keto-friendly when eating out.
Most restaurants offer some kind of meat or fish-based dish. Order this, and replace any high-carb food with extra vegetables.
Egg-based meals are also a great option, such as an omelet or eggs and bacon.
Another favorite is bun-less burgers. You could also swap the fries for vegetables instead. Add extra avocado, cheese, bacon or eggs.
At Mexican restaurants, you can enjoy any type of meat with extra cheese, guacamole, salsa and sour cream.
For dessert, ask for a mixed cheese board or berries with cream.
SUMMARYWhen eating out, select a meat-, fish- or egg-based dish. Order extra veggies instead of carbs or starches, and have cheese for dessert.
Side Effects and How to Minimize Them
Although the ketogenic diet is safe for healthy people, there may be some initial side effects while your body adapts.
This is often referred to as the keto flu and is usually over within a few days.
Keto flu includes poor energy and mental function, increased hunger, sleep issues, nausea, digestive discomfort and decreased exercise performance.
To minimize this, you can try a regular low-carb diet for the first few weeks. This may teach your body to burn more fat before you completely eliminate carbs.
A ketogenic diet can also change the water and mineral balance of your body, so adding extra salt to your meals or taking mineral supplements can help.
For minerals, try taking 3,000–4,000 mg of sodium, 1,000 mg of potassium and 300 mg of magnesium per day to minimize side effects.
At least in the beginning, it is important to eat until you’re full and avoid restricting calories too much. Usually, a ketogenic diet causes weight loss without intentional calorie restriction.
SUMMARYMany of the side effects of starting a ketogenic diet can be limited. Easing into the diet and taking mineral supplements can help.
Supplements for a Ketogenic Diet
Although no supplements are required, some can be useful.
- MCT oil: Added to drinks or yogurt, MCT oil provides energy and helps increase ketone levels.
- Minerals: Added salt and other minerals can be important when starting out due to shifts in water and mineral balance.
- Caffeine: Caffeine can have benefits for energy, fat loss and performance.
- Exogenous ketones: This supplement may help raise the body’s ketone levels.
- Creatine: Creatine provides numerous benefits for health and performance. This can help if you are combining a ketogenic diet with exercise.
- Whey: Use half a scoop of whey protein in shakes or yogurt to increase your daily protein intake.
SUMMARYCertain supplements can be beneficial on a ketogenic diet. These include exogenous ketones, MCT oil and minerals.
A Ketogenic Diet Is Great, but Not for Everyone
A ketogenic diet can be great for people who are overweight, diabetic or looking to improve their metabolic health.
It may be less suitable for elite athletes or those wishing to add large amounts of muscle or weight.
And, as with any diet, it will only work if you are consistent and stick with it in the long term.
That being said, few things are as well proven in nutrition as the powerful health and weight loss benefits of a ketogenic diet.