The Pits and the Pearls of the Ketogenic Diet


Here is the lowdown on this nutrition plan, which is all the rage.

The ketogenic diet, or “keto diet,” as it is known, has been around for many years, but recently more and more people are opting for the high-fat lifestyle. A person following a traditional keto diet consumes 75% of his or her calories from fat, 20% from protein, and 5% from carbohydrates. There are many other variations of the keto diet that involve adjusting those macronutrient percentages to allow for more flexibility.

The Keto diet is touted for benefits including weight loss and decreased inflammation and insulin levels. The diet has been used in hospital protocols for epilepsy and even certain types of cancer. Studies have shown1 that ketone bodies can reduce neuronal firing in epileptic patients.

Here are some examples of what someone who follows a keto diet might eat:

Fibrous carbohydrates. These include arugula, broccoli, blueberries, carrots, celery, romaine lettuce, and spinach.

Healthy fats and protein. These include chicken, eggs, grass-fed beef, high-fat fruits such as avocados and coconuts, quality oils such as extra-virgin coconut and olive oil, raw nuts and seeds, turkey, and wild-caught fish.

Supplements. These include bone broth protein; medium chain triglycerides oil, which is a supplement used to help increase ketones in the body; and whey protein isolate.

So, what is the lowdown on the keto diet? Our body normally runs on glucose, the simplest unit of energy that the body uses. The brain readily uses glucose for fuel. In starvation mode, the liver will begin converting protein into glucose through a process called gluconeogenesis. If a person were to take in very low amounts of carbs for an extended period of time, say less than 50 grams per day or 5% of their total calorie intake, his or her body would go into ketosis.

Nutritional ketosis is when the body is using ketones instead of glucose for energy. When the body has a limited amount of carbs to fuel itself, it starts to rely on ketones, the by-product of fatty acids. Ketosis happens anywhere from 3 days to 1 week after a low-carb protocol is started. When someone becomes “fat adapted," they are typically more than 2 weeks into the low-carb protocol, depending on the individual.

How can one measure or know if he or she is in ketosis? This occurs when the blood ketone levels measure in the range of 0.5 to 3.0 mmol/L. Blood testing is the most reliable of all of methods, followed by urine testing, and breathalyzer and urine strip testing. Urine testing allows one to correlate the result with color samples on the back of the package to see if ketosis is occurring or the body is primarily still using glucose for fuel.

Each test detects a different ketone body. For example, blood testing relies on beta-hydroxybutryate to see if one is in ketosis, while the breathalyzer will detect acetone in the breath. A person’s level of alcohol consumption and hydration can skew results with the breathalyzer. Urine strips only measure the excreted levels of acetoacetate found in the urine. Measuring ketones at the same time each day is important, because ketones tend to be lower in the morning and higher in the evening.

Once someone is fat adapted after 3 or 4 weeks, that person eventually just knows that he or she is in or out of ketosis based on how he or she feels. Some other signs of being in ketosis include fruity-smelling breath, increased energy, more frequent urination, and reduced hunger.

As a person goes into ketosis, it is likely that he or she might experience the “keto flu,” because the body is not yet adapted to the lower amount of carbs present in the bloodstream. Electrolyte shifts may cause some of the symptoms associated with the keto flu, so, having a plan to supplement with magnesium, potassium, and plenty of water can ameliorate any unpleasant feelings.

Symptoms of the keto flu include cravings, fatigue, insomnia, irritability, muscle cramps, or nausea. Depending on the symptoms, adding Himalayan sea salt to beverages or food, increasing fat, magnesium, and potassium, and staying hydrated, can all help. This tends to last about 1 week and varies with each person.

So, what are the pearls of the keto diet? Many people see an initial drop-off in weight on this diet, because of the decrease in carb intake and depletion of excess water retention. Blood sugar levels may stabilize as a result.

Because fat is the most calorie-dense of the macronutrients at 9 calories per gram compared with carbs and protein at 4 calories per gram, people report feeling fuller. Research shows2 that the diet may also suppress the hunger hormone ghrelin.

And what are the pits of the keto diet? One issue that may arise is constipation, because people following this diet are naturally eating more fat. Consuming non-starchy fiber, such as carrots, celery, romaine lettuce, and spinach will help keep things moving.

Another possible pit of the diet is consuming too much saturated fat from animal protein. Incorporating plant-based, healthy fats, such as avocado or flaxseed, or using coconut oil can help. Also selecting grass-fed meat options when available allows those on this diet to reap better health benefits, because grass-fed meat is higher in the fatty acid, conjugated linoleic acid.

Remember that sustainability is important for any diet to be effective. Because this diet is so restrictive, it can be difficult to sustain for a long period. Stress can kick in, and a few cookies and/or too many carbs in general can boot one out of ketosis and cause symptoms such as brain fog or fatigue.

Speak to a doctor, nutritionist, or qualified health care professional to discover what might be the best plan of action for specific needs. Also, listening to one's body when and if beginning the diet is imperative. Some people do well and have minimal symptoms when shifting into ketosis, while others are miserable well into being fat adapted.


1. Ma W, Berg J, Yellen G. Ketogenic diet metabolites reduce firing in central neurons by opening KATP channels. J Neurosci. 2007;27(14):3618 —25.

2. Paoli A, Bosco G, Camporesi EM, Mangar D. Ketosis, ketogenic diet and food intake control: a complex relationship. Front Psychol. 2015;6:27. doi: 10.3389/fpsyg.2015.00027.

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