There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.
"My suggestion is to start with changing your mindset first and foremost around three very important facts: this is not just another diet, you don’t have to live in Ketosis forever, and you will not be depriving yourself. Having said that, if you are used to eating highly-processed sugary food and refined carbohydrates you’ll need to ease into it," she explains.
Why higher fat and moderate protein? Fats have little to no effect on blood sugar and insulin levels. Protein does affect both blood sugar and insulin. If you eat too much protein for your ideal body weight or lean muscle mass (usually more than 1.5-2.0 grams/kg lean body mass), it can spark gluconeogenesis and raise blood sugar. Protein will also spike blood insulin levels temporarily, which can interfere with ketone body production. However, it is important to note that this is an individually driven parameter, as detailed in this excellent post from the Optimizing Nutrition blog.
Calories: The nutrient intake on a ketogenic diet typically works out to about 70-75% of calories from fat, 20-25% from protein, and 5-10% from carbohydrate on a daily basis. However, these ratios don't work well at very low calorie or very high calorie daily totals. And although calorie counting is not required, it is important to understand how macronutrient percentages can be affected by caloric intake, so you may want to read my page on calorie counting to get more information on this subject. Again, low or very high calorie intake will skew the percentages of macronutrients. It is also important to remember that fats are super high-calorie foods, especially if you have extra weight to lose and you are doing keto to lose weight. Read my plateau page if you are not reaching your weight loss goals.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.