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. A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises:
The only issue, however, is that while it’s easy-peasy to load up on veggies, meats, and dairy during mealtimes, finding yourself starving at 4 p.m. without a suitable snack can be quite the downer. Fear not, keto crusader, because there’s more to life (or more to Amazon, at least) than tortilla chips and chocolate chip cookies. These nine keto snacks are only a couple of clicks away.
"Healthy in fat, moderate in protein, and low in carbs, SunButter makes for a tasty addition to a keto diet," explains registered dietitian Toby Amidor, M.S., R.D. (Especially since you can't have peanut butter on the keto diet.) The sunflower seeds used in SunButter are also locally grown, roasted, and processed in a dedicated peanut-free and tree nut-free facility, she adds, meaning it's fair game if you have nut allergies.
Keto bombs are fat cookies that ketogenic dieters love because they’re healthy, delicious cheat foods that are virtually devoid of carbs. I have plenty of videos on how to make keto bombs, but you have to eat them with a meal, not as a snack. The goal would be to stick to one a day. Go to my YouTube channel under Playlists, then Recipes; or to www.DrBerg.com under Recipes.
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.
When you lose weight, fat cells shrink. In a fat cell, there are triglycerides and cholesterol. Now, as that fat cell shrinks, you can burn triglycerides, but you cannot burn cholesterol. So it will go into the blood, go to the liver, and come out through the bile. But you’ll be totally fine as long as your triglycerides are low. (If you’re not using those as fuel, then you’re eating too much sugar.)
Following the ketogenic diet can be safe in the short term but it does come with health concerns. 'It's not something that I recommend for the general population for the long-term,' says Dr Barclay. 'By drastically cutting out carbohydrate-containing foods, you'll miss out on the nutritional benefits of healthy choices like whole grains, fruit, starchy vegetables, and legumes such as beans, chickpeas and lentils.'
One area where food tracking can be especially helpful, though, is ensuring that you're hitting the right ratios of macronutrients—protein, carbs, and fat. "The most researched version of the ketogenic diet derives 70 percent of calories from healthy fats, 20 percent from protein, and only 10 percent from carbs," explains Charles Passler, D.C., nutritionist, and founder of Pure Change. "In the ideal world, each keto meal and snack should have that same (70/20/10) ratio of macronutrients, but studies have shown that you'll still achieve great results even if each meal varies slightly from that ratio, just as long as you don't exceed 50 grams per day of carbs, or eat those carbs in one sitting," says Passler. In order to achieve these ratios without a preset meal plan from a dietitian or doctor, some food tracking is probably going to be necessary. But once you get the hang of things, you may not need it anymore.
In the worst form of diabetes (type 1), a condition called ketoacidosis can exist. This is completely different from ketosis. Ketoacidosis is a disease state where there is no more insulin and acids build up to high levels that are dangerous to one's health. But with ketosis, the pH in the body doesn't even get close to the high levels seen with ketoacidosis.
On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell's mitochondria (the energy-producing parts of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this by using fatty acids. Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the blood–brain barrier. However, the liver can use long-chain fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy.
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.