The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter. Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.
A metabolic process called ketogenesis and a body state called ketosis are responsible. Ketosis is simply a normal metabolic pathway in which body and brain cells utilize ketones to make energy, instead of relying on only sugar (i.e., carbohydrate). In fact, humans developed an evolutionary ability to burn ketones as an adaptation to periods of food scarcity.
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.
In a recent study in the Journal of Sports Medicine and Physical Fitness, Weiss and his colleagues found that participants performed worse on high-intensity cycling and running tasks after four days on a ketogenic diet, compared to those who’d spent four days on a high-carb diet. Weiss says that the body is in a more acidic state when it’s in ketosis, which may limit its ability to perform at peak levels.
Keto-Friendly Dark Chocolate — If not sweetened with stevia or another low carb sweetener, make sure it’s at least 80% cocoa content or higher, as the carbs can add up quickly. Here is an example of low carb friendly chocolate that you can try. You can also make your own by mixing melted coconut oil with cocoa powder and your favorite low carb sweetener(s).
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet. Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term ketogenic diet to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.
It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients. It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed; 24% occasionally prescribed the diet as a last resort; 24% had only prescribed the diet in a few rare cases; and 16% had never prescribed the diet. There are several possible explanations for this gap between evidence and clinical practice. One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.
^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
One cup sliced cucumbers and 10 large olives makes for a great keto-friendly snack, with added benefits: “This is a great snack to help people in ketosis supplement their sodium levels." says Desiree Nielsen, R.D., author of Un-Junk Your Diet. When you're in ketosis, your body needs more sodium, and “without adequate sodium, people are at risk for dehydration, constipation, and more dangerous electrolyte imbalances," she adds.
Bread probably isn’t the first thing that comes to mind when you think about the ketogenic diet because it’s generally full of carbs. But, if you replace your store-bought bread with a homemade keto bread recipe, it can fit seamlessly into your keto low-carb, high-fat diet. How does bread even become keto-friendly? With almond flour, a lot of eggs, cream of tartar, butter, baking soda and apple cider vinegar.
When you’re burning more ketones, you can start releasing a bit of acetone, which smells like nail-polish remover. Or you might release ammonia. Sometimes you get that sulfur smell. For all of these, increase vegetable consumption. Over time, you’ll be more efficient at burning ketones, and a lot less of this will happen. If you’re getting an ammonia smell, it means you’re eating too much protein and need to cut back. A sulfur odor means there’s a gut issue, and you need to regulate your gut bacteria; you should take a type of probiotic called Pro EM-1, which you can find online.
Meat is fair game when you’re following the keto diet, which is why Griffin is a fan of putting together a plate of charcuterie when you’re in the mood for a snack. This doesn’t need to be one of those fancy displays you’d find at a restaurant — you can keep it simple and arrange whatever cured meats you have on hand. (Psst: This one makes a great party appetizer, too!)
But first a little legal and medical coverage: Although I have a Master's degree in Applied Clinical Nutrition, I am not a physician. I do have extensive experience with eating the ketogenic way, and I cured my health problems with a ketogenic diet. I am not guaranteeing that this diet will work for you or cure your health problems. I am just sharing what I know about ketogenic diets. Click here for the full legal disclaimer.
I don’t normally eat a ton of eggs or chicken and stay mostly pescatarian. But I was trying to make an effort to eat more protein. Unfortunately I broke out in hives a few hours after forcing myself to eat the 2 hardboiled eggs provided for breakfast. Went to derm, who had me do a skin prick allergy test and lo and behold, allergic to eggs. (After 35 years on this earth eating the occasional omelette, and certainly many other things with eggs in them, this is surprise- but apparently eating an allergen on an empty stomach first thing is a great way to get the full effect of that allergen. Needless to say, I sadly threw out the rest of the eggs and my dog got a really nice couple of chicken & salmon dinners since I just could not stomach either after the first awful day. I’ve actually just ordered meta morphosis to reset after this Keto thing threw me off so badly. I do want to stress that I don’t fault Urban Remedy for this, I know Keto is trendy and they are responding to a diet plan that I know many people follow. I will continue to order, just never again this plan!
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.