Early studies reported high success rates; in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).[19]
Acetone, the least abundant ketone, is present in the breath and is responsible for the unpleasant odor. Acetone is a solvent in nail polish, if that gives you an idea of what it might smell like. But it's not as bas as it sounds; acetone breath is a sign of ketosis and fat burning. It's the ketone measured in breath tests used for detecting ketosis.6
^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.
In dairy cattle, ketosis is a common ailment that usually occurs during the first weeks after giving birth to a calf. Ketosis is in these cases sometimes referred to as acetonemia. A study from 2011 revealed that whether ketosis is developed or not depends on the lipids a cow uses to create butterfat. Animals prone to ketosis mobilize fatty acids from adipose tissue, while robust animals create fatty acids from blood phosphatidylcholine (lecithin). Healthy animals can be recognized by high levels of milk glycerophosphocholine and low levels of milk phosphocholine.[76] Point of care diagnostic tests are available and are reasonably useful.[77]
A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[20] and followed-up by a report published in 2001.[21] As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.[21][22]
For someone more interested in health/muscle gain rather than weight loss, should I up the protein and good carb levels a bit? I’m around 10% BF and weigh 220, so I require a higher calorie intake the average. In just a few days striving for a Keto-diet, I’m averaging between 50-60g gross carbs (30g net), 160g protein and 220 fat (8%-22%-70%) DO you think that is a good target or should I try and adjust?

A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]


Because some fruits have more carbs than others, knowing which to avoid is key for accelerating weight loss and reaping other possible benefits of keto. Just know that large, long-term, randomized controlled trials on the keto diet are limited, so it’s unclear whether keto is safe and effective to follow for the long haul, according to Harvard Medical School.
For the keto gurus who serve as keto's staunchest evangelicals, conversations swirl around oft-repeated talking points, and any sense of negativity is quickly batted away. I spoked to several "gurus.” The claims they made are already on most low-carb blogs: It’s gonna suck at first, but it’s Worth It. Fat makes you full. Blood sugar will go down. Insulin will be on point. You’ll realize that which has sat dormant in your body for too long -- a demigod. Devoid of carbs, your body will reconstruct in such a way that Zeus descended from parted clouds to congratulate you on your blood test results.
Acetone, the least abundant ketone, is present in the breath and is responsible for the unpleasant odor. Acetone is a solvent in nail polish, if that gives you an idea of what it might smell like. But it's not as bas as it sounds; acetone breath is a sign of ketosis and fat burning. It's the ketone measured in breath tests used for detecting ketosis.6
Whether ketosis is taking place can be checked by using special urine test strips such as Ketostix. The strips have a small pad on the end, which the user dips in a fresh urine specimen. Within seconds, the strip changes color to indicate the level of acetoacetate ketone bodies, which reflects the degree of ketonuria, which, in turn, gives a rough estimate of the level of hyperketonemia in the body (see table below). Alternatively, some products targeted to diabetics such as the Abbott Precision Xtra or the Nova Max can be used to take a blood sample and measure the β-hydroxybutyrate ketone levels directly. Normal serum reference ranges for ketone bodies are 0.5–3.0 mg/dL, equivalent to 0.05–0.29 mmol/L.[29]
It’s easy to get caught up on the “low-carb” part of the diet and not give enough attention to the “high-fat” part. Fat is what makes you full, gives you energy (when in ketosis), and makes food taste delicious. For most people this figure should be north of 70 percent of daily calories. Keep carbs under 20g, hit your protein goal, and eat fat until you’re full.
Those new to keto should be testing to see if their bodies are in ketosis, regardless of method. Testing, in general, is the most objective way to know if you’re in ketosis. There can be some subjective benefits of ketosis: appetite suppression, fat loss, low blood sugar, improvement in mental cognition and focus. But before recognizing these subjective benefits, it’s important to track and measure the level of ketones in the blood to ensure ketosis on a physical level.
Keto breath, on the other hand, is less of a side-effect and more of a harmless inconvenience (your breath literally smells like nail polish remover). Basically, when your body breaks down all that extra fat on the keto diet, it produces ketones—one of which is the chemical acetone, Keatley previously told WomensHealthMag.com. (Yes, the same stuff that's in nail polish remover.)

Then one night, it all changed. I poured honey and water into a 42-ounce canister of Quaker oats and kept spooning because there was no other carb source in the house. Something strange had possessed me; I would later hear other binge eaters call this “blacking out,” or feeling such intense relief and disinhibition that you consume ridiculous quantities of food without fully realizing or experiencing it. At the time, I remember thinking something was very, very wrong, but the thing that was wrong was my lack of self-control and that I would be better -- keto!!! -- forevermore. And then I did it again a few nights later. I gained weight. I gave up on dieting eventually, but it took me years to reestablish a healthy relationship with food.
My keto journey began with chicken and avocado, like many high-fat brethren before me, until I eventually found the paleo cookbooks and created a little diet-friendly life for myself, devoid of family party-friendly foods but productive and communal in its own way. I was joining the online forums. I was reading studies about the health benefits of keto. I was drinking the bone-broth Kool-Aid, believing my fasting states and butter coffee were catapulting me towards some sort of psychophysiological excellence. I lost around 15lbs in 2015 because I didn’t allow myself most of the foods I usually “overdid” and was motivated not only by the progress but by the exclusive, cultish energy of ketosis. We were not the Google diet generation -- we were Google scholar. We treated epilepsy, after all, and our fearless keto leaders preached the Good News to all who would listen, then verbally abused well-meaning bloggers and medical professionals who suggested that extreme dieting might be unhealthy and unsustainable. Amen?

Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.


In addition to the seaweed and glycogen carbohydrates mentioned above, the Inuit can access many plant sources. The stomach contents of caribou contain a large quantity of partially digested lichens and plants, which the Inuit once considered a delicacy. They also harvested reindeer moss and other lichens directly. The extended daylight of the arctic summer led to a profusion of plant life, and they harvested plant parts including berries, roots and stems, as well as mushrooms. They preserved some gathered plant life to eat during winter, often by dipping it in seal fat.[71]
"If you're going to do keto, there's a better and a worse way to do it," registered dietician Kim Yawitz told Everyday Health. "Loading your plate with meats, and especially processed meats, may increase your risk for kidney stones and gout... High intake of animal proteins makes your urine more acidic and increases calcium and uric acid levels. This combination makes you more susceptible to kidney stones, while high uric acid can increase your risk for gout."
"Muscle loss on the ketogenic diet is an ongoing area of research," Clark told Everyday Health. "Small studies suggest that people on the ketogenic diet lose muscle even when they continue resistance training. This may be related to the fact that protein alone is less effective for muscle building than protein and carbohydrates together after exercise."
My question is: what if I want to be in ketosis for all the reasons mentioned in the Life Extension article and because I don't feel a strong urge to eat in between meals when I go lower carb and if I up carb intake I get hungrier more frequently and get urges . . . BUT on the flip side, I don't seem to digest fat all that well(dairy in particular is a no-no) and constipation is an issue and starchy carbs seem to help with that. It's a bit of a catch-22.
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