Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
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. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]

Remember how important it is to measure ketone blood levels accurately? Same goes for food tracking. A food tracking app, like MyFitnessPal, provides insight into macronutrient intake and thus the ability to tweak the diet to achieve ketosis. Tracking diet (inputs) and measuring ketones levels (outputs) delivers the best shot at optimizing the keto diet plan.
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?
I just discovered your site and have been thoroughly enjoying many of the articles and appreciate that you get so in depth in your explanations. I’m in my late 40’s and, while not an extreme endurance athlete, I am moderately active with 18-20 mile rides 3x a week as well as some boxing and body weight resistance (push up, pull up, etc) mixed in. I’ve generally been paleo and stick to quality macros for the most part (grass fed meats/dairy, organic veg and oils) and zero supplements. I recently started following keto (after reading this article) about 10 days ago and things seem good thus far. I do, however, want to avoid any of the negative side effects you mention and also not lose any lean muscle. I’m currently about 174 lbs, 5’8″ and about 19% bodyfat – I’m taking in about 95g protein, 130g fat and <20g net carbs. I'm eating all quality – wild salmon, grass fed beef, pastured eggs, coconut oil, Brain Octane and Grass fed butter in coffee, sardines, etc. With a smattering of organic veg, but it seems real easy to bust through the carb barrier. *I'M ALSO TAKING KETOCANA PRE-WORKOUT* and I notice this is keeping me going throughout a ride or the gym.
Meat – like grass-fed selections – and fresh veggies are more expensive than most processed or fast foods. What you spend on Keto-friendly foods will vary with your choices of protein source and quality. You can select less-expensive, leaner cuts of meat and fatten them up with some oil. Buying less-exotic, in-season veggies will help keep you within budget.
I talk about that quite a bit here :https://bengreenfieldfitness.com/2015/09/things-your-pee-can-tell-you-about-your-body/
The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[7]
Whether you’re whipping them into a recipe or snacking on a handful of them raw, blackberries can make a great addition to your keto meal plan. A ½-cup serving doesn’t contain much fat (less than ½ g) but is also low in net carbs, with just 3.1 g. The same serving size offers 3.8 g of fiber (15.2 percent DV) and 3.5 g of sugar. Blackberries also provide potassium, with 117 mg (2.5 percent DV) per ½-cup serving. It has 15.1 mg of vitamin C (25.2 percent DV) and 14.3 mg of vitamin K (17.9 percent DV). This fruit is also a great snack for weight loss, containing about 31 cal per ½ cup.
^ Jump up to: a b Cardona A, Pagani L, Antao T, Lawson DJ, Eichstaedt CA, Yngvadottir B, Shwe MT, Wee J, Romero IG, Raj S, Metspalu M, Villems R, Willerslev E, Tyler-Smith C, Malyarchuk BA, Derenko MV, Kivisild T (2014). "Genome-wide analysis of cold adaptation in indigenous Siberian populations". PLOS One. 9 (5): e98076. Bibcode:2014PLoSO...998076C. doi:10.1371/journal.pone.0098076. PMC 4029955. PMID 24847810.
2) I'm currently using Ketocana and in that section you state "Similar to the BHB salts and MCT’s from the KETO//OS I discuss above, powdered forms of ketones are excellent if you don’t want to completely eliminate carbohydrates or fat or eat copious amounts of fats, but want to simultaneously maintain high levels of blood ketones." – How would eating copious amounts of fat be a negative? Wouldn't that help contribute to a ketogenic state?

Food is your body’s primary source of energy, and three main nutrients in foods supply your body with this energy. These are carbohydrates, fat, and protein. Typically after eating a meal, your body will first break down carbohydrates from foods, and then fat and protein.Ketosis is a natural metabolic state that occurs when your body doesn’t have enoughcarbs (or glucose) for energy, so it burns fat instead.


The diet is extremely regimented and very difficult to stick to, as just one baked potato and one slice of bread could hold an entire day’s worth of carbohydrates. While this is a deterrent for many, Christy Brissette, RD, a private-practice dietitian in Chicago, notes that many of her patients like the diet because of its strictness. “Some of my clients feel that the keto diet works for them because it doesn't involve any calorie counting and the rules are simple to understand,” she says. “They feel they have strict parameters that can take the guesswork out of dieting.”
These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
^ Jump up to: a b Sinclair, H. M. (1953). "The Diet of Canadian Indians and Eskimos" (PDF). Proceedings of the Nutrition Society. 12 (1): 69–82. doi:10.1079/PNS19530016. ISSN 0029-6651. It is, however, worth noting that according to the customary convention (Woodyatt, 1921 ; Shaffer, 1921) this diet is not ketogenic since the ratio of ketogenic(FA) to ketolytic (G) aliments is 1.09. Indeed, the content of fat would have to exactly double (324 g daily) to make the diet ketogenic (FA/G>1–5).

I am not an athlete. I am a mid 30’s male with a sedentary lifestyle. I am 5’10” and 250lbs. I have mild hypertension, high triglycerides, and pre-diabetes. I have eaten whatever I want and as much as I want for years. I have recently started walking/jogging 3-4 times a week, taking fish oil, and eating significantly less carbs plus added fish and steak. Is this diet appropriate and safe for me?


Western diets are high in carbohydrates, leading to high blood sugar levels, whereas the ketogenic diet enforces a small amount of carbs to be consumed. It can take some weeks of keto dieting to reach increased levels of blood ketones. For others, after 2 - 4 days of low-carbohydrate, high-fat ketogenic dieting, ketone levels in the blood can increase to ~1 - 2 mM, achieving ketosis.5
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[58] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[56]
Great article! As someone who just started a “ketogenic diet” two weeks ago, I am opting to hold off on using ketone supplements for the following reason. You state how “Keto-adaptation occurs when you have shifted your metabolism to relying on fat-based sources, instead of glucose (sugar) sources, as your primary source of fuel.” If the goal is to “switch” our body’s energy supply to ketones and one uses supplemental ketones, how do they really ever know if their body has successfully accomplished this goal if they are using supplemental ketones? Aren’t they getting a false sense of ketosis if their blood or breath tests show them above 0.5 millimolar through the use of the supplements? I understand that it may take me longer to reach ketosis naturally but I guess I see it was worth it to truly reap all of the benefits that you outline in your article.
In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]
Two years after my first oatmeal binge, I found myself in an All Ages and Genders eating disorder support group, sandwiched between a bulimic father/bodybuilder and a teenage girl who had to drop out of high school for inpatient treatment. We would sit around and discuss incentives to eat normally, such as “I don’t want to die of osteoporosis” and “I’d like to have a friend or two sometime in the future” and “I want to enjoy a croissant again.” Together we relearned how to eat, because we had a new and sustainable goal -- we wanted to live a life without shame and obsession.

Along with biomarker testing, subjective symptoms can provide an indication of your ketosis. Sometimes, early side effects of the diet result from carbohydrate withdrawal. This can be known as the "keto flu;" symptoms include nausea, fatigue, headache and dry mouth. They're short-term, typically lasting about a week or less. Keep in mind, however, that we are all different. Our bodies react in different ways. Some of us may experience these symptoms later than sooner, to a lesser extent, or not at all.
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions.[19] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[18]

Hi Ben…first, I have learned so much from you, thank you! I’m interested in using exogenous ketone supplements and I have a question for you. I just read the transcript of an interview Dave Asprey did with Dr. Richard Veech (episode 299). He advises against them, and says they can even be harmful. I was disappointed to read this, and wanted to ask you about it, since I respect your opinion greatly….thank you.

When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]

These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
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