FAQ

Full Disclosure: This is copied directly from the Keto Subreddit. They did a lot of great work and it will be impossible to create anything more comprehensive as this.
Please visit at: https://www.reddit.com/r/keto

What is Keto?

The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet. It has a lot of health advantages compared to the standard western diet. Most people do keto because of the weight loss, but it also has other health advantages like lowering risk for heart disease, diabetes, cancer, stroke, and much more. Just follow these simple rules:

  1. Low in Carbs
    • Less than 50g/day for most people, better below 20g.
    • Fiber isn't counted in your carbs. Vegetables are perfectly acceptable.
  2. Moderate Protein
  3. Enough Fat
    • Majority of energy
    • Variable depending on goals of weight loss or maintenance
  4. The Right Kinds of Fat
    • Eat monos and saturates for fuel (butter, olive oil, coconut oil)
    • Limit high polyunsaturated sources (soy, corn, cottonseed)
  5. Keto Flu
    • Supplement sodium 2g/day (e.g. drink 1-2 cups of broth per day)
    • Replace magnesium to stop muscle cramps
    • Drink lots of water
  6. When in Doubt, Eat Less Carbs
  7. When in Doubt, Eat More Fat

The Standard Approach

What is the premise of a low carb, keto diet?

Low-carb diets are essentially programs that lower carbohydrate intake below 100 grams; strict ketogenic diets are a subset of low carb diets that typically only allow < 50g of carbohydrates per day. The general recommendation of /r/keto is to start with 20g of net-carbs per day. This limit does a good job of eliminating junk foods, refined carbohydrates and any other “fattening” foods.

The full premise of a keto diet is far more than just minimizing carbs, it is a lifestyle about overall health. The diet promotes long, intense bouts of energy, an increase in healthy, delicious food and an overall better outlook on your life. It is easily sustainable with a plethora of options and often is an answer to improving health that many people struggle to comprehend at first. A Ketogenic diet is not easy and will test your willpower but transforms the way you think and understand about yourself, food, and health in general.

How do I start and what can I eat?

Start by:

  • getting the daily NET carbs down to < 50g, preferrably to 20g. Remeber, fiber does not count toward your daily carb intake, so if something you eat has 10g carbs but 8g fiber, then it has 2g NET carbs. Use green, fibrous vegetables as your main source of carbs.
  • keeping protein intake moderate, 0.69 to 1.2 grams per pound lean body mass. (1.5 to 2.64 grams per kg lean body mass.) – Note that going over 0.8 grams is only suggested for people doing heavy lifting and endurance training.
  • increasing the proportion of your diet that comes from fat,
  • increasing the amount of water you drink, and
  • upping your intake of salt, potassium and magnesium (See How do I replenish electrolytes?)

Dr. Andreas Eenfeldt and /r/keto user drcl have both written excellent, simple guides to high-fat low-carb eating.

As far as what you can eat, Ketogenic diets are done differently by different people. Eat dark green leafy vegetables, fatty red meats, chicken with the skin left on, fish, offal (organ meat), eggs, seeds & nuts, full-fat dairy, or anything else you can find rich in nutrition, fat, protein and fiber.

Carbs are a limit. Protein is a target. Fat is to be consumed to remove hunger and meet macros requirements.

Recommended fats are olive oil, grass fed butter, and coconut oil.

Although fiber is a carbohydrate, it is not digested as a simple carbohydrate and is therefore not included in your daily carb count. It's important to stress that fiber doesn't NEGATE carbs – it just isn't counted; so mixing a handful of flax meal into a bowl of ice-cream won't work!

Check out the web resources at the bottom of the page for links to food lists, sample grocery plans and more.

How do I know how many carbs are in my food?

For starters check out this list of acceptable foods, with carb counts, or NutritionData. But at first, you’ll want to track what you eat using a tool such as myfitnesspal.com (“MFP”), which will calculate your carb totals and lots more valuable stats. Once you get familiar with how many carbs are in which foods, you can choose whether to keep tracking your food or not. Tracking your food is highly recommended.

What are NET carbs and how to I calculate them?

The NET carbs for a food are TOTAL CARBS – FIBER. Example: 100g of avocado contains 9g carbs. 7g of these are from insoluble fiber and don't elicit a strong insulin response; you don't count them. 9g – 7g = 2g NET carbs per 100g avocado.

Important notes:

  • You can't ADD fiber to a meal to effectively negate carbs from starch and simple sugars. (See flax + ice-cream example above!)
  • Many countries will already list starch and sugar carbs independently of fiber (EU, UK, AUS). Check on your nutritional labelling to be sure, never assume!
  • Some foods appear to have "negative carbs" – this is not possible and it only appears during erroneous calculations and in food tracking apps like MyFitnessPal when fiber is subtracted from a food that already lists starch and sugar independently of fiber.
  • Carb blockers – Some foods and supplements claim to "block" carbs or slow their absorption to the point of being effective for a ketogenic diet. Such products have not yet been or tested thoroughly and can be considered snake oil until credible evidence shows otherwise.

What about sugar alcohols?

It's important to note that there are lots of different types of sugar alcohols. Some of these are compatible with a low carb approach, some of them should be avoided due to high glycemic index or may have nasty side effects such as constipation, laxitive effects, bloating, flatulence, indigestion and heart burn.

An individual's ability to digest certain sugar alcohols can depend the gut enzymes of each person and the manner in which the sweeteners are consumed.

NameGlycemic Index
Xylitol13
Sorbitol9
Erythritol0
Maltitol36
Mannitol0
Isomalt2
Glycerol3

It is important to note that even if a granulated sweetener uses a sweetener with a GI of 0, it may be bulked out with another sugar alcohol such as Maltitol with a high GI.

If you are have a sensitive gut or can't kick a plateau, ditch sugar alcohols.

What foods should I avoid?

Starchy foods and sugars are always unacceptable: grains (yes, even whole grains), bread, cereal, beans, soda, pasta, potatoes, pizza crust, beer, cookies, bagels, lollipops, honey, tortilla chips, pretzels, popsicles, crackers, and everything in between. They all have one thing in common: to your body, they’re all sugar, which breaks down into glucose in your bloodstream and causes an insulin response.

That’s right, bread is sugar. Even fancy multi-grain organic bread.

Fruit should be mostly avoided because it’s full of sugar, though some ketoers eat small quantities of berries, which have few carbs and are high in fiber.

Nearly all "low-fat" foods should be avoided; non-fat milk, reduced fat salad dressings, low-fat cheese and yogurt, etc., are full of carbohydrates Many also contain chemicals compounds where the effect on the human body is not yet well studied and could be potentially dangerous.

Don’t drink milk or add it to coffee or tea; use cream (also known as heavy cream/HWC in the US, pure cream in Australia, or double cream in the UK) instead. See Wikipedia's entry on cream for a full breakdown of fat % and labelling per country for more information. Also be sure to look for additives on the labelling. Remember to count the calories in cream.

At first you’ll want to track your foods to make sure you’re not unwittingly eating lots of hidden carbs. You may be shocked at how much sugar you have been eating without knowing it, in salad dressings, sauces, packaged foods, etc.

What are macronutrients?

Macronutrients ("macros") are what you use for fuel: fat, protein, and carbohydrates. Every weight-loss diet works by limiting the total amount of calories you eat. The macronutrient makeup of a ketogenic diet make it very easy to stay in a caloric deficit and lose weight. Most people do not need to count calories on that diet, because they naturally start consuming a healthy amount of calories.

The three macronutrients are carbohydrate, protein and fat.

All three nutrients have differing effects on ketosis due to their digestion and subsequent effects on blood glucose and hormone levels.

  • Carbohydrate is 100% anti-ketogenic due to its effects on blood glucose and insulin (raising both).

  • Protein is approximately 46% ketogenic and 58% anti-ketogenic due to the fact that over half of ingested protein is converted to glucose, raising insulin.

  • Fat is 90% ketogenic and ten percent anti-ketogenic, representing the small conversion of the glycerol portion of triglycerides to glucose.

"Both protein and carbohydrate intake will impact the development of ketosis, affecting both the adaptations seen as well as how
much of a ‘protein sparing’ effect will occur. Despite the generally ‘high fat’ nature of the ketogenic diet, or at least how it is perceived, dietary fat intake has a rather minimal effect on ketosis per se. Fat intake will primarily affect how much bodyfat is used for fuel."

Lyle McDonald, "The Ketogenic Diet", page 52

Compared to the diet recommended by the US Food and Drug Administration, the macros in a ketogenci diet are high fat, moderate (adequate) protein, and extremely low in carbohydrates.

How do these 3 macronutrients give energy to our body?
The most accurate way to find out how much fat, protein, and carbs you personally need is to put your data into the keto calculator. Remember to recalculate your data once in a while after your bodyweight has changed, e.g. once a month.

Alcohol is also a macronutrient and it may have applications in explosive exercises, however, due to the small, infrequent levels in which it's consumed, it is rarely referred to when calculating nutritional goals. That's not to say that alcohol can't affect ketosis. Refer to http://www.reddit.com/r/keto/wiki/faq#wiki_can_i_still_drink_alcohol.2Fcoffee.3F.

Protein and the Ketogenic Diet

Although carbohydrate intake is arguably the most important aspect of successfully inducing ketosis, protein intake is extremely important in order to prevent muscle loss. While an easy solution is to simply eat as much protein as possible, too much protein can prevent ketosis as well, disrupting the adaptations which ketogenic dieters seek.

Protein has both ketogenic effects (46%) and anti-ketogenic effects (58%). This reflects the fact that 58% of dietary protein will appear in the bloodstream as glucose, raising insulin and inhibiting ketogenesis.

Therefore, protein intake must fall within a narrow range: high enough to prevent muscle loss but low enough that ketosis is not disrupted.

  • Sedentary people: 0.69 – 0.8g per lean pound

  • Mildly active or doing endurance / strength training: 0.8 to 1.0g per lean pound

  • Heavy strength training / bodybuilders: 1.0 up to 1.2g per lean pound

These are general guidelines. Check out the Keto Calculator to calculate it for yourself.

Protein according to lean pound is recommended for people who are obese or want to achieve low body fat levels.

For the most part, the timing of protein intake is not an issue on a ketogenic diet, except as it pertains to maintaining ketosis. The nature of the ketogenic diet ensures that protein is consumed at most meals with few exceptions.

How can I tell if I’m in ketosis?

There are a good number of “indicators” of ketosis; some of them are simple physical signs and others are physical tools to test for the presence of ketones in the body. Dieters use this to track trends and test to see if they are sensitive to certain substances that may be keto friendly but still have a negative effect on their weight loss.

All about ketostix

Ketosticks/Ketostix is the name for test strips that measure the level of ketones in the urine. Whether correct or not, many ketogenic dieters tend to live or die by the presence of ketones in their urine. The presence of ketosis, which is indicative of lipolysis can be psychologically reassuring, however it should be noted that one can be in ketosis, defined as ketones in the bloodstream, without showing urinary ketones.

Although up to 100 grams of carbohydrate will allow ketosis to develop, it would be rare to see ketones excreted in the urine at this level of intake. Since the only measure of ketosis available to ketogenic diets are Ketostix™ carbohydrates must be restricted below this level of ketosis is to be measured. As a general rule of thumb, dietary carbohydrates should be below 30 grams per day for ketosis to be rapidly established and for ketones to be lost in the urine. However, this value varies from person to person and depends on other factors such as protein intake and activity, which allows individuals to consume relatively more carbohydrate without disrupting ketosis.

After adaptation to the diet, it appears that individuals can tolerate relatively greater carbohydrate intakes without disrupting ketosis. Although not completely accurate, Ketostix™ can provide a rough measure of how many carbohydrates can be consumed while still maintaining ketosis. As long as trace ketosis is maintained, carbohydrates can be gradually added to the diet.

Since Ketostix™ only register relative concentrations, rather than absolute amounts, changes in hydration state can affect the concentration of ketones which appear. A high water intake tends to dilute urinary ketone concentrations giving lighter readings. Ketones in the urine simply indicate an overproduction of ketones such that excess spill into the urine. So it is conceivable for someone to be in ketosis without showing urinary ketones.

Some individuals can never get past trace ketosis, while others always seem to show darker readings. There seems to be little rhyme or reason as to why some individuals will always show deep concentrations of urinary ketones while others will not. Some will show higher urinary ketones after a high fat meal, suggesting that dietary fat is being converted to ketones which are then excreted. Consuming medium chain triglycerides (MCT’s) has the same effect. Other individuals seem to only register ketones on the stick after extensive aerobic exercise. Finally, there appear to be daily changes in ketone concentrations, caused by fluctuations in hormone levels. Generally ketone concentrations are smaller in the morning and larger in the evening, reaching a peak at midnight. Many individuals report high ketones at night but show no urinary ketones the next morning while others report the opposite.

A popular idea is that the deeper the level of ketosis as measured by Ketostix™, the greater the weight/fat loss. However there is no data to support or refute this claim. While some popular diet authors have commented that urinary ketone excretion means that bodyfat is being excreted causing fat loss, this is only loosely true in that ketones are made from the breakdown of fat in the liver. The number of calories lost in the urine as ketones amounts to 100 calories per day at most.

Anecdotally, higher levels of urinary ketones seem to be indicative of slower fat loss. Individuals who maintain trace ketosis seem to lose fat more efficiently although there is no research examining this phenomenon. A possible reason is this: high levels of ketones in the bloodstream raise insulin slightly and block the release of free fatty acids from fat cells. This seems to imply that higher levels of ketones will slow fat mobilization.

The ideal situation would seem to be one where trace ketosis (as measured by Ketostix™) is maintained, since this is the lowest level of ketosis which can be measured while still ensuring that one is truly in ketosis. This should be indicative of relatively lower blood ketone concentrations, meaning that bodyfat can be mobilized more efficiently.

No hard and fast rules can be given for the use of Ketostix™ except not to be obsessive about them. In the same way that the presence of ketones can be psychologically reassuring, the absence of ketones can be just as psychologically harmful. It is easy to mentally shortcircuit by checking the Ketostix™ all the time.

It is recommend you only use Ketostix™ in the mornings, as water intake may dilute your urine, giving a lower reading of ketones.

Acetone Breath

Acetone Breath, otherwise affectionately known as “metal breath” or “keto breath”, is the presence of ketones in your body being produced and turned into acetone. It will taste metallic and have faint wafting essence of ammonia.

Changes in urine

Ketosis not only changes your breath but your urine, too; it will start developing a filmy consistency and smell like its been distilled from dinosaur sweat. The potent smell change will be the most obvious.

How long will it take to reach ketosis?

Ketosis begins when liver glycogen is depleted, and the amount of glycogen in the liver only provides enough glucose for 12-16 hours. Thus, when you limit carbs to 20 net grams, it takes no longer than 24 hours to enter ketosis.

What should I be drinking and how much?

Water suppresses the appetite naturally and helps the body metabolize fat. Studies have shown a decrease in water intake will cause fat deposits to increase, while an increase in water intake can actually reduce fat deposits. Water retention, a notorious issue on Keto, is best combated by drinking more water. This allows the body to release the water it had previously been holding on to in case of dehydration. Water is a huge factor in weight loss and is often underestimated. Your progress will be slow if you don’t hydrate. The actual amount you need will depend on many factors, so try using a hydration calculator.

I am peeing a lot! Is that normal?

Yes. The water weight you lose is just that – water. Even if you're drinking a lot, you'll be peeing more than you're taking in. That's completely normal for the first day or two of ketosis.

Adapting to a Low Carb Lifestyle

What is “keto flu” and how long will I have it?

During the induction phase of a Ketogenic Diet, most people experience a horrid “flu” that often makes people believe from the start that it isn’t right for our bodies. Consider it the first of your many trials to come. The flu is a manifestation of your mental and physical dependence on carbohydrates and the body is essentially going through a phase where it has to learn to use fat as fuel.

Keto flu can be treated by replenishing your electrolytes. (See next section.)

The flu-like symptoms should dissipate in a few days or weeks. But be warned: For as long as you eat low-carb, if you don’t take care to get enough sodium, potassium and magnesium (a.k.a. electrolytes) in your diet, you may experience fatigue, muscle twitching, headaches, muscle cramping, and in severe cases, arrhythmia. Leg cramps may be the most common sign that your electrolytes are out of balance.

How do I replenish electrolytes?

Even if you go out of your way to eat lots of table salt and foods containing potassium and magnesium, you may find you need to take supplements. The minimum daily intake for the three electrolytes is given by Lyle McDonald as:

  • 5000 mg of sodium (salt)](http://en.wikipedia.org/wiki/Sodium_chloride)
  • 1000 mg of potassium, in the form of potassium chloride or potassium sulfate
  • 300 mg of magnesium

You can track the intake of these minerals with a tool such as myfitnesspal.com.

Most of us will not reach these suggested totals with food alone, but there are several ways to ingest extra electrolytes:

  • Drink 1 or 2 cups of bouillon or broth daily
  • Measure salt and/or salt substitute to add to your food over the course of the day.
  • Take a multivitamin containing magnesium and/or potassium
  • Take a magnesium supplement.
  • Use salt or salt substitute to meet the minimum daily intake, over the course of the day.
  • Don't take large amounts, e.g. >250mg of salt substitute (potassium) at once to avoid adverse effects. Spread it out over the day instead.
  • Potassium supplements in capsule/tablet form are limited to 99mg per dose for safety and convenience.

Note: Unfortunately, many potassium-rich foods are not keto-friendly. For example, don’t eat bananas unless you want to get knocked out of keto.

Several companies make low-sodium salt substitutes (LoSalt, Lite Salt, AlsoSalt, etc.) for people trying to reduce their sodium intake. Luckily for keto dieters, these products tend to contain lots of potassium, which we need as a supplement. Read the product label to see how much of which minerals it contains. People with kidney failure, heart failure or diabetes should not use salt substitutes without medical advice, and according to Wikipedia, salt substitutes are contra-indicated for use with several medications.

For scientific references/review that recommends spreading potassium supplementation over the entire day, see p.11 of Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies
on a request from the Commission related to the Tolerable Upper Intake Level of Potassium – The EFSA Journal (2005) 193, 1-19).

What will my weight loss progress look like?

Results vary, but you will typically go through three phases

  1. Honeymoon: Lots of weight comes off fast. This is water that was tied up with glycogen. Note: if you don’t experience rapid weight loss in this period, do not despair. Not everyone is so lucky, and men may be more likely to see rapid initial weight loss than women.
  2. Keto Adaptation: Water and glycogen find a new balance and this causes a stall or even weight gain, which lasts for a week or two. Relax, this is both normal and temporary.
  3. Fully keto-adapted: After 3-4 weeks the body is burning fat as its main fuel and the brain has switched to running on ketones. A bumpy downward trend in your weight will begin. The trend is "bumpy" because there will be days or weeks when your weight stalls, or even goes up slightly. This happens to everyone, on every kind of weight-loss diet. Please don’t post to /r/keto that you gained a pound or two, or plateaued for a week. The trend will be especially bumpy if you are female. In particular, shark week will play hell with your scale weight.

If a plateau lasts more than a couple of weeks, you may need to make adjustments to your lifestyle to break it. See the plateau section.

Is cheating worth it?

Many low-carbers will report experiencing upset stomach, headache or fatigue when cheating with carbohydrates. While cheating on a regular basis is not condoned, letting it happen once in a while isn't the end of the world. Sometimes cheating can help people psychologically because it helps them enjoy the diet/lifestyle more and helps them stick to it long-term (this is the key to success of most diets). It can also help physically by busting a plateau, boosting your metabolism, and resetting leptin (the hunger/satiety hormone). Really consider why you are cheating, and whether or not you are able to get straight back on the keto wagon afterwards. Some choose to be strict and stick to the keto diet 100% of the time, but others can benefit from the occasional cheat meal/day.

Typically when you cheat, you gain water weight rapidly and throw yourself out of ketosis, and it may even re-induce the dreaded keto flu once the carbs have dissolved.

Cheating isn’t the end of the world, though. Keep calm and keto on.

Low carb on a budget

One of the largest criticisms about a low-carb lifestyle is its impact on the user’s wallet. However, it can be done on a tight budget and done with great success. The key to this concept is strategy. When you see a giant sale on meat at your butcher or grocery store, spend more than you would on average (even more than what you could consume that week). This allows you to play the budgeting long game instead of the present budget. Sure, you may spend an extra twenty percent on meat this week but you have protein for three weeks now for the cost of one and a half weeks. Apply this logic with staple foods in your area.
Region plays an important role. Become friends with your local butchers or fish mongers. If you live by the ocean, chances are your fish isn’t as pricy as your chicken or beef; the inverse applies the same as well. Plain cheap foods do exist for Keto, though. There are a couple of small tricks to finding cheap food. You’d be astonished at how much cheaper something like 75/25 ground beef is, with its 80/20 partner being dollars higher with virtually not a single iota of difference between the two. Often you can find offal (organs) from local butchers at little to no cost and if you have the money, you can do extreme things like buying your own entire pig belly and cut your own bacon and fatback to REALLY save on the wallet with some extra effort.
Another part of being involved with your local food “mafia” are the lovely assorted farmers markets and food stands that probably exist scattered across town. Often times these small, quaint shops contain the best, most fresh ingredients you’ll find in two hundred miles. If you’re a repeat customer, sometimes they’re even capable of cutting you special deals. These sort of establishments are usually just as much about community as they are about the promotion of healthy living. One additional benefit of a ketogenic diet is that it is incredibly satiating, so you eat less! With the decreased calorie intake and the lack of money spent on 'junk' foods, your food budget may even be better than pre-keto.

Another expense to worry about is the new wardrobe you’re going to need as you start losing weight. Taking your clothes to a tailor/dry cleaner for alterations can be cheaper than buying new clothes. You could also check out thrift stores, consignment stores, or look for Facebook groups in your area which buy/sell clothes.

What if I’m eating at the office or on the move?

It is entirely possible to remain ketogenic while eating away from home. Many restaurants offer low-carb options, and even when they don’t, you can ask for simple substitutions: a burger without the bun, or salad instead of fries, for two examples. Fast food places and sandwich shops can always substitute lettuce for bread.

On the move/unrefrigerated:
Nuts (almond, cashew, macadamia, etc) and seeds (pumpkin, chia, etc), and jerky (be careful of hidden sugar), pork rinds, avocados, tinned fish (tuna, salmon, sardines, etc), hard boiled eggs (they will keep only for a day), salamis/sausages/pepperoni (the kinds that do not require refrigeration), packaged cheeses (the kinds that do not require refrigeration), nutritional yeast, and low-carb protein powder & bars are travel favorites.

My parents/roommates/friends eat high-carb, what do I do?

The most difficult aspect of a low-carb lifestyle is feedback from other people. The people around us have been led to believe that low-fat food and lots of cardio exercise is the way to health, but for many of us, that prescription is flat wrong. Eating keto can feel a little like swimming upstream, socially, but it doesn’t have to.

The easiest way to coexist is to communicate. Explain what you’re doing in a non-preachy way, and then work out compromises. Roommate making lasagna? Ask if you can save some of the meat to make a hamburger steak. Parents worried keto will give you heart disease? Explain that you’ve done your homework and weighed the evidence, and show them some of the resources on this page. This clip from the movie “Fat Head” is short, funny and thought-provoking, and might spark their curiosity.

But as they say, “misery loves company”, so don’t be surprised if your overweight friends and family have an emotional, negative reaction to your new lifestyle choice.

What if my doctor says low-carb is junk science/a fad/suicidal?

Most MD’s don’t have much training in nutrition, and like everyone else, they’ve been bombarded with the old low-fat, “balanced diet” mantra. Many nutritionists, even, are unfamiliar with, or downright hostile to, HFLC. Frankly, keto eating flies in the face of the cornerstone nutritional guidelines that doctors are trained to use, such as the USDA Food Pyramid and the American Heart Association recommendations. Even if your doctor knows that a low-carb diet works, she may have no incentive to prescribe it, because the peer-reviewed evidence is relatively thin, and patients don’t normally stick to the diet anyway.

However, many /r/keto members have told stories of managing to educate their doctors, either by demonstrating obvious weight-loss success or by giving them books/videos.

Worst case, you can switch doctors.

What about “faux” foods and artificial sweeteners?

Dieting typically leaves people with voids in their diet that they once took comfort in; sweeteners and faux foods are alternatives people seek to fill those voids. The topic is a hot debate among all dieters, as some believe that faux foods generally feel too…well….fake and lack the “true” comfort that their carby cousins seem to provide. However, they are a great way to relive healthy alternatives to dishes and concepts that otherwise would be completely off-limits. Substances such as cauliflower mash allow people to experience the texture of carb laden foods like rice and potatoes without suffering the complications that cheating causes.

There are tons of sweeteners out there that work for low calorie and low-carb diets as an alternative to sugars. They’re often criticized as causing cravings and are associated with being lab chemicals that humans shouldn’t ingest from Paleo dieters. Sucralose, for example is a variant of sucrose that is much sweeter than raw sugar. However, it is bulked into a powder with substances such as maltodextrin. While they’re Keto friendly and DON’T cause an insulin reaction physically, there MAY be evidence that it causes a mental reaction that makes insulin spike from the taste of sweetness on your tongue. Check out this article at Mark Sissons website which explains the composition and effects of different sweetener types. In addition, sugar alcohols are another type of sweetener. Many of these do impact blood sugar and have a calorie value, so be wary when consuming these. They can also cause a laxative effect when eaten in larger quantities. Check out this article for more information.

Can I still drink alcohol/coffee?

In short, yes you can still consume alcohol. However, while the body is metabolizing alcohol you cannot burn fat; it literally impedes your progress until the alcohol is processed. If you still insist on drinking try to stick with spirits that aren’t involved with sugar. Neutral spirits like gin and vodka are great examples. Be cautious, though, alcoholic tolerance is severely lowered in low-carb dieters.

This post explains which alcoholic beverages contain the fewest amount of carbohydrates per serving

Be cautious, though: for many ketoers, alcohol tolerance is severely reduced, leading to dreadful hangovers. Don't forget to hydrate before, during, and after drinking.

Coffee is also very diet friendly on its own but often becomes nefarious once it starts playing with its friends like sugar and milk. Most Ketopians will drink coffee with heavy cream and/or coconut oil to increase their fat intake while getting in some fluid. It’s important to note that coffee in large amounts will flush your intestines and completely mess with your hunger levels throughout the day. Weaker coffee in larger amounts is far better for you than strong coffee in small amounts. Coffee was revised as an acceptable beverage in the latest Atkins approaches and according to A New Atkins for a New You, it may actually prove beneficial in aiding weight loss gently. A small subset of ketoers complain of headaches in the first few weeks, which may be due to a reduced ability to metabolize caffeine.

Help, I’m in keto and I never poop! What do I do?

Constipation happens mostly in the early stages. A few suggestions:

  • Drink more water and eat more leafy greens and other high-fiber vegetables
  • Eat 1-2 tbs of coconut oil every day (also helps keep you full) or eat other sources of fat such as nuts
  • Make sure your salt intake is sufficient
  • Make sure your protein intake isn't too high
  • Get some psyllium husk powder (the main ingredient in fiber supplement products like Metamucil) and mix it with a glass of water 1-2X/day
  • Read some poop threads for more tips

How should I eat after reaching my goal weight?

In short: keep calm and keto on.

After many hit their goal weight they seem to get careless and load back on the carbs thinking that they’re capable of handling it. More often than not, they do gain back a ton of their weight and find themselves back on the low-carb wagon to put their weight back down. Any time you go back to the lifestyle that made you fat in the first place, it will make you fat again.

Just because your weight loss is over it doesn’t mean you should get lazy or apathetic about what you eat. You should always know what you’re fueling your body with. Keeping weight off is just as much of a challenge as losing it all. Some convert over to a Paleo-style diet (/r/paleo) and focus on whole foods without grains, refined sugars or refined fats. Others will gradually include more carbs by into their diet by 5g/week until they find a point where their weight maintains itself. Doing a ketogenic diet should be part of a new lifestyle change, and you should always avoid going back to your old eating habits.

The Science Behind Keto

The FAQ glosses over the details, so if you want to dig deeper check out The Ketogenic Diet by Lyle
McDonald or this brief summary of the book, by user ladysixstring.

What is insulin and how does fat storage work?

Insulin is one of the most important aspects of your body that a Ketogenic diet focuses on. It is a hormone secreted by the pancreas that regulates the metabolism of fat and carbs, specifically in the blood. Its main job is to regulate the distribution of energy to the cells of the body from fat storage. Its other job is to regulate blood sugar by producing lipoproteins (or fat proteins) that act as a bailiff for your blood stream and imprison the fat cell into your body once the glucose has been converted to fat. As you eat carbohydrates, the body must produce more insulin to keep up with ramped levels of glucose in the body and eventually your body begins to resist insulin which eventually leads to type 2 diabetes.

When you eat less carbs, less insulin is required to patrol your bloodstream and regulate your blood sugar. This means, simply, less fat storage as a result.

What are the different kinds of fats?

All foods containing fat – even pure oils – contain a mixture of three kinds of fat:

  • saturated
  • polyunsaturated, and
  • monounsaturated.

Foods are often identified by their predominant fat; for example, olive oil as “monounsaturated” butter as “saturated” – but all real foods contain mixtures of the three.

All three types of fats are necessary and important to human health and should be incorporated into the diet in a balanced proportion. The question is, what ''is'' balanced.

  • Saturated fat, particularly in the absence of high carbohydrate intake, is not dangerous to human health — on the contrary, when balanced with mono and poly-unsaturated fats in a controlled carbohydrate dietary environment, saturated fat may actually have real and measurable benefits in a number of different arenas. Saturated fat is quickly oxidized to energy, once you are keto adapted. So you can enjoy plenty of butter and animal fat guilt free. Interestingly, coconut oil is something very different: it consists of Medium Chain Triglycerids (MCT) which cannot be stored by the body, it has to immediately oxidize it. That means when you eat coconut oil, your body will immediately produce ketones, even when you are not keto-adapted. Nevertheless this does not mean you are getting all the metabolic advantages that you would get when keto-adapted state.
  • In addition, the benefits of monounsaturated fats (like olive oil) are well known and well documented.
  • Fats high in polyunsaturated fats, like vegetable oils, usually contain a lot of omega-6, and very little omega-3. The ideal ratio between omega-6 to omega-3 is 2:1 to 1:1, and in general this ratio is often 20:1 or even worse. It is therefore important to avoid oils high in omega-6, like corn or soy. Vegetable oils that are rich in omega-3 contains it in the form of ALA which the body has to convert to DHA and EPA to be of any use. The conversion is highly inefficient, so in practice ALA omega-3 rich vegetable oils like flaxseed oil or canola are no good choice either. The best way to get omega-3 is through fatty fish like salmon, or with a DHA + EPA supplement.

As a general rule of thumb, avoid fats high in omega-6, and run like hell from highly processed fat(anything that says "hardened", or contains trans-fats) like margarine. Eat foods naturally high in fat like meat, fish, and nuts; use plenty of olive oil, butter. In fact 50% butter with 50% olive oil approximates quite closely the composition of body fat – meaning that this is the type of fat that the body can make best use off.

Common Fat Composition

Keto Myths and Concerns

Aren't whole grains good for me?

The concept of health in modern times is often a warped and strange one. Whole grains are no different and often are portrayed as healthy and necessary in a western diet. The fact is that whole grains are no different from sugar and often have a higher glycemic index than sugar itself. This means that eating raw sugar causes less of an insulin response in your body than a slice of bread. Gary Taubes reports in Why We Get Fat: And What To Do About It that a man has to walk up approximately twenty-two flights of stairs to burn off the energy of one slice of bread. The truth about grains is that they are energy dense and lack the nutrients or longevity of fats and proteins, in addition to being strongly associated with auto-immune diseases.

Is more protein than fat OK?

Yes, but typically not necessary. The common recommendation is between 0.8-1.2g of protein/lb of lean mass (more than 0.8g is only recommended if you are weight training intensely, and even then, there are not too many studies showing protein above this amount being effective). For most people, this will be around 50g-150g of protein a day, which is more or less independent of your fat macro. Thus if you are severely restricting calories (and thus your fat macro since carbs are minimal) and have a lot of lean mass, you may end up having more protein than fat.

Also, unless you are having an obscene amount of protein (>2g of protein/lb bodyweight), you probably will not affect ketosis. The only thing you are hurting is your wallet and maybe your regularity.

Won't fat make me fat (and diabetic)!?

Fat making people fat has got to be one of the most misunderstood concepts in history. This logic doesn't apply properly to anything else; if it did we’d all be green if we ate a lot of cucumbers. Fat makes us fat when its paired with high levels of carbohydrates, actually. That is when fat makes you fat but putting all the blame on fat isn’t solving the problem, it only points to half of the problem.

Diabetes is becoming an increasingly worrisome problem that plagues the western world. Type-2 Diabetes is a serious problem that needs to be remedied. However, it seems that most people don’t understand what complicates diabetes. Diabetics aren’t affected by large amounts off fat or protein; while they cause insulin responses it is nowhere near the response you get from carbohydrates. When a diabetic eats a hamburger with fries the sections that alter the blood sugar most drastically are the starchy fries and bun of the burger. It is not the fatty meat or pile of cheese and pickles that cause problems. It makes sense that the things that cause more drastic insulin spike would cause the disorder that surrounds insulin problems. Fat is not to blame at all; it just happens to take the fall.

Carb blockers and raspberry ketones can supplement a low carb diet, right?

These are brand new products with very little scientific research associated with their usage. Until this FAQ is updated with peer-reviewed information that proves otherwise, these products can be disregarded as snake oil. Eat fewer carbs and you will make your own ketones. There's no magic workaround.

What about cholesterol and heart disease?

Cholesterol is a waxy, charming lipid gracing every cell’s membrane and our blood plasma. Its jobs, which are many, include insulating neurons, building and maintaining cellular membranes, metabolizing fat soluble vitamins, producing bile, and kick-starting the body’s synthesis of many hormones, including the sex hormones. Cool stuff actually.

Given all the work cholesterol has to do, the liver is careful to ensure the body always has enough, producing some 1000-1400 milligrams of it each day. In comparison, the 300 milligram recommended limit for dietary cholesterol (your tax dollars at work in the USDA) is a drop in the bucket. And get this: our livers come with feedback mechanisms (at no additional cost) that regulate cholesterol production in response to our dietary intake. When we eat more, it makes less, and vice-versa. Imagine that!

What are HDL/LDL/Triglycerides?

First, there are high density lipoproteins (HDL/the “good” one). He has the popular job of transferring cholesterol from the body’s tissues back to the liver.

Next, there are low density lipoproteins (LDL/the “bad” one). LDL is a lipoprotein and delivery man as well. He has the disgraced job of transporting cholesterol after production from the liver to the body’s tissues.

Third, there are triglycerides, which are essentially the form that fat takes as it travels to the body’s tissues through the bloodstream. The relationship between triglycerides and cholesterol is more of an association. A high triglyceride level, which is unequivocally fueled by a high carb diet, is very often a marker for other problems in the body, particularly insulin resistance (and accompanying risk of diabetes) as well as inflammation (with its risk of heart disease). High levels are often seen with low HDL cholesterol.

What is the real issue?

In short, the only important factor is how many LDL particles (LDL-P) you have. Period. (See The straight dope on cholesterol – Part VI, Part V, The Triglyceride / HDL-C Ratio – Thomas Dayspring MD, FACP (PDF), Low Carb Explained, Interview with Dr. Mary Vernon, Specialty Health – Dr. Tara Dall – It’s not the passengers, it’s the cars). The parameters LDL cholesterol (LDL-C), Triglycerides, particle size matter only because they influence particle count (see below). When you have too many particles, you are at risk. If you do not know your LDL particle count, you simply do not know if you are at risk.

The ideal LDL particle concentration is below 1000 nmol/L. Above 1600 nmol/L means high risk. (See Optimal Ranges for LDL-P)

That being said, a good predictor for LDL particle is the Triglycerides to HDL ratio:

  • Trig/HDL ratio in mg/dl: 1 is perfect, below 2 is good, above 3 means significant disease, above 5 means you will explode any moment.
  • Trig/HDL ratio in mmol/l: 0.44 is perfect, below 0.88 is good, above 1.33 means significant disease above 2.2 means you will explode any moment.

Details about Cholesterol

Imagine your bloodstream is a highway. You want to move a given number of passengers (called Cholesterol) from A to B, with as few accidents (crashes into your artery wall that build up plaque) as possible. How can you do this?

  • When you have only few passengers (low LDL-C), you can get away with using small vehicles (small LDL-particles) to carry them because this will not lead to lots of traffic. When you have lots of passengers to move (high LDL-C) and still use small vehicles, you will need lots of vehicles (high LDL-P) hence get lots of crashes (increased risk of CHD).
  • When you have few passengers (low LDL-C) but large vehicles that can carry lots of passengers, your highway is empty and you will have hardly any crash. You can also get away with lots of passengers to move (high LDL-C) when your vehicles are big enough that your LDL-P stays reasonable.
  • Now this is not the whole story. We got other passengers as well (Triglycerides) who want to be moved around as well. These guys take away precious seats that could otherwise be used to carry cholesterol. When you have lots of Triglycerides to carry around you will need a higher number of vehicles to carry the same amount of cholesterol. Again, more vehicles means higher risk, so high Triglycerides drive high LDL-P.

I don't need to lose that much, is that OK?

Absolutely. You can lose 500lbs or 5lbs on keto by eating the exact same foods. If you're already very lean or athletic, you may need to be more strict about carbs and increase your exercise expenditure but it's certainly possible. Regardless of the weight loss, the other health benefits associated with a low carb diet are reason enough to stick with it long term and see results.

Won't I go into "starvation mode"?

Starvation mode is defined as a state in which the body is responding to prolonged periods of low energy intake levels. Most dieters tend to drop calories extremely low based on the idea that the greater the deficit, the more weight that will be lost. Up to a point this appears to be true, in that greater caloric restriction yields greater fat loss. However this ignores the potential effects of extreme caloric restriction on metabolic rate, muscle loss, etc. A recent review of twenty-two studies found that extremely low calorie levels, below 1000 calories/day, caused a much greater drop in metabolic rate than even 1200 calories/day. So, there appears to be a threshold level of caloric intake where metabolic rate is more greatly affected. When starting a fat loss diet, calorie levels should be restricted no more than 10-20% below
maintenance levels. This caloric deficit can be generated by decreasing food intake or increasing activity with exercise.

Some reddit discussions about starvation mode:

  • The fear of going into starvation mode with keto…
  • "Starvation mode?"
  • If "starvation mode" isn't a real thing, is it not important to eat breakfast?
  • Whats the skinny on "Starvation Mode"?
  • Does anyone have stored away any good scientific studies about the starvation mode myth, good/bad fats, and cholesterol?
  • Can ketosis… kill? Help me dispel (or understand) this point of view.
  • the symptoms of ketosis, the body's "ohshitohshitohshit" reaction to starvation. We imagine that fewer people would choose to fast if it were referred to by its proper scientific name: "slow, painful suicide." – Cracked.com
  • Not getting hungry as often, will I "starve" from low calorie intake?
  • Is it detrimental to weight loss if you don't eat every 3 hours?
  • Lower than "normal" caloric intake – OK or not-so-OK?

I feel tired and light headed

This is a common experience that can easily be solved with a bit more salt in the diet. Here is why: When you become keto-adapted your kidney switches from retaining salt to rapidly excreting it. The body is getting rid of excess water and salt, which is a good thing. This also means that you need to drink more water and get more salt in the diet, because your body is now quicker at processing it. When your body is low in salt, the kidney tries to compensate this by releasing potassium. This loss of potassium is bad for your muscle mass. When you do not get enough salt, common symptoms are:

  • You feel light-headed when standing up quickly
  • You feel sluggish
  • You feel faint
  • Fatigue if you exercise enough to get 'warmed up'
  • Headaches
  • Constipation
  • Heart palpitations or fast heart beat
  • Muscle cramps

The best solution is to drink 1 or 2 cups of bouillon or broth daily. This will add about 1-2 grams of sodium to your daily intake. On days that you exercise, you might also want to drink one dose of broth within the hour before you start. Unprocessed meat and green leafy vegetables are high in potassium. If you grill your meat, potassium leaves with the drippings. Don’t discard ‘the solution’!

Source: "The Art and Science of Low Carbohydrate Living", page 41, "The Art and Science of Low Carbohydrate Performance", page 82

Why have I developed a rash?

One very rare occurrence when beginning a ketogenic diet is the development of a localized rash around the back, neck or chest. A possible explanation is that as fat breaks down, fat-soluble substances stored within might be released suddenly into the bloodstream, provoking the release of histamines if the person has a sensitivity to those substances. Histamine release is an allergic reaction that can result in skin swelling, such as hives — raised, red, itchy areas of inflammation. Source: http://www.livestrong.com/article/482095-atkins-and-rashes

It will pass, other members have applied hydrocortisone cream to help with soreness/itching. Antihistamine could help too. Check with a doctor if the condition doesn't subside.

Specialist Approaches to Keto: TKD, CKD, Carb Loading, etc. (please see /r/ketogains for more thorough info)

What is the Targeted Ketogenic Diet Routine (TKD)?

The TKD is nothing more than the standard ketogenic diet (SKD) with carbohydrates consumed at specific times around exercise, as a way to replenish muscle glycogen. This means that carbohydrates are consumed only on days when exercise is performed. If fat loss is the goal, the number of calories consumed as carbohydrates should be subtracted from total calories, meaning that less dietary fat is consumed on those days. The TKD is a compromise approach between the SKD and the CKD. The TKD will allow individuals on a ketogenic diet to perform high intensity activity (or aerobic exercise for long periods of time) without having to interrupt ketosis for long periods of time. For a TKD to work, high glycemic, easily digested carbs are preferred – think sport gels, hard candy, dextrose.

–"The Ketogenic Diet" by Lyle McDonald

AnabolicMinds forum post explaining the method behind TKD

What is the Cyclical Ketogenic Diet Routine (CKD)?

The CKD attempts to harness the effects of a ketogenic diet while maintaining exercise performance. However, rather than providing carbohydrates only around exercise as a TKD, the CKD inserts a one (or two) day period of high carbohydrate eating to refill muscle glycogen. This means that for the CKD to work, muscle glycogen must be depleted fully each week by doing very intense "depletion" workouts. A CKD is not appropriate for beginning exercisers or those who are unable to perform the amount of training necessary. During the carb-loading phase of the CKD, the body’s metabolism is temporarily switched out of ketosis, with the goal of refilling muscle glycogen levels to sustain exercise performance in the next cycle.

–"The Ketogenic Diet" by Lyle McDonald

Here are some resources to consider:

  • /r/ketogains – For how to implement a TKD/CKD, what types of carbs to consume, etc.
  • Lyle McDonald – A brief introduction to CKD (Web article)
  • The Ketogenic Diet by Lyle McDonald (Book)
  • The Carb Nite Solution: The Physicist's Guide to Power Dieting (weekly CKD cycle, no exercise required)
  • Underground Body Opus by Daniel Duchaine (Book)
  • CKD Plan (Author unknown) (Web article)
  • Carb Back-Loading – keto diet with carbs timed to heavy resistance training

Can I do exercise/sports while on a ketogenic diet?

Of course. Any diet with exercise will yield you better results than the diet alone.
Some people do report increased energy levels while doing a ketogenic diet (this normally happens after the induction phase) so take that in mind. Check the specialized sub-reddit for doing any kind of sports while practicing a ketogenic diet, /r/ketogains

Can vegetarians/vegans do ketogenic diets?

Your personal ethics needn’t prevent you from enjoying the benefits of a ketogenic diet. Many people have and do still thrive on ultra low carb foods which are solely plant-based. It’s a little more difficult and you might require supplements to meet some of your nutrient quotas but it can certainly be done. Check out the carb counts/food list in the resources for an acceptable list of seed/vegetable oils which can replace fats found in meat. Olive oil, flax seed oil, coconut oil and (if you eat it) oily fish are all excellent sources of fat with good anti-inflammatory properties. Nuts, fish (again, if you eat it), firm tofu, peanut butter and eggs are also good sources of protein. If you struggle to obtain virgin or cold-pressed oils and aren’t eating oily fish, you should really be supplementing your diet with EPA/DHA capsules. Check out the awesome sister sub-reddit full of recipes and support over at /r/vegetarianketo

How can I eat a paleo ketogenic diet?

Keto and Paleo share a lot of similarities in the sense of getting rid of man-made processed garbage food. Sometimes people do an overlap of both diets quite successfully. The bulk of the discrepancies appear when it comes to sweeteners and fruit. Paleo-ers argue that we don’t have splenda in the wild and shouldn’t eat it and Keto-ers are screaming that modern fruit is largely altered by genetic enhancement and are more dense with sugar than our Paleolithic predecessors. Obviously, copious amounts of fruit aren’t allowed on Keto so if you wish to combine these two diets you’re going to have to forget about certain fruits and sweeteners and find natural, healthy alternatives.

Paleolithic foods such as green leafy vegetables and unprocessed meat are often naturally very low in carbohydrates and lend themselves perfectly to the ketogenic approach. One thing that Paleo keto will limit you to, though, is the sources of your foods and the manner in which they are prepared and packaged. Certain oils (like seed oils) which are industrially extracted are not really acceptable on a true paleo diet either, but as with any lifestyle, its all about how you can make the approach meet you as an individual. Check out /r/paleo for advise on the paleo lifestyle.

What is fasting and how does it benefit me?

Fasting is when one abstains from caloric intake for comparatively extended periods of time. The actual fasting period varies depending on personal approach and preferences but typically you'd look to fast for at least 16 hours and then allow yourself 8 hours in which to eat. 20/4 and 19/5 are other popular fasting ratios. Fasting is a great tool for weight loss and a great way to teach a dieter a positive discipline. Fasting is considered natural and a way to exercise constantly without exerting so much effort. A fasted state means any period in which you consume less than ten calories per hour, so during a fast only water and ultra-low calorie beverages can be consumed. Black coffee and tea without milk/cream and sweetener are all acceptable. No food is permitted during a fast. It's very important when fasting to observe caloric intake as it's extremely easy to eat beyond satiety when intermittently breaking from a fast.

Benefits of fasting

Fasting and Exercise are metabolically the same. In detail, fasting leads to low insulin levels and high growth hormone. When those two are inverse, (one low, one high) more free fatty acids are released in your blood. This leads to increased fat burning. ("increased metabolism") This, in turn leads to increased amino acid movement through your muscles and means more energy and more efficient use of nutrients for the muscular tissue. In addition, your body increases in epinephrine and nor-epinephrine production which results increased alertness and mental clarity. This means that exercising in a fasted state is preferable and powerful.

Variants of fasting

There are a good number of different forms of fasting. The main two sub sets of fasts used by low-carb diets are Intermittent Fasting and the Atkins Fat Fast. Intermittent Fasting, or IF colloquially, is a division of time between eating and fasting that typically are presented in a ratio of twenty-four hours. For example, a 20/4 IF is a 20 hour period of fasting (less than 10 cals per hour, remember) followed by a four hour window to consume your daily calories. Your IF schedule may vary based on your availability to eat. You can pretty much do anything with at least a fourteen hour fast period or more. The hardcore IFers encourage a 23/1 fast system and claim it is how you get the most energy out of fasting for exercise.

The Atkins Fat Fast is a system in which you consume no more than 1,000 calories per day with a ninety percent fat consistency. This is not recommended unless you have been plateaued for some time (more than a month, at least), and should be only be done for three days maximum.

Why we plateau and what to do about it

Taken from here. The ketogenic diet is an effective weight loss tool, but it does not guarantee that you will move from fat to thin without complications. It simply allows your body to regulate its fat cells better, and should your body choose a destination that is fatter than you like, you may find yourself stuck there. This then becomes the homeostatic weight that your body prefers to maintain, for whatever reason.

Possible scientific mechanisms for plateau

Glucose tolerance

When we initially put on our weight, we likely did so in an environment of chronically elevated blood sugar. We are all likely to have a problem with our glucose tolerance, thanks to the standard grain-focused, carbohydrate-laden diet. There are two aspects to this issue. First is the glucose sensitivity of cells. We need our cells to be eager to use blood glucose when it is available, rather than rely heavily on insulin to force it. The other side of the coin is in the pancreas, in how much insulin we secrete when carbohydrates pass through the upper GI tract, or when we think about eating sweet food or place sweet food on the tongue (artificial sweeteners included). These problems can be described as insulin resistance, insulin sensitivity, insulin oversecretion, etc. We may reach a homeostatic weight, even with small amounts of carbohydrate in the diet, due to the various ways in which our glucose tolerance may be impaired.

Visceral fat

Insulin-driven fat storage seems to deposit fat more in the abdomen than in other locations. This is the so called apple/pear body shape talk you may have heard. Interestingly, visceral fat is more hormonally active than other types of fat and may resist collection, even when the metabolism has been restored to normal function via the cessation of carbohydrate intake. These fat cells secrete hormones called adipokines that interfere with proper glucose tolerance. They are the zombie fat cells that want to eat the brains of your properly-functioning metabolism.

Overnutrition

There are some who say that eating too many calories will cause a plateau. Here is a sample from Dr. Eades' blog on the subject. I believe this hypothesis, but it may not happen as frequently as one would expect. Lowering calories may lower carbohydrate intake. If one oversecretes insulin, even a slight lowering of carbs will aid metabolic regulation and may set the homeostatic point back some amount. But for the cases where our metabolism is healthy and we are overeating, the body will likely not dip too deeply into any of its fat stores. Another form of overnutrition may be an overconsumption of protein. Again, if we have problems with glucose tolerance, the protein may tap into those issues as our body converts it to glucose.

Keto adaptation

Your body will gradually use ketones more efficiently (see some comments here). There may even come a time when you cannot make your ketostix turn purple at all. This is not a bad thing and it does not mean you cannot lose weight, or that the health advantages of low-carb are gone. The Inuit thrive on this diet their whole lives, after all. It means that you may have to watch calories a little more closely than in the years prior, although it should still be extremely difficult to gain fat.

Leptin signaling

Fat is hormonally active. It sends out leptin, a satiety hormone whose job is to say "hey, come eat me." As you lose non-visceral fat, there will be fewer fat cells around sending this signal to your metabolism. This is one possible answer to the tapering off of weight loss (on any diet, in fact). I sincerely hope it isn't the case, but some obesetologists theorize that being obese for the long term can permanently burn out leptin receptors. And to add to your misery, insulin interferes with leptin reception – but that is something keto helps solve.

Carb creep / cheating / other "user error"

We get comfortable with our diets and experiment with expanding our palate. We lose some of the rigor that we applied when starting. The end result is that we are eating more carbohydrate than we expect.

What to do about plateaus?

Before you take action to fight your plateau, make sure you are actually stuck. Don't rely on your scale alone; use body tape, callipers, a tight pair of pants, number of belt loops, or whatever tools you might have where you can verify that nothing is changing. There are times on keto where you may drop a size without losing weight. Now that we have that out of the way, you may have noticed the individual letters prefixed to the mechanisms above. I will use those letters to indicate how the methods and mechanisms are related.
When you undertake any action, test it for a fixed period (2-4 weeks) to see if it is effectual, and if not, you needn't bother yourself with integrating it into your lifestyle. You may be able to try some of this occasionally to kick start the weight loss process, which will then go again even if you discontinue the behaviour. Some of these tools can be used as an ongoing adjunct to keto.

  • Glucose tolerance – Employ an endurance exercise program. I personally recommend HIIT as it has been shown to be more effective than cardio (or SIT, in this study), but it seems that any sort of endurance training improves glucose tolerance. It's not about burning calories.
  • Glucose tolerance, Visceral fat – Give intermittent fasting a shot, either a gentle 16/8 schedule, or even up to a more aggressive ADF (alternate day feeding) schedule. This is not necessarily a means of calorie restriction, since some IF practitioners call for completely making up for the missed meal period. Hence, this is a way of redistributing your calories in your schedule such that you are relying on fat reserves more often.
  • Glucose tolerance, Overnutrition – Eat a nearly zero-carb diet that is 90% fat, and optionally restrict yourself to little more than 1,000 calories per day (Atkins called this "The Fat Fast"). As stated above, a bad idea unless you have been on the plateau for over a month, and should never be done for more than 3 days.
  • Carb creep / cheating – Make sure carb counts are correct and that you're attaining your goals. Cheating? Oy! Don't do that.
  • Overnutrition, Carb creep / cheating, Keto adaptation) Reduce caloric intake. (Last resort IMO.)
  • Glucose tolerance, Visceral fat, Leptin signaling – Wait. It takes a number of years for all the cells in your body to replace themselves. The cells that grow while on the ketogenic diet will hopefully be more insulin sensitive than your old cells, and over time your homeostatic weight may drop.

Resources

Videos

Introductions

On Sugar

On Obesity

  • The Cause of Obesity –
    Robert H. Lustig is a medical doctor, researcher and expert on obesity. In this video he explains why insulin is driving the obesity epidemic.
  • Why We Get Fat –
    Gary Taubes spoke to Googlers in Mountain View on May 2, 2011 about his book Why We Get Fat: And What to Do About It.
  • How Bad Science and Big Business Created the Obesity Epidemic –
    David Diamond, Ph.D., of the University of South Florida College of Arts and Sciences shares his personal story about his battle with obesity. Diamond shows how he lost weight and reduced his triglycerides by eating red meat, eggs and butter.
  • The Battle of the Diets: Is Anyone Winning (At Losing?) –
    January 17, 2008 presentation by Christopher Gardner for the Stanford School of Medicine Medcast lecture series. He compares diets types and weight loss strategies.

Other Health Effects

  • Dr. Terry Wahls – Minding Your Mitochondria –
    Dr. Terry Wahls learned how to properly fuel her body. Using the lessons she learned at the subcellular level, she used diet to cure her MS and get out of her wheelchair.
  • How to Cure Type 2 Diabetes –
    Jay Wortman, MD, tells the story of how he got rid of his rampant type 2 diabetes using a simple dietary change. Eight years later he is still free from the disease and needs no medication. Basically he stopped eating the foods that turn to sugar in the gut. Jay discusses use of ketogenic diets for children and pregnant women with no ill effects.
  • Why We All Don’t Get Cancer — Sloan-Kettering –
    Craig B. Thompson, President and CEO of Memorial Sloan-Kettering Cancer Center, discusses new ways to think about cancer and how cancer arises in human beings.

More Scientific Background

  • Low Carb Explained –
    Dr. Mary Vernon, MD, is one of the world’s foremost experts on treating obesity and diabetes with low carbohydrate nutrition. “The job of insulin is to stop fat burning and enhance fat storage”.
  • Loren Cordain – Origins and Evolution of the Western Diet: Health Implications for the 21st Century. –
    Dr. Cordain is a Professor in the Department of Health and Exercise Science at Colorado State University in Fort Collins, Colorado. His research emphasis over the past 15 years has focused upon the evolutionary and anthropological basis for diet, health and well being in modern humans.
  • Robb Wolf talks about how evolutionary science saved his life. –
    Steve talks to Paleo Guru and Author of New York Times Best Selling Title "The Paleo Solution" Robb Wolf about how evolutionary science saved his life and paleolithic nutrition. Robb discusses anecdotal data of how the Paleo Diet has resulted in remission of symptoms in several cases of autoimmune patients and how it's helped improve the performance of athletes around the globe.
  • The Paleo Solution by Robb Wolf –
    Brief introduction asking the question "Does the paleo concept ‘work’"? If so, how and for whom? Clinical examples of nutrition, exercise and lifestyle interventions. Discussion of memes and complex human systems. Why the Paleo concept is not a fad.
  • Low Carb Living –
    Dr Stephen Phinney, MD, PhD, knows more about this than almost anybody. He has researched adaptation to very low carb diets (and exercise) for a long time. Here he shares this knowledge, as well as insights from traditional cultures (including Inuits) who never ever ate a lot of carbs.
  • The Science of Low Carb –
    Do you want to improve your health and weight by eating real food? After 150 years of on-off popularity, low carb diets are finally getting the scientific support they need to be taken seriously. – An interview with Dr Eric Westman – A co-author of "A New Atkins for a New You".
  • How Your Blood Panel Values Respond to a Ketogenic Diet – Even though we know lipid panels do not correlate well with cardiovascular disease, many newbies often find the initial increase in bad numbers concerning. Dr. Volek talks about how significant weight loss basically make lipid panels useless.

Web Resources