What is the Keto Diet? A Guide to Eating for Optimal Health

What is the Keto Diet? A Guide to Eating for Optimal Health Introduction

In the quest for optimal health and wellness, the ketogenic diet stands as a beacon of hope for many seeking transformation. This comprehensive guide illuminates the path to understanding and harnessing the power of "ketogenic eating." The keto diet, a paradigm shift in nutritional intake, redefines the body's energy utilization by embracing fats as the primary fuel source, thus challenging conventional dietary norms. With roots tracing back to therapeutic applications, the keto diet has evolved into a lifestyle choice that promises weight loss, enhanced mental clarity, and a plethora of health benefits. As we delve into the intricacies of ketosis, the roles of macronutrients, and the diet's impact on bodily functions, we invite you to explore the profound effects of this dietary revolution.

1.What is the keto diet?

The ketogenic diet, commonly referred to as the "keto diet," is a nutrition plan characterised by a high-fat, moderate-protein, and very low-carbohydrate intake. This diet aims to shift the body's metabolism into a state called ketosis, where it burns fats for energy instead of carbohydrates. The keto diet is designed to induce a metabolic state in which the liver converts fat into compounds called ketones, which can be used by the brain and other organs for energy (1, 2, 3, 4).

The keto diet has evolved from a passing trend to an accepted dietary regimen, offering numerous health benefits similar to the well-regarded Mediterranean diet. The typical macronutrient distribution in a keto diet is around 70–75% fat, 20–25% protein, and only 5–10% carbohydrates. This diet has been found to be particularly effective for weight loss, as the body begins to burn its fat stores for energy (1, 4).

The keto diet plan involves calculating and adjusting your macronutrient intake—fats, proteins, and carbohydrates. The goal is to limit carbohydrate intake to about 20–50 grams per day to maintain ketosis. As you start, tracking your food intake can be helpful to ensure you're hitting these ratios correctly.

2. History and origins of the keto diet

The ketogenic diet has a rich history dating back to the early 20th century. The concept of a diet that mimics the effects of fasting by restricting carbohydrate intake and increasing fat consumption was first explored by Dr. Russell Wilder at the Mayo Clinic in the 1920s (6). Wilder, who coined the term "ketogenic diet," observed that this diet reduced the frequency and intensity of seizures in a subset of his patients who followed this dietary approach (6). 

The ketogenic diet was initially developed as a treatment for epilepsy, particularly in children. Wilder's colleague, Dr. Mynie Gustav Peterman, formulated the classic diet, which consisted of a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat (6). This diet proved to be very successful in children, with 95% of 37 young patients showing improved seizure control and 60% becoming seizure-free (6). 

The ketogenic diet gained popularity in the 1920s and '30s, but its use declined with the introduction of anticonvulsant drugs in the 1930s and '40s. However, the diet experienced a resurgence in the 1990s, particularly after a 1994 episode of the TV show "Dateline" highlighted its effectiveness in treating epilepsy (7). Since then, the ketogenic diet has been studied extensively for its potential benefits beyond epilepsy, including weight loss, improved neurological functioning, increased mental clarity, and sustained all-day energy (8, 7).

In recent years, the ketogenic diet has become increasingly popular for weight loss and general health, with the global market size projected to reach USD 4.74 billion by 2028 at a compound annual growth rate (CAGR) of 7.7% (9). The diet's popularity is driven by growing awareness of its health benefits, the increasing availability of keto products, and the rise of online platforms and social media promoting the diet (9).

3. How does the keto diet work?

3.1. Ketosis process

The process of ketosis involves the body's adaptation to a low-carbohydrate diet by shifting its primary energy source from glucose to ketones. When carbohydrates are restricted, the body's glycogen stores are depleted, and the liver begins to break down fat into molecules called ketones. These ketones are then used by the brain and other organs for energy (10, 3, 2).

3.2. The role of fats, protein, and carbohydrates

The role of fats, protein, and carbohydrates in the keto diet is crucial. Fats are the primary source of energy in the diet, making up approximately 55% to 60% of the daily caloric intake. Protein intake is moderate, typically ranging from 30% to 35% of the daily caloric intake. Carbohydrates are significantly reduced, typically limited to 5% to 10% of the daily caloric intake (10, 3, 2).

3.3. Effect on insulin and blood sugar
The keto diet works by significantly reducing carbohydrate intake, which triggers a series of metabolic changes. When carbohydrates are restricted, insulin secretion decreases, leading to an increase in glycogenolysis, gluconeogenesis, and lipolysis. This process results in the enhanced production of free fatty acids, which are converted to acetyl-CoA through beta-oxidation. This process leads to the production of ketone bodies (acetoacetate, acetone, and 3-β-hydroxybutyrate) that provide an alternative energy source for various tissues (11, 12, 10).
The effect on insulin and blood sugar is significant. Insulin secretion is low due to feedback from blood glucose levels, leading to a decrease in the stimulation of glucose uptake by cells. This results in a decrease in blood glucose levels, which is beneficial for individuals with type 2 diabetes (13, 14). The keto diet has been shown to be effective in managing blood sugar levels and promoting weight loss in individuals with diabetes (13, 14).

3.4. Effects on energy sources in the body

The effects on energy sources in the body are also significant. The keto diet induces a metabolic state where the body uses fat as its primary source of energy instead of carbohydrates. This is achieved by the production of ketone bodies, which are used by the brain and other organs for energy (11, 12, 10). The body's ability to use ketone bodies as an energy source is regulated mainly by insulin, which inhibits ketogenesis when glucose levels are high (12).

4. Benefits of the keto diet
One of the most significant advantages is its ability to aid in weight loss and fat burning (4, 2).

4.1. Lose weight and burn fat.
The keto diet promotes weight loss by drastically reducing carbohydrate intake and increasing fat consumption. This shift in macronutrient distribution triggers a metabolic state called ketosis, where the body uses fat as its primary source of energy instead of carbohydrates (4, 2). The diet's high fat content also helps to increase the production of certain hormones that aid in weight loss and improve metabolic health (4, 2).

4.2. Increased energy and mental clarity.
The keto diet is also known for its ability to increase energy levels and mental clarity. The high-fat diet provides a sustained energy source, which can help alleviate symptoms of fatigue and improve mental focus (4, 2). 

4.3. Improve blood sugar control and insulin sensitivity
The keto diet has been shown to be effective in managing blood sugar levels and improving insulin sensitivity. This is achieved by drastically reducing carbohydrate intake and increasing fat consumption, which triggers a metabolic state called ketosis. In ketosis, the body uses fat as its primary source of energy instead of glucose, resulting in improved insulin sensitivity and blood sugar control (4, 15, 2). The diet's emphasis on whole, nutrient-dense foods also helps to reduce inflammation and improve overall health signs (4,15).

4.4.  Enhance athletic performance and endurance
The keto diet is known for its potential to enhance athletic performance and endurance. The high-fat diet provides a sustained energy source, which can help athletes perform at a higher level for longer periods of time. Additionally, the diet's emphasis on whole foods and adequate hydration can help reduce the risk of dehydration and other performance-related issues (16).

4.5. Potential neuroprotective effects and improved cognitive function
The keto diet has  been found to have potential neuroprotective effects and improve cognitive function. The diet's high-fat content has been shown to increase the production of certain hormones that aid in weight loss and improve metabolic health. Additionally, the diet's emphasis on whole, nutrient-dense foods can help reduce inflammation and improve overall health signs (4, 15, 2).

4.6. Reducing the frequency of seizures in epilepsy patients.
The keto diet has been shown to be effective in managing seizures in epilepsy patients. This is achieved by drastically reducing carbohydrate intake and increasing fat consumption, which triggers a metabolic state called ketosis. In ketosis, the body uses fat as its primary source of energy instead of glucose, resulting in improved seizure control (17, 18). The diet's emphasis on whole, nutrient-dense foods also helps to reduce inflammation and improve overall health signs (17, 18).

4.7. Potential benefits for certain medical conditions.
The keto diet has also been found to reduce inflammation and improve health signs. The diet's high-fat content has been shown to increase the production of certain hormones that aid in weight loss and improve metabolic health. Additionally, the diet's emphasis on whole, nutrient-dense foods helps to reduce inflammation and improve overall health signs (19).

4.8. Reduce inflammation and improve health signs.
The keto diet has also been found to have potential benefits for specific medical conditions. For instance, it has been shown to help manage chronic pain by reducing inflammation and promoting a healthier nervous system (19, 20). Additionally, the diet has been linked to improved cognitive function and a reduced risk of neurodegenerative diseases such as Alzheimer's and Parkinson's (19).

5. Potential risks and side effects
The keto diet has been shown to have many risks and potential side effects, especially during the initial adaptation period and in the long term. Here are some of the most important risks and side effects:

5.1 Keto flu” and the initial adaptation period
The initial adaptation period to a keto diet can be challenging, and many people experience symptoms such as fatigue, headaches, and nausea. This is often referred to as the "keto flu." The keto flu is caused by the body's adaptation to a new source of energy as it transitions from relying on glucose to relying on ketones (21, 22, 23).
The keto flu can be managed by staying hydrated, taking electrolyte supplements, and gradually introducing the diet. It is essential to consult with a healthcare professional before starting a keto diet, especially if you have any underlying health conditions (21, 22, 23).

5.2. Dehydration and electrolyte imbalance
Dehydration and electrolyte imbalances are common side effects of a keto diet. The diet can cause an increase in urine production, leading to dehydration if not properly managed. Electrolyte imbalance can also occur due to the loss of essential minerals such as sodium, potassium, and magnesium (22, 24, 23).
To manage dehydration and electrolyte imbalance, it is essential to drink plenty of water and consume electrolyte-rich foods such as leafy greens, nuts, and seeds. Electrolyte supplements can also be taken if necessary (22, 24, 23).

5.3. Constipation, diarrhoea, and digestive problems
Constipation, diarrhoea, and digestive problems are common side effects of a keto diet. The diet can cause changes in the gut microbiome, leading to digestive issues (25, 24).
To manage digestive problems, it is essential to consume fiber-rich foods, stay hydrated, and consider taking probiotics or prebiotics. If symptoms persist, it is recommended to consult with a healthcare professional (25, 24).

5.4. Mineral deficiency and nutrient imbalance
The keto diet can lead to mineral deficiency and nutrient imbalance due to the restrictive nature of the diet. This is particularly concerning for individuals who may not be able to obtain essential nutrients from the diet alone (26, 27, 28).
The keto diet can cause a decrease in the intake of essential minerals such as magnesium, potassium, and sodium. This can lead to a range of symptoms, including muscle cramps, fatigue, and weakness (26, 27, 28). It is essential to consult with a healthcare professional before starting a keto diet, especially if you have any underlying health conditions (26, 27, 28).

5.5. Possible negative impact on heart health and kidney function
The keto diet has been linked to a possible negative impact on heart health and kidney function. The diet's high-fat content can increase the risk of heart disease by increasing LDL cholesterol levels (29, 23).
The keto diet can also cause a decrease in kidney function due to its high protein content. This can lead to a range of symptoms, including increased blood pressure, swelling, and fatigue (29, 23). It is essential to consult with a healthcare professional before starting a keto diet, especially if you have any underlying health conditions (29, 23).

6. Start following the keto diet
Starting the keto diet requires a solid understanding. To get you started, consider the following step-by-step guide:

6.1. Understanding Macronutrients and Ketosis
The keto diet is based on the concept of macronutrients, which are carbohydrates, proteins, and fats. The diet aims to put your body into a state called ketosis, where it burns fat for energy instead of carbohydrates (29, 30).
To achieve ketosis, the diet requires a specific ratio of macronutrients. The typical ratio is 70–75% fats, 5% carbohydrates, and 20–25% proteins (29, 30). This ratio is crucial to ensuring that your body is burning fat for energy and not relying on glucose from carbohydrates (29, 30).

6. 2. Calculate your macros
Calculating your macros is a crucial step in starting the keto diet. You need to determine how much of each macronutrient you should consume daily to achieve ketosis (29,  30).
There are various keto calculators available online that can help you calculate your macros. These calculators take into account your age, weight, height, activity level, and other factors to provide you with a personalised macronutrient ratio (29, 30).

6.3. Foods to eat and avoid on the keto diet

The keto diet is based on the concept of macronutrients, which are carbohydrates, proteins, and fats. The diet aims to put your body into a state called ketosis, where it burns fat for energy instead of carbohydrates (31, 32).

To achieve ketosis, the diet requires a specific ratio of macronutrients. The typical ratio is 70–75% fats, 5% carbohydrates, and 20–25% proteins (31, 32). This ratio is crucial to ensuring that your body is burning fat for energy and not relying on glucose from carbohydrates (31, 32). 

Foods to eat on the keto diet include:
Meat and poultry
Fatty seafood
Oils and fats
Dairy and eggs
Low-carb vegetables
Nuts and seeds
Berries
Beverages like black coffee and tea

Foods to avoid on the keto diet include:
Grains
• Starchy vegetables
• High-sugar fruits
• Sweetened yoghourt
• Juices
• Honey, syrup, or sugar in any form
• Chips and crackers
• Baked goods
• Processed foods
•Desserts
Most fruits
• Processed meats
• Canned soups
• Boxed foods
• Prepackaged meals
• Foods containing artificial ingredients
• Sweetened and caloric beverages

6.4. Meal planning and preparing keto-friendly recipes

Meal planning and preparing keto-friendly recipes are crucial to ensuring you're getting the right balance of macronutrients. Here are some tips to help you plan and prepare keto-friendly meals (32, 33):
• Plan your meals around healthy fats, grass-fed meats, non-starchy vegetables, and fat-based fruit (avocado).
• Choose recipes that are high in fat and low in carbohydrates.
• Use keto-friendly ingredients like coconut oil, olive oil, and avocado oil.
• Prepare meals in advance to save time and ensure you're sticking to your keto diet.

7. How to implement the keto diet 

7.1. Setting goals and monitoring progress

Before starting the keto diet, it is important to set realistic goals and monitor your progress to stay motivated. This can include tracking your weight, body measurements, or even taking before-and-after photos to visualise changes (34). 

7.2. Choose healthy fats and protein sources

The ketogenic diet is a low-carb, moderate-protein, and high-fat eating plan. When choosing fats, opt for healthy options such as olive oil, avocado oil, nuts, seeds, and fatty fish like salmon and mackerel. For protein, include a variety of unprocessed or grass-fed meats, seafood, and eggs (35, 3).

7.3 Manage carbohydrate intake

Keep your daily carbohydrate intake between 20 and 50 grams, choosing non-starchy and fibrous vegetables like broccoli, spinach, and cauliflower.Avoid starchy and high-carb foods like grains, potatoes, and sugar (35).

7.4. Stay hydrated and manage electrolytes

Staying hydrated is crucial on the keto diet, especially during the initial transition phase. Drink plenty of water and consider adding electrolytes like salt to your meals to prevent the "keto flu," characterised by symptoms like brain fog, drowsiness, and headaches (35).

7.5. Food supplements and potential additives

While not necessary, some supplements can be beneficial on the keto diet. These include MCT oil, minerals, caffeine, exogenous ketones, creatine, and whey protein (3).

7.6. Overcoming the Keto Flu and Side Effects

The "keto flu" is a common side effect during the first week of the keto diet, caused by your body's transition from burning glucose to fat. Symptoms include fatigue, brain fog, nausea, and digestive issues. To alleviate these symptoms, stay hydrated, increase electrolytes, and get plenty of rest (35).

7.7. Incorporate exercise into your keto lifestyle

Exercise is an important component of the keto lifestyle. Aim for a combination of strength training and cardio exercises, such as weight lifting, running, or high-intensity interval training (HIIT) (34).

8. Who should avoid the keto diet?

8.1. People with specific health conditions
The keto diet may not be suitable for individuals with specific medical conditions, including kidney disease, liver disease, gallbladder issues, adrenal fatigue, and hypothyroidism. Always consult a healthcare professional before starting the keto diet, especially if you have any health concerns (36, 37, 38, 39, 35).

8.2. People who have experienced eating disorders in the past
Individuals with an active eating disorder or a history of disordered eating patterns should avoid restrictive diets like keto, as they may trigger unhealthy patterns and negatively impact their overall health (34, 36).

8.3. People with kidney or liver problems
The keto diet may put extra strain on the kidneys and liver due to the increased intake of protein and fat. If you have existing kidney or liver problems, it is recommended to consult a healthcare professional before starting the keto diet (38).

8.4. Pregnant or breastfeeding women
Pregnant and breastfeeding women have higher nutritional needs and require a well-balanced diet. The keto diet may not provide sufficient nutrients and could be restrictive, potentially impacting the health of both mother and child (36, 39).

8.5. Individuals with type 1 diabetes
The keto diet can be dangerous for individuals with type 1 diabetes, as it may increase the risk of diabetic ketoacidosis, a life-threatening condition. It is crucial for individuals with type 1 diabetes to consult their healthcare team before considering the keto diet (38).

9. Keto-Friendly Recipes and Meal Ideas

9.1. Breakfast recipes 

• Veggie and egg muffins with tomatoes (40).
• Egg, tomato, basil, and spinach omelette (40).
• Sugar-free Greek yogurt with peanut butter, cocoa powder, and berries (40).
• Chia pudding with coconut and blackberries (40).
• Cream cheese pancakes with blueberries (40).

9.2. Lunch and dinner recipes

• Chicken salad with olive oil, feta cheese, olives, and a side salad (40).
• Salmon with asparagus cooked in butter (40).
• Cheese-shell tacos with salsa (40).
• Pork chops with Parmesan cheese, broccoli, and salad (40).
• Chicken stuffed with pesto and cream cheese, served with grilled zucchini (40).
• White fish cooked in olive oil with kale and toasted pine nuts (40).
• Keto beef bowls with ground beef and cauliflower rice (41).
• Chicken bacon ranch casserole (41).

9.3. Snacks and sweets

• Jicama (a low-carb root vegetable) (35).
• Nuts and seeds (35, 42).
• Hard-boiled or deviled eggs (35).
• Keto-friendly snack bars (35).
• Full-fat Greek yogurt with nut butter and cocoa powder (35).
• Bell peppers with guacamole (35).
• Strawberries and cottage cheese (35).

9.4. Sample meal plans for different calorie intakes

For a 1,500-calorie keto meal plan (40):

• Breakfast: veggie and egg muffins with tomatoes
• Lunch: Chicken salad with olive oil and feta cheese
• Dinner: Salmon with asparagus and butter

For a 1,200-calorie keto meal plan (40):

• Breakfast: egg, tomato, basil, and spinach omelette
• Lunch: almond milk, peanut butter, spinach, cocoa powder, and stevia milkshake
• Dinner: cheese-shell tacos with salsa  

10. Tips for eating out and travelling on the keto diet

Eating out and travelling on a keto diet can be challenging, but with the right strategies and snacks, it's definitely possible to maintain your diet while on the go. Here are some tips to help you navigate between restaurants and menus, packable keto snacks for travel, and keto-friendly options at fast food chains.

10.1. Navigate between restaurants and menus

When eating out, it's crucial to be mindful of the ingredients and portion sizes to ensure you're staying within your keto diet guidelines. Here are some tips to help you navigate menus (41 ,42, 43):

Read the menu carefully: Pay attention to the ingredients and descriptions of each dish to identify potential keto-friendly options.

Ask questions: Don't hesitate to ask your server about ingredients, portion sizes, and cooking methods to ensure your meal aligns with your dietary needs.

Look for keto-friendly keywords: Identify dishes that contain keywords like "grilled," "baked," "roasted," or "low-carb" to increase the chances of finding a keto-friendly option.

Consider ordering from the appetiser or side dish menu: These options often have fewer carbohydrates and can be a great way to add some variety to your meal without compromising your diet.

10.2. Travel-Friendly Packable Keto Snacks

Having keto-friendly snacks on hand can be a lifesaver when you're travelling or on the go. Here are some packable keto snacks that are easy to prepare and transport  (42, 43, 44):

Nuts and seeds: almonds, walnuts, pumpkin seeds, and chia seeds are all keto-friendly and can be easily packed in a bag or container.

Dried fruits and vegetables: Dried fruits like apricots, prunes, and dates are keto-friendly, as are dried vegetables like broccoli and cauliflower.

Cheese and meat: Packaged cheese sticks, beef or turkey jerky, and hard-boiled eggs are all easy to pack and can be a convenient source of protein and fat.

Low-carb granola: Look for low-carb granola recipes that use nuts and seeds as the base, or purchase a low-carb granola from a reputable brand.

10.3. Keto-friendly options at fast food chains

While it's generally recommended to avoid fast food when on a keto diet, there are some options available at popular fast food chains. Here are some keto-friendly options to consider (41, 42, 43):

Burger King: Order a lettuce-wrapped burger or a grilled chicken sandwich without the bun.

Chick-fil-A: Choose a grilled chicken sandwich without the bun or a side salad with a low-carb dressing.

In-N-Out: Opt for a protein-style burger without the bun or a side salad with a low-carb dressing.

Panera Bread: Select a salad with a low-carb dressing or a bowl with a protein source like chicken or turkey.

11.Commonly Asked Questions Concerning the Keto Diet

1. Can I lose weight on the keto diet?
Yes, the keto diet has been shown to be effective for weight loss, with studies indicating that patients consistently lost more weight on the ketogenic diet than on a low-fat diet (45, 46).

2. How does weight loss with keto work? 

Keto weight loss involves shedding water weight due to glycogen depletion in the initial stages, followed by steady fat loss as the body adapts to using fat as its primary energy source (32, 45,).

3. How much weight can you lose on keto?
Individuals on a keto diet can expect to lose an average of 10–12 pounds in their first month, with a drop of up to 10 pounds during the initial rapid water loss phase. As the diet progresses, losses range from 1-2 pounds per week as long as a calorie deficit is maintained (32, 45).

4. How much weight can a person lose on keto on average?
The average weight loss on the keto diet is around 1-2 pounds per week (32, 45).

5. How much time does ketogenic weight loss take?
You can start seeing rapid weight loss results within two weeks on the keto diet (32, 45).

6. What should I know before starting keto? 

Before starting the keto diet, it is essential to consult with a healthcare professional, especially if you have any health concerns or are taking medications. A well-planned meal plan and regular monitoring of progress are crucial for success (45, 46).

7. What is keto-adaptation, and what does it feel like?
Keto-adaptation is the process of your body adapting to using fat as its primary energy source. It can take anywhere between 2 and 7 days to get into ketosis, and during this time, you may experience flu-like symptoms known as the "keto flu," which include headaches, fatigue, and nausea (45).

8. How long does it take to become keto-adapted?
It can take anywhere between 2 and 7 days to get into ketosis, depending on individual factors such as diet, exercise, and health status (45).

9. What does being in a state of ketosis mean?
Being in a state of ketosis means that your body is primarily burning fat for fuel instead of carbohydrates (3).

10.What may put me out of ketosis, and how can I get back into it quickly?
Factors that may put you out of ketosis include consuming too many carbohydrates or not maintaining a calorie deficit. To get back into ketosis quickly, focus on reducing carbohydrate intake and increasing fat consumption (32, 45).

11. Should I track my ketone levels?
Tracking ketone levels can be helpful in monitoring your progress and ensuring you are in ketosis. However, it is not necessary for everyone, and individual results may vary (32, 45).

Conclusion

Embarking on the ketogenic journey is akin to charting a course through uncharted waters—challenging yet profoundly rewarding. This guide has served as your compass, navigating through the benefits and potential pitfalls, the practicalities of meal planning, and the nuances of sustaining a keto-adapted life. Whether you're seeking to shed pounds, bolster your cognitive faculties, or manage medical conditions, the keto diet offers a versatile and potent solution. As we conclude, remember that the keto diet is not a one-size-fits-all remedy; it is a personalised voyage of nutritional discovery, one that requires mindfulness, adaptation, and a commitment to health that transcends conventional eating patterns. Embrace the journey, for it holds the key to unlocking a healthier, more vibrant self.

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