What Is the Ketogenic Diet?
The ketogenic (keto) diet was originally developed in 1923 by a doctor at the Mayo Clinic to help control seizures in children with epilepsy. These days, it is used for controlling or reversing symptoms of a myriad of chronic health conditions such as autism, cancer, diabetes, neurological conditions, autoimmune conditions and more. (See Benefits of the Ketogenic Diet, below). We recommend working with your healthcare practitioner for implementing this diet for your child.
It is a high-fat, low-carbohydrate diet that mimics the effects of fasting because the body stops burning glucose and begins using ketones from stored fat for fuel. This is a state known as ketosis, meaning that it is burning the stabler fuel source of ketones rather than glucose.
While many people say that they are following a ketogenic diet, in truth they are not unless about 60-75% of their calories come from fat and about 5-10% of daily calories come from carbohydrates, which usually equates to 30 grams of carbohydrates or less per day. Most people keep track of what are called “net carbs”, or the net amount of carbohydrates, which equals the total amount of carbohydrates in grams minus the amounts of fiber and sugar alcohol in grams. Eating in this way usually causes the body to be in a state of ketosis.
A common misconception about the keto diet is that it is a high-protein diet; this is not the case. Protein consumption is similar to other diets where protein makes up about 20-35% of calories.
To do this diet properly, you’ll need to weigh and keep track of your foods in a spreadsheet or app that tracks macronutrient (fat, carbohydrate and protein) percentages. To make sure that you’re in ketosis, you’ll need to purchase a home ketone monitor and measure ketone levels a few times per day. (See What Are Optimal Levels of Ketones, below, for target ketone ranges.) It’s also a good idea to measure and track blood glucose levels at the same time so that you can see how these levels correlate to each other.
This diet can be difficult to implement without continuously measuring, weighing and tracking foods to keep carbohydrate levels low enough to maintain ketosis. Macronutrient levels of fat and carbohydrate must be very specific and consistently maintained to reap benefits.
Variations of the ketogenic diet are the Modified Atkins Diet (MAD), MCT (medium chain triglyceride) diet and LGIT (low glycemic index treatment) diet. These versions typically don’t require as much strict adherence to weighing and tracking of the macronutrients of fats, carbohydrates and protein.
What Are Optimal Levels of Ketones?
Ketones can be measured in urine, breath and blood. Blood levels are accurately and easily assessed with a home ketone monitor, which is similar to a home glucose monitor in that a finger is pricked for blood and the blood is placed on a test strip which is inserted into a monitor.
Ketone readings of 0.5 – 3.0 mmol/L are what most clinicians agree are optimal levels of ketones to be in light-to-moderate ketosis. For those with conditions such as epilepsy, cancer, or endocrine and metabolic disorders, therapeutic levels between 3.0 – 5.0 mmol/L may be more beneficial. Fasting, aerobic exercise and higher-fat diets often lead to higher levels of ketones.
Type 1 diabetics should use caution when following a keto diet, as ketone levels of about 9.0 mmol/L combined with a blood glucose level above 240 mg/dl can lead to the serious condition of ketoacidosis. Type 1 diabetics should be supervised by a medical practitioner if they choose to follow this diet.
Benefits of the Ketogenic Diet
Thousands of research studies have documented the potential benefits of implementing a ketogenic diet. (See Sources & References, below). Some of these benefits include:
- Reduction of seizures
- Control of blood sugar (glycemic control)
- Reduction of insulin sensitivity
- Reduction of inflammation
- Enhancement of mitochondrial function
- Improvement of liver function
- Control of hormone levels
- Improvement of DNA methylation
- Increase of beneficial microbiota
- Decrease of gut pathogens by denying them of their preferred food sources
- Keeping glutamate levels in check because it controls low blood sugar effects
- Stabilization of moods
Because of these many benefits, the ketogenic diet has been used to control or reverse symptoms of the following conditions (see Sources & References, below):
- Alzheimer’s and other dementias
- Parkinson’s
- Cancer
- Multiple sclerosis
- Autism
- ADHD
Potential Side Effects
Therapeutic benefits of the ketogenic diet must outweigh known risks. Some potential side effects of this diet include dehydration, ketoacidosis (especially in type 1 diabetics), hypoglycemia and gastrointestinal distress. Work with your healthcare practitioner to determine if this diet is helpful for your child.
What’s Avoided and Allowed in the Ketogenic Diet
While no foods are technically off-limits, keto-diet followers will find it extremely difficult to stay in a state of ketosis if they don’t limit their carbohydrate intake. Higher-carbohydrate foods will usually “kick you out of ketosis”. Maintaining ketosis is easiest with the elimination of all grains, legumes, and starchy foods including corn, rice, potatoes, sweet potatoes and starchy vegetables. Most sweeteners are also removed.
What Is Dirty Keto?
Dirty keto uses processed foods to fulfill ketogenic macronutrient requirements. For example, you’ll often see ingredients such as cream cheese or artificial sweeteners in recipes. We urge you to steer clear of such foods, as they can add to the total load of stressors on the body. We recommend that you avoid foods that contain:
- Refined carbohydrates
- Processed foods
- Vegetable oils
- Trans fats
- Preservatives
- Artificial colors
- Artificial and natural flavors
- Other additives such as lecithin or carrageenan
What Is Clean Keto?
Clean keto foods have significantly higher amounts of vitamins, minerals, antioxidants, polyphenols and other phytonutrients than processed foods because these are foods that were raised/grown as they naturally do. There is a focus on organic, grass-fed and wild-caught foods, which means that foods are grown without pesticides, antibiotics or hormones. Clean keto foods include:
- Animal fats
- Coconut oil
- Avocado oil
- Olive oil
- Palm oil
- Grass-fed meats
- Wild-caught seafood
- Pasture-raised organic eggs and foul
- Coconut milk
- Fermented foods
- All non-starchy vegetables
- Fruit (in very limited amounts); berries are best
- Nuts and seeds (in very limited amounts)
- Single-ingredient spices and herbs
- Apple cider vinegar
- Coconut vinegar
Learn more about eating a clean diet here.
Implementation Tips for the Ketogenic Diet
The following tips can add to your success in switching to a ketogenic diet from a Standard American Diet (SAD):
- Add in more protein, fat and fiber to each meal and snack to lessen cravings for sweets and carbohydrates.
- Eating sour foods like pickled foods can often stop the craving for carbohydrates.
- “Carbs beget carbs” means that if you’ve eaten a high-carbohydrate food, you’re more likely to crave more until blood sugar and ketone levels are brought back into line.
- Remember that healthy foods such as vegetables, fruits, nuts, olives and avocados contain carbohydrates. These are not foods to be eaten freely without weighing and tracking their macronutrients.
- Pecans and macadamia nuts have lower levels of carbohydrates than other nuts do.
- Add avocado slices or other healthy fats to a dish to increase the fat content.
- Explore “fat bomb” recipes. Fat bombs are high-fat desserts that are sweetened with monkfruit and/or sugar alcohols.
- Not everyone tolerates sugar alcohols well, and research indicates that it could be related to the risk of a cardiovascular event.
- Some companies sell fat bombs that are also called keto cups. These contain ingredients such as coconut, chocolate and nuts and are usually one to two grams of net carbohydrates per serving.
- Sugar alcohols can often increase blood sugar levels even though they are considered keto. If you’re looking to control blood sugar, eliminate sugar alcohols or at least track blood sugar after eating to see the response.
- Eat low-/no-carb snacks such as zero-sugar beef jerky, eggs and dill pickles when blood-sugar levels are higher than desired.
- Try substituting foods such as spiralized zucchini and cauliflower rice for grain-based noodles and rice.
- Try out new recipes with your family to find foods that they like and will eat before you completely pull the plug on the processed foods you’ve previously eaten.
- Add in MCT (Medium Chain Triglycerides) oil and/or exogenous ketones to boost ketone levels. Go easy on the MCT oil to begin with, as it can cause loose stools.
- Not all foods sold as “keto” or “keto-friendly” are actually keto. Be sure to read the label to see how the macronutrients fit in to your daily limits.
- Full-fat coconut milk is your friend! A one-third cup serving has 14 grams of fat and two grams of carbohydrates. It is naturally sweet and contains about 54% MCT oils.
- Add in fattier sauces such as hollandaise, mayonnaise (get the kind not made with vegetable oil) and pesto.
- Plain, Dijon and German mustards have zero calories and zero carbohydrates per serving. Read the nutritional label to make sure there are no added sweeteners.
About Maria Rickert Hong CHHC
Maria Rickert Hong is a Co-Founder of, and the Education and Media Director for, Documenting Hope.
She is a former sell-side Wall Street equity research analyst who covered the oil services sector at Salomon Smith Barney and Lehman Brothers under Institutional Investor #1 ranked analysts.
Later, she covered the gaming, lodging & leisure sector at Jefferies & Co. and Calyon Securities. She quit working on Wall Street when her first son was born.
Prior to working on Wall Street, she was a marketing specialist for Halliburton in New Orleans, where she also received her MBA in Finance & Strategy from Tulane University.
She is the author of the bestselling book Almost Autism: Recovering Children from Sensory Processing Disorder and the co-author of Brain Under Attack: A Resource for Parents and Caregivers of Children with PANS, PANDAS, and Autoimmune Encephalitis. She is a co-author of Reversal of Autism Symptoms among Dizygotic Twins through a Personalized Lifestyle and Environmental Modification Approach: A Case Report and Review of the Literature, J. Pers. Med. 2024, 14(6), 641.
Maria is also a Certified Holistic Health Counselor. Her work can be found on DocumentingHope.com, Healing.DocumentingHope.com, Conference.DocumentingHope.com and MariaRickertHong.com
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Resources
Articles
Mayers, Dara. The nutrition advice given to most diabetics might be killing them. U.S. News Health & Medicine, July 2003.
Totty, Patrick. ADA’s Latest Low-Carb Stance Is Severely Flawed, Says Longtime Low-Carb Advocate Dr. Bernstein. Diabetes Health, 8 February 2008.
Books
Bernstein, Richard K. Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. Little, Brown Spark, 2011.
Jockers, David. Keto Metabolic Breakthrough: A Radical Approach to Reversing Metabolic Dysfunction, Optimizing Nutrient Timin g, and Balancing Hormones for Success on a Low-Carb Diet. Victory Belt Publishing, 2020.
Seyfriend, Thomas. Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer. Wiley, 2012.
Wahls, Terry. The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles. Avery, 2020.
Wahls, Terry. The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Avery, 2017.
Winters, Nasha. The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies. Chelsea Green Publishing, 2017.
Websites
Dr. Bernstein’s Diabetes Solution
