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Learn how to start eating a ketogenic diet with this beginners guide to keto. In this guide, you’ll learn about the different types of macros, the foods to eat, how to cut the carbs from your diet and how to tell if you are in ketosis.
What Is A Ketogenic Diet?
A ketogenic diet consists of a food intake that is high in fats, contains moderate protein content, and very low carbohydrate content. The dietary macronutrients are divided into approximately 55% to 60% fat, 30% to 35% protein intake, and 5% to 10% carbohydrates. Specifically, in a 2000 kcal per day diet, carbohydrates amount up to 20 to 50 g per day. (Masood, 2022).
In the Standard American Diet, refined carbohydrates (such sugar and flour) are the primary source of energy in the body. It is estimated to comprise around 55% of the typical Standard American Diet (200 to 350g/day). Excess consumption of low-quality carbohydrates may displace and leave no room in the diet for healthier foods like nuts, unprocessed grains, fruits, and vegetables.
These carbohydrates are absorbed into the body in the form of sugar. This triggers an insulin response which helps the sugar make it’s final journey into the cell where it is burned for fuel.
The key take-home message is that insulin, not only transport sugar into the cells, but it stimulates the fat cells (adipose tissue) to store any excess energy by the production of more fat seen around the abdomen in the form of the expanding waist-line.
What is Nutritional Ketosis?
The aim ketogenic diets is to reduce the insulin response, and to switch the body from using over from carbohydrate burning to burning fat as the primary energy source. Fat is broken down into ketone bodies as a replacement from sugar. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained.
This metabolic state is referred to as “nutritional ketosis.” As long as the body is deprived of carbohydrates, the metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH.
The keto diet greatly differs from ketoacidosis, a life-threatening condition where the body produce ketones in extremely larger concentrations, altering blood pH to an acidotic state.
Research suggests, people on a standard ketogenic diet initially lose weight rapidly by up to 5kg in 2 weeks or less. This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by fat loss.
Interestingly with this keto diet plan, lean body muscle is largely spared. As a nutritional ketosis state sustains, hunger pangs subside, and an overall reduction in caloric intake can help with further weight loss.
Is A Keto Diet Helpful for Hormone Health And Menopause?
Menopause can lead to an imbalance of hormones, we call this dysregulation. It impacts estrogen and progesterone. These hormone changes have an impact on insulin, and cortisol.
Additionally symptoms of perimenopause and menopause such as night sweats, frequent urination and night and insomnia can impact metabolic hormones further. These hormonal changes contribute to a reduction in insulin sensitivity, slower metabolism of glucose and fatty acids.
It also impacts hormones of fullness and hunger - leading to food cravings and weight gain.
While keto diet does not directly regulate your ovarian hormones: estrogen and progesterone, it can play a role in regulating the balance of certain hormones that influence appetite regulation and insulin production.
Some women find it too restrictve to go full-keto, but reducing your intake of refined carbs and foods with a high glycaemic index, will reduce the work of your pancreas and help support your insulin and metabolism.
Beginners Guide To Keto
1. Limit your carbohydrate intake to 50 grams or less per day as part of your food intake.
2. Focus on eating whole foods with good quality mono and polyunsaturated fats such as avocados, olives, olive oil, needs, and nuts.
3. Make sure to eat adequate protein each day, especially if you are exercising regularly.
4. Drink plenty of water, avoid sugary beverages an focus on high fat diet.
5. Test your ketone levels regularly to make sure you are in ketosis.
6. Consult with a doctor or registered dietitian before starting any new keto eating plan.
By following these quick tips, you can successfully follow a ketogenic diet and reap all the benefits that come with it!
Ketogenic Diet Benefits
Some of the benefits of keto diets are as follows:
Weight loss, improved BMI and abdominal circumference
Improved mental clarity
Decreased inflammation
Improved blood sugar levels with Type 2 diabetes
Reduced symptoms in neurological disorders such as epilepsy
Hypertension control (high blood pressure)
Improved cardiovascular health.
Common Keto Mistakes
Inadequate fat for keto diet
One of the most common keto mistakes when following a ketogenic diet is not getting enough fat. The goal of a ketogenic diet is to train your body through eating a high fat diet to burn fat for fuel, it’s important to make sure you’re consuming enough healthy fats each day such as:
fatty fish,
avocado,
nuts and nut butters,
coconut and extra virgin olive oil.
Another consideration to make in your keto meal plans is when you eat too much protein. The main reason is that the body can convert high protein foods into sugar, which increases insulin secretion and in turn, slows the transition into ketosis (Melkonian, 2022).
Failing to Monitor ketones
Additionally, another common keto mistake people make is not monitoring their ketone levels.
Ketone levels can be measured through urine, breath, or blood tests. It helps you to understand which foods are helping your to stay in nutritional ketosis and which foods bring you out of it.
Inadequate Plant Food/Fiber Consumption
Some people who eat a keto diet mostly focus on animal products to get their protein and fats, and their diet becomes devoid of fiber. If this is the case you may develop gut symptoms such as constipation and you may alter your microbiome in a negative way.
Drawbacks Of A Ketogenic Diet
There are a few potential drawbacks to following a ketogenic diet, such as the need to monitor your low carb high fat intake meticulously. The symptoms will improve after 2 to 3 days and the constipation will improve with adequate dietary fiber from plant foods or supplementary fiber.
These side effects typically go away once your body adjusts to burning fat for fuel. Overall, the ketogenic diet, when looking at the health benefits vs the drawback, for most people it is a safe and effective way to lose weight, improve mental clarity, and decrease inflammation.
Also for some people the dietary restrictions needed to sustain ketosis may lead to it being hard to sustain in the long term.
Long-Term Effects Of Keto Diet
At present there is a lack of long term evidence regarding the long-term cardiovascular implications of a keto diet. However some studies have made the following findings:
There can be an increase in LDL cholesterol, which is associated with development of accelerated hardening of arteries and increased risks of heart disease (Bueno, 2013).
Other studies have mentioned “favourable” lipid profile associated with the ketogenic diet, which included an increase in favorable HDL which is associated with removal of cholesterol deposits
Possible low sustainability of long-term weight loss (Stern, 2004).
Research suggests, symptomatic relief from polycystic ovary syndrome.
Short Term Side Effects Of Keto Diet
There are a number of common short term side effects when converting to a keto diet. These include:
Dehydration
Hypoglycemia
Lethargy (Keto flu)
Halitosis (bad breath).
Gastrointestinal side effects such as nausea, vomiting, diarrhea, and constipation.
To manage this transition and to reduce the effects of the keto flu symptoms, start by staying hydrated, replacing electrolytes, getting plenty of sleep, avoiding strenuous activities, and eating enough fats and slowly reducing your carb intake over time.
Who Should Not Do The Keto Diet?
If you have any of the following conditions you should really seek medical advice regarding a ketogenic diet. Anyone with these conditions who utilize a keto diet needs close medical supervision to avoid serious complications.
Pregnancy and lactation;
History of mental disorders and behavioral problems, abuse of alcohol and other substances;
Hepatic or renal failure;
Type 1 Diabetes;
Porphyria, unstable angina, recent myocardial infarction.
How do you follow a ketogenic diet?
If you want to follow a ketogenic diet, the first step is to limit your carbohydrate intake to 50 grams or less per day. Focus on fruit and vegetables that are naturally low in sugars such as;
mushrooms
leafy greens such as spinach, kale and swiss chard
brassicas such as cauliflower, broccoli,
zucchini/courgette, asparagus
garlic, onions, shallots
lettuce
berries
Next, focus on eating healthy fats, such as avocados, olive oil, and nuts.
Make sure to get enough protein each day, especially if you are exercising regularly.
Drink plenty of water and avoid sugary beverages.
Food list for keto diet
There are a variety of foods that you can eat on a keto diet, including:
Meat: Beef, pork, lamb, chicken
Fatty fish: Salmon, tuna, trout, and mackerel
Eggs: Whole eggs with the yolk are best.
Low carb vegetables/non starchy vegetables: Spinach, broccoli, cauliflower
Healthy oils: Olive oil, coconut oil, avocado oil
Nuts and seeds: Almonds, pistachios, walnuts, flaxseed, chia seeds, chia seeds
Butter and cream: Grass-fed butter and heavy cream
Dairy: Cheese, unsweetened yogurt
Beverages: Water, coffee, tea
Avocados: whole avocados, or freshly made guacamole.
Reducing the net carb intake can be done without sacrificing the nutritional benefit. Given the right menu, low carb diets can be a sustainable diet. The drawback is that under a Standard American.
Foods to avoid on a ketogenic diet
The main food group to avoid in your keto journey are those high in carbs, especially those that are highly processed foods. These foods increase insulin levels, increase the number of highs in your blood sugar and do not help you to lose weight.
There are a few food groups that are not allowed on a keto diet, including:
Grains or starches: Wheat, rice, oats, etc.
Fruit and fruit juice: All fruit except for small portions of berries.
Starchy vegetables: Potatoes, sweet potatoes, carrots, etc.
Sugary foods: Honey, agave, maple syrup, etc.
Unhealthy fats: Margarine, vegetable oil, shortening, etc.
Alcohol: Beer, wine, spirits, etc.
Junk foods: processed foods, and foods with added sugar.
Sugar -free diet foods: Any food that uses artificial sweeteners, including Stevia
Beans or legumes: Peas, kidney beans , lentils, chickpeas
Condiments or sauces: Low fat mayonnaise, salad dressing and condiments have high levels of added sugar.
These lists of foods are broad, however the goal of being successful on a keto diet is to eliminate or reduce the carb intake.
How long should you stay on a ketogenic diet?
There is no one-size-fits-all answer to this question. Some people may choose to stay on a ketogenic diet for months or even years, while others may only follow the keto diet for a few weeks. It ultimately depends on how you tolerate the diet, your keto journey and health needs.
Consult with your doctor or registered dietitian to create the right keto diet regime.
How do you know if you’re in ketosis?
There are a few ways to measure nutritional ketosis, including:
Urine test strips: These test for the presence of ketones in your urine.
Blood test: This measures the level of ketones in your blood.
Breath test: This measures the level of ketones in your breath.
Additionally some people may experience symptoms of ketosis, such as:
Increased energy levels
Decreased hunger or appetite
Increased thirst and dry mouth
Frequent urination
Image from dietdoctor.com
Above is some ketone values for a targeted ketogenic diet to consider:
Anything below 0.5mmol/L is not considered ketosis
Nutritional ketosis is achieved when ketones reach 0.5 -3mmol/L
Over 3mmol/L is higher than necessary and does not confer additional benefits.
Over 8-10mmol/L means that something has gone wrong. The most common cause would be Type 1 Diabetes and immediate medical review is required. Symptoms of type I diabetes include: feeling very unwell, nausea and vomiting, abdominal pain, confusion
Keto And Gut Bacteria
The high fat, high sugar Western diet negatively impacts gut health (Zinöcker, 2018).
The ketogenic diet has complex effects on the composition and diversity of the gut microbiome (Paoli 2019). There are a number of outstanding issues as to the effects of the ketogenic diet on the gut microbiome including:
A diet high in saturated fats has a negative effect on the gut microbiome, so what is the optimal ratio of polyunsaturated and monounsaturated fats to saturated fats for people following a keto diet?
Using artificial sweeteners in keto diet is controversial (seen as cheating) and these non-nutritive sweeteners have been shown to disrupt the structure and function of gut microbiota and gut mucosa.
Are fermented foods sufficient to provide prebiotics, probiotics and maintain a balanced gut microbiome for people eating a probiotic diet?
How does plant versus animal protein modify microbiome? This appears to alter the abundance and composition of the gut microbiome but further research is needed in this area.
Tips for a healthy gut microbiome while on keto diet
Introduce the use of whey and plant proteins (i.e. pea protein);
Reduce the intake of animal protein;
Implement fermented food and beverages (yoghurt, water and milk kefir, kimchi, fermented vegetables);
Introduce prebiotics and specific probiotics (if needed);
Reduce omega 3 to omega 6 fatty acids ratio (increase omega 3 and decrease omega 6);
Introduce an accurate quantity and quality of unsaturated quality fats;
Avoid artificial sweeteners (such as stevia) and processed foods;
Test your microbiome if needed (analysis of 16S rRNA to identify biodiversity and richness). A pre keto sample would be helpful to compare with.
Frequently asked Questions
What is the difference between a keto diet and low carb diets?
A keto diet is a specific type of low carb diet (called a very low carbohydrate ketogenic diet or VLCKD in the medical literature) that is focused on training your body to burn fat for fuel.
Research suggests, keto diets improves metabolic health, gives better blood sugar control and helps in weight loss
The main difference between a keto diet and a traditional low carb diet is the macronutrient ratios. A typical keto diet consists of 70-80% fat, 10-20% protein, and 5-10% carbs, while a traditional low carb diet consists of 50-60% carbs, 30-40% protein, and 10-20% fat.
A low carb diet is similar to a keto diet in that it eliminates refined carbs such as sugars and refined grains such as flour and breakfast cereals. A low carb diet attains it’s carbohydrates from fruit and vegetables and is much less restrictive in terms of which fruit and vegetables can be consumed.
Hopefully this beginners guide to keto has been useful as you start your low-carb or keto journey and helps you to cut the carbs.
Further information about nutrition:
References
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de Wit N, Derrien M, Bosch-Vermeulen H, et al. Saturated fat stimulates obesity and hepatic steatosis and affects gut microbiota composition by an enhanced overflow of dietary fat to the distal intestine. Am J Physiol Gastrointest Liver Physiol. 2012 Sep 1;303(5):G589-99.
Dhamija R, Eckert S, Wirrell E. Ketogenic diet. Can J Neurol Sci. 2013;40(2):158-167.
Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Melkonian EA, Asuka E, Schury MP. Physiology, Gluconeogenesis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
Muscogiuri G, Barrea L, Laudisio D, et al. The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide. J Transl Med. 2019 Oct 29;17(1):356.
Nettleton J.E., Reimer R.A., Shearer J. Reshaping the gut microbiota: Impact of low calorie sweeteners and the link to insulin resistance? Physiol. Behav. 2016;164:488–493.
Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140(10):778-785.
Zinöcker MK, Lindseth IA. The Western Diet-Microbiome-Host Interaction and Its Role in Metabolic Disease. Nutrients. 2018 Mar 17;10(3):365