A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence was inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.
The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[7]
Before starting, ask yourself what is really realistic for you, Mattinson suggests. Then get your doctor’s okay. You may also work with a local registered dietitian nutritionist to limit potential nutrient deficiencies and talk about vitamin supplementation, as you won’t be eating whole grains, dairy, or fruit, and will eliminate many veggies. “A diet that eliminates entire food groups is a red flag to me. This isn’t something to take lightly or dive into headfirst with no medical supervision,” she says.

It’s stunning how often we eat out of boredom, nervousness, habit, or frustration—so often, in fact, that many of us have actually forgotten what physical hunger feels like. If you’re hankering for a specific food, it’s probably a craving, not hunger. If you’d eat anything you could get your hands on, chances are you’re truly hungry. Learn how to recognize these feelings mistaken for hunger, then find ways other than eating to express love, tame stress, and relieve boredom. But talk to your doctor if you think you’re always hungry for a medical reason. Here are 10 medical reasons you might be hungry.
After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]
There are many reasons why you might want to lose weight. If you have been significantly overweight or obese for a long time, then you might have concerns about what the extra weight could be doing to your health. Obesity increases your risk of many health problems, including diabetes, non-alcoholic fatty liver disease, gallbladder disease, and some types of cancer.[1] If you have recently gained a bit of weight, then you might just want to lose some weight to fit back into your old jeans. Whatever your reason for wanting to lose weight, there are some important strategies that you should know about.

The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy.[26][27] It is approved by national clinical guidelines in Scotland,[27] England, and Wales[26] and reimbursed by nearly all US insurance companies.[28] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][29] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[5][30]
The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals, and calcium-rich foods. In particular, the B vitamins, calcium, and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[18] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises three small meals and three small snacks:[28]
A body of research out of Pennsylvania State University finds that eating water-rich foods such as zucchini, tomatoes, and cucumbers during meals reduces your overall calorie consumption. Other water-rich foods include soups and salads. You won’t get the same benefits by just drinking your water, though (but you will get other benefits of staying hydrated). Because the body processes hunger and thirst through different mechanisms, it simply doesn’t register a sense of fullness with water (or soda, tea, coffee, or juice). Here are 15 weight loss tips doctors wish you would stop following.

The ketogenic diet is not a benign, holistic, or natural treatment for epilepsy; as with any serious medical therapy, complications may result.[28] These are generally less severe and less frequent than with anticonvulsant medication or surgery.[28] Common but easily treatable short-term side effects include constipation, low-grade acidosis, and hypoglycaemia if an initial fast is undertaken. Raised levels of lipids in the blood affect up to 60% of children[38] and cholesterol levels may increase by around 30%.[28] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and if persistent, by lowering the ketogenic ratio.[38] Supplements are necessary to counter the dietary deficiency of many micronutrients.[18]

The information you share, including that which might otherwise be Protected Health Information, to this site is by design open to the public and is not a private, secure service. You should think carefully before disclosing any personal information in any public forum. What you have written may be seen, disclosed to, or collected by third parties and may be used by others in ways we are unable to control or predict, including to contact you or otherwise be used for unauthorized or unlawful purposes. As with any public forum on any site, this information may also appear in third-party search engines like Google, MSN, Yahoo, etc. Your use of this site is governed by Harvard University and its affiliates Terms of Use located at www.health.harvard.edu/privacy-policy and may be amended from time to time.


Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
I would like to know what led you to the conclusion to recommend eating in the morning and fasting in the evening instead of the other way around. You do not link any studies here that show TRF in the morning is better than TRF in the evening. You do state “Nighttime eating is well associated with a higher risk of obesity, as well as diabetes.” but I would hazard a guess that alot people that snack into the evening have many other factors at play that could effect their risk of obesity and diabetes and are possibly not fasting at all. I have been doing TRF from 12-8pm every day for almost a year and have seen vast improvements in my health, not least of which is a loss of 70 lbs, so it seems odd to read items 3 and 4 on your 4 ways to use this information for better health. If you have evidence that supports the idea that TRF in the evening is bad then I would like to see it and perhaps change my dieting habbits.

Positive science on ketosis coupled with personal successes passed by word-of-mouth have driven more people to explore the ketogenic diet, says Volek. More recently, the keto diet hints at having a promising therapeutic role in cancer, Alzheimer’s, Parkinson’s and polycystic ovary syndrome (PCOS). Research is still early in many areas, but Volek suspects there will more definitive answers on the wider scope of the diet’s benefits within the next decade.
Blanket statement: It’s always best to check with your doctor before starting on this regimen. With that said, “the keto diet isn’t recommended for those with liver or kidney disease, or someone with a medical condition, such as a gastrointestinal issue, who can’t metabolize high amounts of dietary fat,” says Sarah Jadin, a Los-Angeles based registered dietitian and founder of Keto Consulting, LLC. If you’ve had your gallbladder removed, the keto diet may be a no-go. Women who are pregnant or breastfeeding and people with certain rare genetic disorders shouldn’t try this diet.
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You can eat twice as much pasta salad loaded with veggies like broccoli, carrots, and tomatoes for the same calories as a pasta salad sporting just mayonnaise. Same goes for stir-fries, omelets, and other veggie-friendly dishes. If you eat a 1:1 ratio of grains to veggies, the high-fiber veggies will help satisfy your hunger before you overeat the grains. Bonus: Fiber is highly beneficial for preventing constipation, which can make you look bloated.
IF makes intuitive sense. The food we eat is broken down by enzymes in our gut and eventually ends up as molecules in our bloodstream. Carbohydrates, particularly sugars and refined grains (think white flours and rice), are quickly broken down into sugar, which our cells use for energy. If our cells don’t use it all, we store it in our fat cells as, well, fat. But sugar can only enter our cells with insulin, a hormone made in the pancreas. Insulin brings sugar into the fat cells and keeps it there.

It usually takes three to four days for your body to go into ketosis because you have to use up your body's stores of glucose, i.e., sugar first, Keatley says. Any major diet change can give you some, uh, issues, and Keatley says he often sees patients who complain of IBS-like symptoms and feeling wiped out at the beginning of the diet. (The tiredness happens because you have less access to carbs, which give you quick energy, he explains.)

The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][10]
The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]
It’s the best fruit for weight loss. That means Pink Lady apples, watermelon, red grapes, and raspberries. The higher levels of nutrients called flavonoids—particularly anthocyanins, compounds that give red fruits their color—calm the action of fat-storage genes. In fact, red-bellied stone fruits like plums boast phenolic compounds that have been shown to modulate the expression of fat genes.

Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]
The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.[56]
The information you share, including that which might otherwise be Protected Health Information, to this site is by design open to the public and is not a private, secure service. You should think carefully before disclosing any personal information in any public forum. What you have written may be seen, disclosed to, or collected by third parties and may be used by others in ways we are unable to control or predict, including to contact you or otherwise be used for unauthorized or unlawful purposes. As with any public forum on any site, this information may also appear in third-party search engines like Google, MSN, Yahoo, etc. Your use of this site is governed by Harvard University and its affiliates Terms of Use located at www.health.harvard.edu/privacy-policy and may be amended from time to time.
You’re consuming less food and thus spending less money. Rather than overeating to put on 1 pound of muscle and 4 pounds of fat in a week or two, you’re aiming to eat exactly enough to put on 1 pound of muscle without adding much fat on top of it. Yeah, it’s a delicate balance, but there’s far less swing involved. You are just slowly, steadily, and consistently building muscle and strength over many months.
Why? If you have celiac disease and eat gluten, your immune system freaks out a bit. This reaction can mess with the lining of your small intestine, hampering its ability to help you absorb nutrients properly, according to the Mayo Clinic. Inflammatory bowel diseases like Crohn’s disease can also lead to unexplained weight loss due to malabsorption as well.
Avoid sweetened drinks. Drinks that are sweetened, whether artificially or naturally, will have little nutritional value and add lots of empty calories to your diet. Do not drink fruit juice or other sweetened drinks. Even natural sugars will increase your daily calorie intake and prevent weight loss. If you chose to drink juice, do not exceed 4 oz per day (1/2 cup). Instead of drinking sweetened beverages throughout your day, drink unsweetened, calorie-free beverages. Some beverages to avoid include:

The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals, and calcium-rich foods. In particular, the B vitamins, calcium, and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a multivitamin with minerals and calcium with vitamin D.[18] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises three small meals and three small snacks:[28]
The benefits above are the most common ones. But there are others that are potentially even more surprising and – at least for some people – life changing. Did you know that a keto diet can help treat high blood pressure, may result in less acne, may help control migraine, might help with certain mental health issues and could have a few other potential benefits?
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