Ketogenic Diet Guide The goal of a low carb, ketogenic diet plan is to achieve a metabolic state called ketosis. Ketosis is simply a normal metabolic process in which the body cells burn fragments of fats called ketones instead of glucose for fuel. Note of Caution You should check with your physician if you have any concerns about starting a ketogenic diet plan with pre-existing health conditions, especially if those conditions involve kidney or heart problems. People with kidney disease should definitely consult with their physician about starting a ketogenic diet. However, remember too that most classically trained doctors don't understand the effect of foods on the body, much less ketogenic diets, so you may get push back, and a terrifying "danger of ketosis" sermon. Just remember the doctor is confusing nutritional ketosis with a more dangerous condition called ketoacidosis. These are two different conditions The Basic Concepts There are many low carbohydrate, ketogenic diet plans from which to choose. They all involve following a higher fat, moderate protein, low carb food plan. The main difference between a regular low carb diet plan and a ketogenic diet plan is the amount of carbohydrate and protein allowed on a daily basis: A ketogenic diet plan requires tracking the carb amounts in the foods eaten and keeping carbohydrate intake between 20-100 grams per day. If you are trying to lose weight, you can aim for 0-20 grams per day. The daily protein requirement will be moderate, and depends on height, gender and how much exercise is done. Protein requirement is at least 30 grams per meal. The balance of calories will be from fats. Eat fat to satiety meaning until you are no longer hungry. These ratios ensure that most people go into ketosis and stay there, which is the main objective of the ketogenic diet. The nutrient intake on a ketogenic diet typically works out to about 70-75% of calories from fat, 20-25% from protein, and 5-10% from carbohydrate on a daily basis when calories are not restricted. Since a ketogenic diet reduces hunger, calorie counting is optional. The key to understanding a ketogenic diet plan is to remember that one is swapping out the carbs in the diet with a higher fat and a moderate protein intake. Why high fat and moderate protein? Fats have little to no effect on blood sugar and insulin levels. Protein does affect both blood sugar and insulin, if large quantities are consumed. If you overeat protein (more than 1.5-2.0 grams/kg lean body mass), it can drive up your blood insulin levels temporarily. High insulin levels can put the brakes on the body's ability to release and burn the fatty acids which provide the substrate for ketosis. This affects some people more than others, however. It most likely depends on how insulin resistant you are and how much you exercise. Fats and Oils Since the majority of calories on a ketogenic diet will come from dietary fats, choices should be made with digestive tolerance in mind. Most people cannot tolerate eating a large amount of vegetable oil, mayonnaise or even olive oil over time. And this is a good thing, since vegetable oils are high in polyunsaturated Omega-6 fatty acids. The Omega-6 fatty acids (found in nut oils, margarines, soybean oil, sunflower oil, safflower oil, corn oil, and canola oil) should be limited due to the inflammatory effect they trigger within the body. Most nuts (with the exceptions of macadamias and walnuts) are high in Omega 6 fatty acids as well, so go easy on them). Your intake of polyunsaturated fats should be balanced between Omega 6 and Omega 3 types. Eating wild salmon, tuna and shellfish will provide balancing Omega 3 fatty acids and are important part of a low carb food list. If you don't like seafood, then consider taking small amounts of a fish or krill oil supplement. Saturated and monounsaturated fats such as butter, macadamia nuts, coconut oil, avocado and egg yolks are tolerated more easily by most people, and since they are chemically stable, they are less inflammatory. Fats and oils can be combined in sauces, dressings, and other additions to basic meals. Over time, it will become a habit to add a source of fat to each meal. Avoid hydrogenated fats such as margarine to minimize transfats intake. If you use vegetable oils (olive, canola, sunflower, safflower, soybean, flaxseed and sesame oils) choose "cold pressed." Keep cold pressed oils like almond and flaxseed refrigerated to avoid rancidity. Avoid heating vegetable oils. Use clean non-hydrogenated lard, beef tallow, coconut oil, ghee and olive oil for frying, since they have high smoke points. Avocado (very high in fat, so I’m including it here) Avocado oil Almond oil Beef tallow, preferably from grass fed cattle Butter: try to find organic sources Chicken fat, organic Duck fat, organic Ghee (butter with milk solids removed) Lard such as organic leaf lard (make sure it is NOT hydrogenated) Macadamia Nuts Macadamia oil Mayonnaise (most has carbs, so count them. Duke’s brand is sugar free.) Olives Olive oil, organic Organic coconut oil, coconut butter and coconut cream concentrate Organic Red Palm oil Peanut Butter: make sure to use unsweetened products, and limit due to Omega 6 content. Seed and most nut oils: Sesame oil, Flaxseed oil, etc. These are higher in inflammatory Omega 6 fats, so limit amounts, and don’t heat them. 85-90% dark chocolate can be used in small amounts, or use Chocoperfection low carb chocolate. Sources of Protein Fattier cuts of meat are better because they contain less protein and well, more fat. Choose organic or grass fed animal foods and organic eggs if possible to minimize bacteria, antibiotic and steroid hormone intake. Websites such as www.eatwild.com, www.localharvest.org or www.flipflopranch.com can point you to local sources of clean, grass fed meats and poultry. These clean proteins are the best choices for a low carb food list. Meat: beef, lamb, veal, goat and wild game. Grass fed meat is preferred, as it has a better fatty acid profile. Pork: pork loin, Boston butt, pork chops, ham. Look out for added sugar in hams. Poultry: chicken, turkey, quail, Cornish hen, duck, goose, pheasant. Free range is better if it’s available. Fish or seafood of any kind, preferably wild caught: anchovies, calamari, catfish, cod, flounder, halibut, herring, mackerel, mahi-mahi, salmon, sardines, scrod, sole, snapper, trout, and tuna. Canned tuna and salmon are acceptable but check the labels for added sugars or fillers. (Exception: Avoid breaded and fried seafood.) Shellfish: clams, crab, lobster, scallops, shrimp, squid, mussels, and oysters. (Exception: imitation crab meat. It contains sugar, gluten and other additives.) Whole eggs: These can be prepared in various ways: deviled, fried, hard-boiled, omelets, poached, scrambled, and soft-boiled. Bacon and sausage: check labels and avoid those cured with sugar or which contain fillers such as soy or wheat. Specialty health food stores carry most brands of sugar-free bacon. Peanut butter and soy products such as tempeh, tofu and edamame are good sources of protein, but they are higher in carbohydrate, so track them carefully. Whey protein powders, plus rice, pea, hemp or other vegetable protein powders. Be aware that whey protein is insulinogenic (meaning it causes an insulin spike) in the body, so if you having trouble losing weight or getting into ketosis limit amounts or avoid whey. Fresh Vegetables Most non-starchy vegetables are low in carbs. Choose organic vegetables or grow your own to avoid pesticide residues. Avoid the starchy vegetables such as corn, peas, potatoes, sweet potatoes, and most winter squash as they are much higher in carbs. Limit sweeter vegetables such as tomatoes, carrots, peppers, and summer squashes. This list is by no means comprehensive, so if there is a green vegetable you like that is not on this low carb food list, feel free to include it. Alfalfa Sprouts Any leafy green vegetable Asparagus Avocado Bamboo Shoots Bean Sprouts Beet Greens Bell peppers* Bok Choy Broccoli Brussels sprouts Cabbage Carrots* Cauliflower Celery Celery root Chard Chives Collard greens Cucumbers Dandelion greens Dill pickles Garlic Kale Leeks Lettuces and salad greens (arugula, Boston lettuce, chicory, endive, escarole, fennel, mache, radicchio, romaine, sorrel.) Mushrooms Olives Onions* Radishes Sauerkraut (watch for added sugar) Scallions Shallots Snow Peas Spinach Sprouts Summer squash* Swiss chard Tomatoes* Turnips Water chestnuts * Limit amounts of these vegetables, as they are higher in carbs. Dairy Products Raw milk products are preferable; choose organic if raw products are not available. Be aware that dairy proteins (whey and casein) are insulinogenic (meaning they cause an insulin spike) in the body, so if you having trouble losing weight or getting into ketosis limit amounts or avoid. Heavy whipping cream Full fat sour cream (check labels for additives and fillers. Look for brands such as Daisy which are pure cream with no added milk; carbs and protein will be low.) Full fat cottage cheese All hard and soft cheeses: (count each 1 ounce portion as 1 carb generally) Cream cheese (count each 1 ounce portion as 1 carb generally) Unsweetened whole milk yogurt (limit amounts as it is a little higher in carb) (Fage full fat Greek yogurt is divine) Mascarpone cheese Nuts and Seeds Nuts and seeds are best soaked and roasted to remove anti-nutrients. They are also very high in calories and higher in carbs per serving. It's very easy to eat a handful of nuts and not realize how much carb is included. If you are having trouble getting into ketosis or losing weight, reduce or avoid nuts. Nuts: macadamias, pecans, almonds and walnuts are the lowest in net carbs and can be eaten in small amounts. Cashews, pistachios and chestnuts are higher in carb, so track carefully to avoid going over carb limits. Nut flours, such as almond flour. I include this because a low carb food list shouldn't completely exclude baking. Almond flour is a great flour substitute. See my recipe page for ideas on how to use it with the foods on this low carb food list. Peanuts are actually legumes and are higher in protein and are also high in Omega 6 fats, so limit amounts and include protein grams in daily totals. Seeds (pumpkin, sunflower, sesame, etc.) are also very high in Omega 6 fats, limit amounts. Most nuts are high in Omega 6 fats, which increase inflammation in the body, so don't rely on nuts as your main protein source. I have found that eating too many nuts over several days makes me feel stiff and sore and ruins my mood. I attribute this to the Omega 6 fats. Your mileage may vary. Beverages Clear broth, bone broth Decaf coffee (caffeine can drive up blood sugar) Decaf tea (unsweetened) Herbal tea (unsweetened) Water Flavored seltzer water (unsweetened) Lemon and lime juice in small amounts Almond milk (unsweetened) Coconut milk (unsweetened, can or carton) Soy milk (unsweetened, count protein grams as well) Sweeteners Avoiding sweetened foods in general will help “reset” the taste buds. However, if there is a desire for something sweet, these are the recommended choices for sweeteners. Note that the powdered forms of most artificial sweeteners usually have maltodextrin, dextrose or some other sugar added, so liquid products are preferred. Stevia, liquid preferred as the powdered usually has maltodextrin in it. Erythritol Xylitol (keep any food with this sweetener in it away from dogs) Splenda*, liquid preferred as the powdered usually has maltodextrin in it. Lo Han Guo Monk Fruit Inulin and Chicory Root (Just Like Sugar brand) *Some research suggests artificial sweeteners like Splenda are bad for you Fruit/Miscellaneous Berries (blueberries, strawberries, raspberries) can be enjoyed occasionally in small amounts, as they are the lowest in carbohydrate. Avoid other types of fruit as most are too high in carb and can interfere with ketosis. Japanese Shirataki noodles Pork Rinds (these are great with dip, or as a substitute for bread crumbs, but note they are also high in protein, so limit amounts) Spices Spices do have carbs, so be sure to count them if they are added to meals made using this low carb food list. Commercial spice mixes like steak seasoning usually have added sugar. Sea salt is preferred over commercial salt, which is usually cut with some form of powdered dextrose. Cookbooks with Low Carb Food Lists These are great resources for how to prepare the items on this low carb food list. 500 Low-Carb Recipes: 500 Recipes from Snacks to Dessert That the Whole Family Will Love by Dana Carpender. This is out of print, but Amazon has links to different sellers. 200 Low-Carb Slow Cooker Recipes: Healthy Dinners That Are Ready When You Are! by Dana Carpender QUICK FOOD LIST FOR YOUR FRIDGE FAT When buying meats, you want to try and get those with a good fat content. If you are using lean meat, add fat to it like butter or coconut oil if you are trying to reach your fat macro. Coconut oil Tallow Duck fat Olive oil Butter Ghee Red Palm Oil Avocado Oil Macadamia Nut Oil MCT Oil Sardines Oysters DAIRY The key to finding keto-friendly dairy is to look at the carb and sugar content. Regular cow’s milk is generally out as it’s fairly carb heavy, but heavy creams are a great and tasty substitute. Experiment with new cheese findings! Full-fat cheeses Heavy whipping cream Full-fat sour cream Butter (avoid margarines) Full-fat cream cheese VEGETABLES MEATS/PROTEINS When buying meats, you want to try and get those with a good fat content. If you are using lean meat, add fat to it like butter or coconut oil if you are trying to reach your fat macro. Bacon Steak Ground beef Eggs Ribs (Pork/Beef/Lamb) Roasts (Pork/Beef/Lamb) Pork Loin, Chops & Steaks Chicken (skin-on breasts, thighs, wings, drumsticks) Ham Sausages Deli meats (double check nutrition for certain brands that use carb fillers) Cured Meats (pepperoni, salami, prosciutto) SEAFOOD (CANNED OR FRESH) Shrimp Lobster Tilapia Cod Scallops Crab Tuna Albacore Salmon You will want your carb sources to basically be vegetables/limited fruits. The purpose of this diet is to eat high fat, moderate protein, and low carbohydrate. Almonds * Hazelnuts * Macadamias * Pistachios * Walnuts * Pecans * Sesame seeds * Sunflowers seeds * Pumpkin seeds * Flax seeds * CONDIMENTS Mayonnaise Mustard Soy sauce (tamari if you’re eating glutenfree like me) Hot sauce Salad dressings (full-fat Ranch, Caesar, Bleu Cheese, Italian) * Lemon/Lime Juice MISC. Asparagus Squash (spaghetti, butternut, etc.) Peppers (jalapeno, bell, banana, etc.) * Mushrooms Cucumbers Cabbage Brussel sprouts Cauliflower Various leafy greens (spinach, romaine, arugula, bib lettuce, etc.) Broccoli Artichoke hearts Garlic * Onion * FRUITS Avocado Blueberries * Raspberries * Blackberries * Strawberries * Cranberries * NUTS & SEEDS Be careful when consuming nuts. They are extremely easy to overeat and they do have a carb content. This includes nut butters. Cocoa powder (unsweetened) almond milk (unsweetened) coconut milk/cream (unsweetened) Almond meal/flour Olives Pickles Herbs Spices Pork Rinds Beef Jerky Dark Chocolate (85% cocoa+) SWEETENERS Erythritol Stevia Splenda (I don’t use this, personally, but many do) * Items marked with an asterisk have a carb content and need to be moderated This is just a simple and barebones version of a ketogenic diet food list. It will then be your choice to decide whether some things are worth purchasing, like diet sodas, for example. Always read the food labels to make sure they are low in carbs Body Fuel Basics Normal body cells are able to create energy by using the food we eat and the oxygen we inhale to complete normal cellular “respiration” and make ATP (adenosine triphosphate), our main cellular energy source. Most of this energy production happens in the mitochondria, tiny organelles which act as cell fueling stations. There are two primary types of food-based fuel that our cells can use to produce energy: The first cellular fuel is glucose, which is commonly known as blood sugar. Glucose is a product of the starches and sugars (carbohydrates) in our diet. This fuel system is necessary, but it has a limitation. The human body can only store about 10001600 calories this way. The amounts stored depend on how much muscle mass is available. Men will be able to store more because they have larger muscles. Since most people use up about 2000 calories a day just being and doing normal stuff, you can see that if food weren’t available for more than a day, the body would run out of energy. Not good for continuing life. The second type of cellular fuel is ketone bodies, which come from the breakdown of fatty acids. These come from fats we eat or from the metabolism of stored fat from our fat cells. The human body can store hundreds of thousands of calories in the form of fat, so we could say that this system of energy is almost unlimited, depending on how long one goes without food. Eventually, it would get used up, but people have been known to fast for months and live through it. When glucose levels are low, especially over time, most cells will switch to using ketone bodies for fuel. Ketones allow cells to be metabolically flexible, so to speak. Even the brain and nerve cells, which are heavily dependent on glucose, can utilize ketone bodies for fuel. This ability of most normal cells to use ketones when glucose is unavailable indicates that their cellular mitochondria are healthy and functioning properly. In addition, ketones have some unique properties which make them a “cleaner” fuel for your cells to use. Burning fat for fuel causes less oxidative damage (think “free radicals”) to the cell, and actually makes it possible for the cell to create much more energy than it can from glucose. Fallacies and Fears: Is a Ketogenic Diet Plan Dangerous? The "dangers of low carb diets" are really just myths told by people who have a limited understanding of how low carb diets work. The main criticisms include fears about fat intake and the process of ketosis. Fears about fat: Most people have trouble on a ketogenic diet plan because they are scared to increase the amount of fat they eat, especially saturated fat. The message that fat is bad has been pounded into the collective American consciousness for the last 30 years. It's hard to unlearn the message that fat makes you fat, and saturated fat especially is very bad for you. I understand that message has been repeated over and over, but it is a lie. Here's the reality: A high carb diet drives up blood sugar and insulin levels. All that sugar and insulin are inflammatory. The standard American diet offers lots of foods that are high sugar AND high in saturated fat, and in studies, these two factors were lumped together. So although saturated fat is healthy, it got the blame for the inflammation that causes heart disease because it was studied in combination with a high carb diet. A ketogenic diet plan which is high in saturated fat and very low in carbohydrate will REDUCE inflammation. ( Saturated fat is not harmful in the context of a low carb diet. This study from Johns Hopkins Medical School confirms this. The ketogenic diet plan is healthier because the higher saturated fat intake increases your HDL cholesterol, and at the same time, a lower carb intake decreases your triglycerides levels. These two factors are the major markers for heart disease, and the closer your triglyceride/HDL ratio is to 1, the healthier your heart. In reality, the cause of heart disease is a chronically high carbohydrate consumption, not a high saturated fat and cholesterol intake. Some people don't do well in ketosis. You should check with your physician if you have any concerns about starting a ketogenic diet plan with pre-existing health conditions, especially if those conditions involve kidney or heart problems. Although there is evidence that many people do well with reducing carb intake, I don't recommend going much lower than 10-20 carbs per day. The ketogenic is a very low carb diet, but it is not a zero carb diet. If you find (after at least a month on the diet) that you are one of the people who doesn't feel well at very low carb levels, adding enough carbohydrate in the form of sweet potatoes and other starchier vegetables back into your diet should bring you out of ketosis and resolve the issues. If you stay away from grains and rely on vegetables, a moderately higher carb content (60-100 grams/day) should result in health benefits. You won't be in ketosis of course, but still, you should feel better. General Side Effects Switching to a ketogenic diet plan is sometimes not easy at first. That withdrawal period and side effects are associated with the time it takes for your body to refit itself to burn mostly fat instead of sugar. New enzymes have to be created. Dr. Mike Eades has a great analogy for this process in his blog post. He writes: "When you’ve been on the standard American high-carb diet, you’re loaded with enzymes ready to convert those carbs to energy. You’ve got some enzymes laying in the weeds waiting to deal with the fat, but mainly dealing with it by storing it, not necessarily burning it. All the pathways to deal with carbs and their resultant blood glucose are welloiled and operating smoothly. Then you start a low-carb diet. Suddenly, you’ve idled most of the enzyme force you have built to process the carbs in your diet while at the same time you don’t have a ready supply of the enzymes in the quantities needed to deal with your new diet. It would be like a Ford automobile factory changing in one day into a plant that made iPads. All the autoworkers would show up and be clueless as how to make an iPad. It would take a while – not to mention a lot of chaos – to get rid of the autoworkers and replace them with iPad workers. In a way, that’s kind of what’s happening during the low-carb adaptation period. Over the first few days to few weeks of low-carb adaptation, your body is laying off the carbohydrate worker enzymes and building new fat worker enzymes. Once the workforce in your body is changed out, you start functioning properly on your new low-carb, higher-fat diet. The carbs you used to burn for energy are now replaced to a great extent by ketones..." In addition, during the first week or so, your blood sugar will drop, and you may experience insulin overload and reactive hypoglycemia once you burn through all of your stored glycogen (carb energy stored in your muscles and liver). For those of you that have been living on a high carb diet for a long time, the effects may be even more pronounced, as your blood sugar and insulin levels are probably chronically high. Shakiness, Weakness or Muscle cramps This is a side effect of hypoglycemia or low blood sugar. It could also be a symptom of dehydration or low mineral levels. Add some more protein to your daily diet to offset the drop in blood sugar levels, and eat more salt (put a 1/4 teaspoon of salt in a glass of water and drink it) and include more potassium containing foods. You could also take a potassium citrate supplement and a magnesium supplement. Sugar Cravings As your body goes through the process of retrofitting itself to burn fat instead of sugar, there's a transition period for carb cravings. Always eat something fatty before giving in to eat a carb. If you keep your fat intake high, these cravings will disappear. Eating a large amount of carb will bring the cravings right back, and for some of us, eating sugar in any amount will start the slide down that slippery slope to carb overload. Low Carb Diet Side Effects Are Temporary If you plan for them, these low carb diet side effects can be minor obstacles, and after you adjust to the diet, they should get better and finally subside. After that, you ought to be feeling pretty darned good! Here's what to expect the first month after switching to a ketogenic diet plan. Freedom from hypoglycemia, food fixations and sugar cravings. Lack of hunger: Ketone bodies dampen the appetite and fat is very satisfying. Lower blood pressure: If you are taking any blood pressure medications, be aware that you might start feeling dizzy from too much medication while on a ketogenic diet plan. You may be able to reduce your BP meds (talk to your doctor first). Drop in Cholesterol: Cholesterol is made from excess glucose in the diet. As you eat less sugar creating foods, you do less damage to your arterial system and inflammation drops. Your cholesterol will drop as your body has less glucose from which to make it, and less need for repairing the damages of inflammatory chemicals. Increase in HDL Cholesterol (the more saturated fat you eat, the higher it will go.) This is actually a good thing, because it improves the ratio of HDL/LDL. Higher HDL levels (above 39 mg/dL) indicate a healthier heart. A drop in triglycerides: carbohydrate consumption is closely tied to triglyceride levels, and one of most well-known ketogenic diet benefits. The less carbohydrate you eat, the lower your triglycerides readings will go. The ratio of triglycerides to HDL (expressed Triglyceride/HDL) is the best predictor of heart attack risk and is one of blood test results to which you should really pay attention. The closer this ratio is to 1:1, the healthier you are. See this paper. Drop in fasting blood sugar and fasting insulin levels: less sugar coming in, less sugar driving up blood sugar and insulin levels. Your levels of C Reactive Protein (CRP) and HbA1c proteins will decrease. These are both markers of inflammation and heart disease risk. More energy. You'll be amazed at how much energy you have. Any chronic fatigue symptoms should get better. Decrease in stiffness and joint pain. This is one of the best side effects of following a ketogenic diet plan. The diet eliminates grain based foods from your diet, and they, in my opinion are the biggest cause of chronic illness and pain, especially muscle stiffness and joint pain. As I often say, no grain, no pain. Clearer thinking. The "fogginess" that accompanies a high carb diet will disappear. My theory on this is that the brain is over 60% fat by weight, and the more fat you eat, the better it can maintain itself and work to its full capacity. Others more scientifically inclined might talk about essential fatty acids and neurotransmitter function. Changes in your sleep patterns and an improvement in sleep apnea symptoms. I believe that sleep apnea is tied to grain consumption, the heartburn it causes, and reactive hypoglycemia from a high carb diet. I used to have apnea, but once I cut grains out of my diet and permanently reduced my carb intake, I no longer have it, just as I no longer get heartburn or hypoglycemia. Another sleep benefit of eating less carbs is that those urges to take a late afternoon nap will go away. Not falling asleep at your desk every afternoon is one of the best ketogenic diet benefits. Weight loss: sticking to a ketogenic diet plan can be very effective for normalizing your weight. Most people who are very heavy have very broken metabolisms. However, they are also the people who are most likely to experience many of ketogenic diet benefits. If you do not experience weight loss, there may be other issues such as thyroid disease that need to be dealt with first. Heartburn relief: if you suffer from GERD or other heartburn issues, the symptoms should lessen or disappear. Heartburn, I believe, is a direct result of eating grain based foods, sugar and for some people, nightshade vegetables such as tomatoes. I also believe it is tied to problems with sleep apnea, as described above in the sleep section. Gum disease and tooth decay: sugar changes the pH of your mouth and contributes to tooth decay. Three months into a ketogenic diet, any gum disease you might have will decrease or disappear. Digestion and gut health get better. You will see a decrease in stomach pain, bloating, gas etc. These are all associated with grain and sugar consumption. Mood stabilization. Ketone bodies have been shown to be beneficial in stabilizing neurotransmitters such as serotonin and dopamine which result in better mood control. As you can see from the list above, the temporary unpleasant effects of switching to a ketogenic diet are totally worth it when you experience the many ketogenic diet benefits.