The Ketogenic Diet (KD) is a low carbohydrate, high fat, diet that is moderate in protein. Once the body becomes keto-adapted, the body switches from using primarily glucose to fat as fuel. The ability for the body to increase fat breakdown and oxidation can aid in weight loss, general health, and even human performance.
What Is a Ketogenic Diet?
Low Carbohydrate vs. Ketogenic Diet
While the KD is also low in carbohydrates, it is NOT synonymous with traditional low carbohydrate diets in which the amount of carbohydrates and protein intake differs (usually both are higher in general “low carb diets.”) In the literature, a low carbohydrate diet is classified as any diet in which less than 30% of the total daily macronutrient calories come from carbohydrates. While these diets can be very beneficial, it must be reinforced that they are DIFFER from a well-formulated Ketogenic Diet. In general, the macronutrient ratio for a Ketogenic Diet consists of about 5-10% of carbohydrates, 15-30% protein, and the remaining (60-80%) as fat. By restricting glucogenic substrates, a deeper level of ketosis can be achieved which can have a plethora of benefits as discussed below.
Ketogenic Diet vs. Traditional Atkins
The ketogenic diet and the Atkin’s diet are often used synonymously; however, they also differ . While both diets lower carbohydrate consumption, the Atkins diet allows for a period in which both protein and carbohydrate intake are increased (while lowering fat intake) beyond what would classify as ketogenic. The goal of the KD is to shift the body to primarily utilize fat as it’s primary fuel source. By doing so, the body creates a metabolic substrate known as ketones. However, due to the increasing content of both carbohydrates and protein and lowering of fat intake, the Atkins diet often does not result in state of ketosis and therefore is metabolically different from a KD.
In addition to the traditional Ketogenic and Atkins Diets as described above, there are modifications that can be implemented to both of these diets in order to produce greater benefits on an individual basis. One such amendment, namely the Modified Atkins Diet (MAD), is structured similarly to the Atkins Diet in which carbohydrates are monitored while the other two macronutrients (protein and fat) are consumed freely. This approach is commonly being used in children with epilepsy with great success due to its ability to increase the likelihood of adherence to the diet while still minimizing glucose intake in the form of dietary carbohydrates.
There exists great debate on how to quantify the macronutrient ratios for a traditional Ketogenic Diet. Despite the numerous opinions, one must keep in mind that the ultimate objective is to develop a diet that is sustainable and achieves the desired outcome (i.e. a state of ketosis). As such, while it is suggested that 65-80% of the total calories come from fat and 15-30% from protein, these numbers will be optimized according to individual’s unique metabolic needs. For example, an individual who is trying to achieve a state of ketosis might have different macronutrient ratios than someone who is using the KD to improve their body composition. Once the body begins to use fat as its primary fuel source, metabolic “keto-adaptation” accompanied by a production of ketones occurs which will be further described below. It must be reinforced that there is no set optimal level of ketosis nor macronutrient profile that is standard for everyone since factors such as activity level and the desired outcome will influence these variables. Although individualized, Ketogenic.com currently recommends anyone who is just starting out on the diet try to begin with (Note: These percentages are based on total caloric intake):
Benefits of the Ketogenic Diet
Restricting carbohydrates can provide many different health benefits. Due to the higher level of ketone production accompanied with a Ketogenic Diet, the majority of these benefits, named below, can be more robust when compared to a general low carbohydrate diet:
Both fat and ketone bodies can both be utilized as a fuel source for the body. Once the body begins to use fat and ketones as its primary fuel source, there will be a noticeable increase in energy.
Ketones may be the preferred fuel source of the brain as well as cardiac tissue. Due to the tissue preference, upon ketone production, it is very common for individuals to report an increase cognitive performance.
Physical changes to the body are one of the primary reasons people are attracted to and implement low carbohydrate diets. By definition, being in a state of ketosis means you are able to tap into the body’s fat stores in order to break it down and utilize it to produce ketones as energy. Furthermore, the KD has been shown to improve insulin sensitivity which may lead to less storage of fat by the hormone insulin. While both “low carbohydrate” and Ketogenic Diets are effective for weight loss, several studies have demonstrated that the Ketogenic Diet Is superior.
Traditionally, endurance athletes tend to consume a high amount of carbohydrates in order to “fill up” their fuel stores for their competitions. Thus, a diet in which carbohydrates are restricted seems extremely counter-intuitive for these individuals. However, studies have shown that once an individual is truly keto-adapted, not only is their performance the same or better than a high carbohydrate consuming individual, but their glycogen “fuel stores” are the same as well. Despite consuming a diet lower in carbohydrates, these athletes are able to adapt and primarily utilize a nearly limitless supply of fat as fuel.
The Ketogenic Diet was developed in the 1920’s as an alternative therapeutic option to treat children suffering from drug resistant epilepsy. Since its inception, the Ketogenic Diet has expanded its utility where it has been applied as a therapeutic treatment for many other conditions such as Alzheimer’s, Parkinson’s, GLUT-1 deficiency, and even Cancer. While low carbohydrate diets collectively can offer therapeutic benefits, there are additional and more potent benefits from the application of a traditional Ketogenic Diet due to the unique nature of it’s ability to increase ketone production in the body.
Is the Ketogenic Diet Safe?
Quite simply the answer is an astounding “Yes” for a majority of people. Due to its high-fat nature, it is often perceived as a health risk and nonetheless, a deterrent. Despite this misconception, research has demonstrated that the Ketogenic Diet is safe for most people unless you suffer from one of the following conditions:
Even some of these circumstances may be able to utilize a well formulated, tightly monitored Ketogenic Diet with the aid of a physician.
Isn't Fat Bad?
Unfortunately, it has been ingrained into society that consuming dietary fat is detrimental for our health. Due to the early “research” by individuals such as Ancel Keys, these concepts have plagued us for numerous decades and have only since seen a significant change in the way we start to look at dietary fat. In fact, dietary fat, in the absence of carbohydrates is inert. Meanwhile, it is the high consumption of fat and carbohydrates together (i.e. fast food) that has led to many serious health problems that we face today. This gives rise to the quote, “Don’t blame the butter for what the bread did.”
What is Ketosis?
When we restrict carbohydrate intake, the body will shift its primary fuel source from glucose to fats as an energy substrate in which the body is primed to enter a state of “ketosis.” Ketosis is a metabolic state that is characterized by lower, stable, blood sugar levels coupled with elevated blood ketone levels. Ketones are made in the liver through a process known as ketogenesis (i.e. keto + genesis (formation of)). In contrast to a state of ketosis, when we consume carbohydrates, they are broken down into the energy substrate, glucose, resulting in higher blood glucose levels which is is also coupled with the pancreatic secretion of insulin (the fat-storage hormone which inhibits ketone production). In contrast, when we restrict our carbohydrate intake, our blood glucose and insulin levels are decreased and by doing so, we force the metabolism to utilize fat stores as the energy substrate. Once our metabolism is primed for fat burning (fatty acid oxidation), the liver will produce additional fuel molecules known as ketones. Most cells in the body can utilize either fatty acids or ketones as fuel including the brain which seems to actually prefer ketones as fuel over glucose.
Ketosis vs. Ketoacidosis
The confusion and synonymous uses between Ketosis and Ketoacidosis is a prominent reason why many individuals steer clear from the Ketogenic Diet. Ketoacidosis typically occurs in Diabetics (DKA) or those suffering from insulin resistance or insulin deficiencies (Type 1 Diabetes). In those suffering from such cardio-metabolic disorders, DKA occurs when there is an elevated blood glucose coupled with elevated ketone levels. More specifically, due to this dysfunction in insulin/insulin deficiency, these individuals are not able to use the glucose effectively and as such, the cell starvation occurs resulting in uncontrolled ketone production. In turn, a highly-acidic bio-environment is created and can have detrimental effects on an individual’s health, including death. It must be echoed that the Ketogenic Diet, which induces “nutritional” ketosis is vastly different, and should never be confused with DKA. To put this in perspective, a normal state of ketosis as achieved via the Ketogenic Diet may elevate ketones anywhere from .3-5mM, meanwhile DKA results in ketone levels of about 15mM or higher.
Where Do Ketones Go?
Glucose is the primary fuel source for most tissues throughout the body. However, once “keto-adapted,” many tissues, increase their capacity and ability to take up and utilize ketones as fuel. Once such tissue, namely the brain, uses ketone bodies as its primary and preferred fuel source. In contrast, there are certain cells that cannot oxidize fatty acids or use ketone bodies and are considered “obligate glucose users.” Red Blood Cells and certain cells in the Central Nervous System are obligate glucose users. Don’t stress however, because even though you may not be consuming carbohydrates, these cells can obtain glucose through a biological process called gluconeogenesis.
How To Achieve Ketosis?
|Restrict carbohydrates to 30 grams or less a day or roughly 5% of total calorie intake|
|Keep protein to roughly 20-25% of your total calorie intake.|
|Eat enough fat to fill the rest of your calories, typically 70-75% of calorie intake|
How Long Does it Take to Get into Ketosis?
The answer to this question is often individualized and will depend on the metabolic state of each individual. It should be noted however, that the simple production of ketone bodies does not mean that an individual is in “ketosis” or is “keto-adapted.” In fact, a short period of fasting (overnight) or carbohydrate restriction can result in ketone body production. As such, by definition, in order to be in full ketosis and thus “keto-adapted,” ketones must be one’s primary fuel source and can take anywhere from a couple of weeks to several months to make certain adaptations that come from being in a state of ketosis.
As mentioned above, once there is a shift in the primary fuel source from carbohydrates to fats, and a Ketogenic-state is achieved, one is coined as “keto-adapted.” This metabolic “shift” biologically primes the body to utilize this new fuel source. Such modifications include a decreased and stabilized blood glucose levels, increase fat oxidation and increased ketone production but more notably, an increase in ketone utilization.
When it comes to the question of how long it takes to adapt to a ketogenic diet, the answer is similar to most questions related to the diet in that individual variability is major factor.
Side Effects of Keto-Adaptation
Despite the high –efficacy and therapeutic benefits of a Ketogenic Diet, some individuals may experience side effects during the “keto-adaptation” process. Again, this will vary depending on the individual. The set of common side-effects associated with keto-adaptation have been collectively coined as the “Keto Flu” as outlined below:
The Keto Flu
The “Keto Flu” is a term used to define the period of discomfort that accompanies the biological changes that occur when switching the body’s primary fuel source from carbohydrates to fats. With symptoms that often feel like an illness, the “Keto Flu” may be characterized by symptoms below:
As mentioned above, if the Ketogenic Diet has been well-formulated, many of these symptoms may not occur or can be alleviated through proper electrolyte supplementation.
In addition to the “Keto-Flu,” during the keto-adaptation period, many individuals may also experience a reduction in physical performance as your body is adapting to this new primary fuel source; however, this is only temporary and will be regained upon full adaptation. As such, decreased performance may be expressed as:
|Lack of Motivation to Exercise|
|Lack of Strength|
Rapid Weight Loss
At the start of a Ketogenic Diet, it is not uncommon for an individual to experience rapid and robust weight loss. This may concern some people but it is worth noting that not ALL weight lost is body fat. When we lower our carbohydrate intake, our insulin lowers and when our insulin lowers we tend to excrete more water. Additionally, reducing our carbohydrate intake may cause the body to burn through glycogen stores. The loss of both water and glycogen can be part of the reason why rapid weight loss occurs initially. But don’t be discouraged! You are likely burning some body fat as well and more fat burning is to come!!
Troubleshooting Your Keto Side Effects
As one begins to eliminate carbohydrates from their diet, it is not uncommon to experience carbohydrate cravings. If this occurs, there are several options outlined below; however, it should be noted that as the body keto-adapts, hunger and appetite will become suppressed.
Add more volume through increased consumption of high-fiber vegetables
Increase water consumption
Increase fat consumption
If you are experiencing sugar cravings, try making a keto dessert from our recipe section!
A simple increase in fats may also aid in the alleviation of the cravings.
Headaches can be a common symptom of the “keto-flu.” Outlined below are several options to help alleviate the symptoms:
|Drink more water|
|Take a short nap|
|Eat more fat/MCTs|
Due to the high expulsion of water while on a Ketogenic Diet, dehydration is another commonly experienced symptom and is also responsible for potential “dry mouth.” An effective remedy is to ensure that there is sufficient consumption of water coupled with electrolyte balance (particularly magnesium). If dehydration persists, an increase in electrolytes may be needed.
In order to cope with this symptom, several options below may be consumed during this “adaptation” phase:
-Medium Chain Triglycerides (MCTs)
As mentioned above, the elimination of carbohydrates coupled with the high-expulsion of water often leads to constipation. If this occurs, simply increasing water consumption as well as the incorporation of more fiber in the diet can alleviate these symptoms.
Are There Different Types of Ketosis?
There are several different ways in which the body can enter the metabolic state of ketosis:
1. Fasting Ketosis
Fasting Ketosis, also referred to as starvation ketosis, played a major role in the development of the Ketogenic Diet. The concept of fasting has been around for centuries and can date back as far as Biblical times. By definition, fasting is the absence of food consumption for a period of time. This can range from several hours to several days and can have profound effects on the degree of ketosis. As the duration of the fasting increases, so does the production of ketones and thus, a deeper Ketogenic state. As such, the mechanisms of ketone production are similar among a fasting and dietary applications in which both result in lower and more stable levels of Insulin and blood glucose accompanied by fat metabolism.
2. Nutritional Ketosis
Nutritional Ketosis is classified as any dietary application that elicits the metabolic state of ketosis. There are 3 sub-types of Nutritional Ketosis:
- Carbohydrate Restricted Ketosis – This type of ketosis mimics the same biological amendments as seen during long duration fasts but without the complete restriction of food. Carbohydrate-restricted ketosis is achieved primarily through a low carbohydrate Ketogenic Diet. This restriction, in turn, promotes reductions in insulin and blood glucose levels similar to that of fasting which again promotes an increase in blood ketone levels. For most individuals, Nutritional Ketosis is much more sustainable than fasting or starvation ketosis.
- Supplemental Ketosis: This form of ketosis has recently gained momentum in the field of Ketogenic Dieting. Supplemental ketosis is a Ketogenic state that is achieved through the ingestion of Ketogenic supplements. The commonly used supplements on the market are:
- MCT Oil – MCT oil is a fat that in contrast to other longer-chain fatty acids, goes straight to the liver and is readily metabolized. This in turn allows for ketone production in the liver to occur faster than with other fats.
- Exogenous Ketones – Exogenous ketones are synthetic substances that mimic the ketones produced in our body (endogenous ketones). Exogenous ketones can come in the form of ketone salts or ketone esters.
It is very important to note than consuming these substances alone does not mean that an individual is “keto-adapted.” While these products can help during the keto-adaptation period, especially if one is experiencing the “keto-flu,” they will only elicit short-term increases in blood ketone levels. Exogenous ketones can produce benefits similar to the Ketogenic Diet acutely; however, these products are best used in conjunction with a well-formulated Ketogenic Diet or at minimum, a diet that restricts carbohydrates.
- Alcoholic Ketoacidosis: Is a Ketogenic-state that occurs following the consumption of alcohol. When alcohol is metabolized in the liver, ketones are produced. Furthermore, as with other Ketogenic-states, certain biological changes, specifically at the hormonal level, occur to promote fat metabolism and thus, ketone production. It is critical to note, that Alcoholic Ketoacidosis will not occur if the alcohol consumption is coupled with sugar.
Note: Ketogenic.com does NOT recommend or promote the consumption of alcohol to produce a Ketogenic state.
3. Pathological Ketosis
Pathological Ketosis, also known as Diabetic Ketoacidosis (DKA) is the variation of ketosis that is responsible for deterring society from ever considering the adoption of a Ketogenic Diet. Pathological Ketosis occurs primarily in those suffering from diabetes or those individuals that have insulin resistance or deficiency. The inability of our body to appropriately utilize insulin prevents ingested carbohydrates from entering our cells as a substrate for energy production. Due to this induced cellular starvation, the body will begin to produce ketones at an uncontrolled rate. Detrimentally, this results in high levels of both ketones and glucose. Both of these high levels in the blood will elicit an extremely dangerous biological environment that can even result in death. It must be clarified that Pathological Ketosis and as such Diabetic Ketoacidosis are very different than Nutritional Ketosis or Fasting Ketosis.
How Do I Know If I Am in Ketosis?
In order to maximize the benefits of a Ketogenic Diet, self experimentation and learning what the optimal level of ketosis for you is important. In addition to quantifying blood ketone levels, there are several biological changes that your body will experience to help identify a Ketogenic state. These changes will be more robust for some; however, in contrast to the negative side effects often experienced while on other low carbohydrate diets, a Ketogenic-state, and especially upon “keto-adaptation” can elicit euphoric effects including:
-Increased Cognitive Performance
Testing Your Ketones
To determine whether or not you are in ketosis, there are several ways of looking at ketones that may be beneficial. This process can be done through several different methods as noted below:
|Urine Strips||To measure ketone levels in the urine, these strips will elicit a color change based on the level of ketones, namely acetoacetate, that is present in the urine. It is important to note that acetoacetate is a different than the ketones present in the blood, namely, Beta-Hydroxybutyrate (BHB). Due to its nature, urine ketone testing may be a sufficient, initial, method to test ketone production; however, it is not the ideal method for determining the utilization of these ketone bodies, especially once “keto-adapted.”|
|Blood Ketone Meter||To measure the ketone levels, blood ketone testing is a more accurate and predictive indicator of an individual’s metabolic state of ketosis. In parallel process to measure blood glucose levels, this method also uses a blood meter and an chemo-sensitive strip made specifically to measure ketones (BHB). As with blood glucose measurements, a blood sample can be acquired through a finger prick. The ketone level on the meter will be revealed within a few seconds of sample placement on the stip.|
|Breath Ketone Analysis||This method analyzes an individual’s breath to determine whether or not one producing ketones, specifically, acetone. While this method has also been found to be an effective indicator, more research needs to be done to examine how this compares to the blood testing.|
Optimal Ketone Range
As with other facets of the Ketogenic Diet, the optimal ketone levels will also vary on an individual basis. Despite the potential for range, typically, literature suggests that mild Nutritional Ketosis will begin once blood ketones are around 0.5 mmol/L. Upon “keto-adaptation,” this value can increase to around 1.0-3.0 mmol/L. If an individual is following a Ketogenic Diet strictly for therapeutic reasons, one may consider trying to achieve a deeper level of ketosis, thus eliciting greater benefits through production of ketone levels above 3.0 mmol/L.
Testing ketones may be a good way to initially determine one’s metabolic state of ketosis; however, as mentioned above, since the “optimal” levels of ketones vary among individuals, daily ketone testing is not necessary.
How Do I start?
There are several strategies for transitioning into a Ketogenic state. Depending on a variety of factors and lifestyle habits, some individuals choose to ease into the process by first adopting a low carbohydrate diet prior to implementing full Ketogenic Diet. One place to start would be by eliminating sugar and processed foods and begin to eat a whole foods diet that is low in carbohydrates. In doing so, you will begin to understand the Ketogenic Diet and once ready, you can dive fully into ketosis. To aid in the transition to a Ketogenic lifestyle, our “Keto For You App” is an excellent resource!
How Do I Eat?
As mentioned above, learning which foods promote a Ketogenic state may be the most difficult and time-consuming task for most individuals adopting a Ketogenic Diet. Below you will find several outlined steps which may help aid in this process. It should be noted that it is critical to eliminate sugar or any fast-digesting carbohydrates and may include but are not limited to: cookies, chocolate, cakes, crackers, ice cream, cereal, pretzels, pastries, baked goods, fruit juice, soft drinks, honey, candy, chips, bread, white potatoes, etc.
1.Cut the “Healthy” Carbs: Even the carbohydrate-containing foods that are considered healthy need to be eliminated on a Ketogenic Diet including but not limited to: fruit, rice, pasta, quinoa, sweet potatoes, yogurt, whole grain products, granola, oatmeal, and sports drinks.
2.Stick to high-quality protein/fatty cuts of meat, healthy-fats, and high-fiber cruciferous vegetables while drinking plenty of water. These are the three staples of a Ketogenic Diet.
Below you will find a basic shopping list to help aid in learning which foods are Ketogenic-friendly. Again, this is not a comprehensive list, and based on carbohydrate tolerances of individuals. Not all of these foods may be “optimal” for one’s own Ketogenic-adaptation.
Become accustomed to reading nutrition labels paying careful attention to “sneaky carbohydrates” that may be included in dressings and sauces and dips which can add up quickly and knock individuals out of ketosis.
Common Ketogenic Dieting Mistakes
As one embarks on a Ketogenic lifestyle, there are major changes that need to occur aside from the mentioned biological adaptations in which there is a learning curve. Below are common mistakes that individuals make while adopting a Ketogenic Diet.
|Not Having Enough Fat:||People restrict their carbohydrates but fail to increase their fat intake.|
|Having Too Much Protein:||This may not be an issue for everyone, but for others, having too much protein can negatively impact ketosis due to its glucogenic effects.|
|Letting Carbohydrates Creep Up||Those who do not track may end up exceeding the 20-50g or the 5-10% that is traditionally recommended.|
|Drinking Too Much Alcohol||Certain alcohols may be tolerated in moderation by individuals while remaining in a Ketogenic state. However, consuming too many alcoholic beverages that are often high in carbohydrates can prevent some from achieving a Ketogenic state or will knock one out of ketosis if the Ketogenic state has already been achieved.|
A Well-Formulated Ketogenic Diet
When adopting a Ketogenic Diet, ensuring that it has been “well-formulated” is indispensable. Unfortunately, this critical factor is often overlooked and makes adherence to this diet very difficult. In addition, taking into consideration food quality and micronutrients are also just as critical. A well-formulated Ketogenic Diet will also aid in the prevention or alleviation of the side-effects/ “Keto-flu” that are often experienced with the Keto-adaptation process. To help create a well-formulated, Ketogenic Diet, outlined below are some points of consideration:
|Fiber||Adequate fiber ensures that you have proper digestive function and may aid in the prevention of constipation.|
|Water||As mentioned above, water loss can be rapid on a Ketogenic Diet. To prevent dehydration, consumption of more water than accustomed to will be necessary. If an individual experiences lightheadedness, brain fog, constipation, and headaches, dehydration may be the culprit.|
|Electrolytes||Due to the increased water expulsion by the kidneys, many electrolytes are simultaneously lost. Electrolyte imbalances are heavily responsible for catching the “Keto-Flu.” Important electrolytes to pay careful attention to and one must consider replacing are: Sodium, Potassium and Magnesium. These electrolytes can be replenished through increasing your intake of certain foods and/or supplementation.|
Here is our user-friendly, step-by-step guide to create a Ketogenic meal:
- Choose A Protein Source – Choose a protein source of preference. Typically, it is easier to choose a fattier protein source such as red meat, eggs, salmon, or chicken thighs. However, leaner meats will likely still work, fat will just have to be added elsewhere.
- Add a High-Fiber Vegetable(s) – Selection preference is given to cruciferous, dark-leafy greens. Salads following the suggested criteria for a well-formulated Ketogenic Diet are always an excellent option.
- Top with Fat – It is imperative than individuals on a Ketogenic Diet consume adequate fat. This macronutrient can be achieved through the incorporation of full-fat salad dressings, butter, oils (e.g. coconut, olive oil), full-fat cheeses and lower carbohydrate nuts.
Snacking on a Ketogenic Diet
Snacking on a Ketogenic Diet is not a requirement and is a personal choice made on an individual basis. Here is our list of Top 6 easy low carb snacks on the go if hunger arises:
- String Cheese
- Pork Rinds
- Hard Boiled Eggs
- Nuts and Seeds
- Dehydrated Meats/Jerky
For those of you looking to mix up your food choices, be sure to give some of our favorite keto recipes a try:
Tips For Dining Out
Using the provided tips below, maintaining a Ketogenic lifestyle while dining out is stress-free.
- Check out the menu ahead of time.
- Ask questions! Inquire with the server as to how how a dish is prepared (sauces, dressings).
- Avoid the bread basket.
- When in doubt, keep it simple by ordering meat and veggies or a side salad with a fatty dressing.
Supplements on a Ketogenic Diet
|Electrolytes||To reiterate, maintaining electrolyte balances is critical on a Ketogenic Diet in order to prevent side-effects and the “Keto-flu.” While this can be done exclusively through whole foods, some individuals may require additional supplementation. Sodium, magnesium, and potassium can all be replenished via supplementation.|
|Caffeine||Caffeine can be a useful supplement during diet initiation since it is not uncommon for energy to be lower at first.|
|MCT Oil||MCT oil is an oil comprised of the fats primarily found in coconut oil. MCT oil can contribute to ketone production and can be a reliable energy source since it is metabolized so quickly.|
|Fiber||As with electrolytes, fiber can also be acquired exclusively through food. For those individuals who do not prefer eating a lot of vegetables, one may consider a fiber supplement.|
|Green Supplements||To ensure micronutrient levels are sufficient and balanced, some individuals may consider incorporating a green supplement; however, it is critical that the supplement is low in carbohydrates.|
|Fish Oil||Fish oil is an excellent addition to any healthy diet, especially in a diet that is lacking in Omega-3 fatty acids.|
Supplemental or exogenous ketones are gaining popularity and that may very well have been how some of you have heard about the Ketogenic Diet! Exogenous ketones are synthetic ketones that when ingested can increase blood ketone levels. Exogenous ketones can come in the form of powders or liquids. Currently, there is an explosion of ketone supplements on the market, primarily in the form of ketone salts due to the fact that they are cheaper to produce and more palatable than the “jet-fuel” esters.
It is important to note that consuming these supplements does not mean that you are keto-adapted. These products can acutely put your body into a state of ketosis, which can be beneficial for some. However, for most people these products are best consumed in conjunction with a Ketogenic Diet.
Tip: Consuming exogenous ketones during the initial adaptation period could potentially speed up the adaptation process and at the very least provide you with more energy. Once adapted, these products can be great for giving you an additional increase in ketones which could be beneficial for athletic performance, energy, cognitive performance, and maybe even disease treatment.
Ketone salts consist of the beta-hydroxybutyrate (BHB) molecule bound to a mineral salt such as sodium, calcium, magnesium, potassium (though potassium BHB is very hydroscopic and nearly impossible to make in powdered form by itself) or to amino acids such as lysine, arginine, creatine, citrulline, agmatine, and isoleucine, however these are less popular and just now emerging. These ketone salts appear as a white, powdered substance and have started to become more readily available on the market. The mineral/salt load of these ketone supplements is something that people are immediately weary of. As a society, similar to fat, we have demonized high levels of sodium and most of these supplements use a BHB molecule bound to sodium as a main source of ketones. In general, the mineral content varies depending on what molecule it is bound to. As a general example, the sodium content is usually around 18 percent, magnesium 10.5 percent, and calcium 16 percent, respectively, for each gram of ketone salt.
In order to avoid any potential issues with the mineral loads of the ketone salts, various ketone esters have been developed. Ketone esters are salt free and can exist as a mono (one), di (two) ester, or even in tri (three) ester forms. Without going into great detail, what this means is that instead of binding the ketone to a mineral like we discussed above, the ketone molecule is bound to a different substance (via an ester bond). This means that these ketone esters are liquid compared to the ketone salts which are powder.
More and more research is emerging utilizing both ketone esters and ketones salts. Studies have shown everything from improved cycling performance to serving as an effective aid in assisting with Alzheimer’s disease. By elevating ketone levels to a degree typically only seen on a very strict diet, it is plausible that individuals will obtain many of the benefits that ketones themselves offer (i.e neuroprotection, fuel source, lowering inflammatory markers, etc.).
Keto For Therapeutics
In the “Benefits of Ketogenic Dieting” section we touched on the therapeutic potential of being in a state of ketosis.
Keto and Blood Lipids
Lack of proper education has incorrectly held a high-fat diet responsible for an increase in blood lipids. Decades of research combined with efforts to shift the paradigm, are now revealing that increased dietary fat consumption does not directly result in increased blood lipids. It is actually carbohydrate consumption that will actually increase total cholesterol with noticeable increases in the HDL “good” cholesterol.
Keto For Diabetes
The Ketogenic Diet can be extremely effective therapeutic treatment for Diabetes. Since Type 2 Diabetes is hallmarked by insulin resistance, a Ketogenic Diet can lower and stabilize both blood glucose and insulin levels, improving insulin sensitivity, and providing an alternative fuel source through ketone production. Due to the numerous benefits of the Ketogenic Diet, common contributors to Diabetes such as obesity can be managed or prevented.
Keto For Epilepsy
Keto For Cancer
Cancer is now being thought of as a metabolic disorder in which and glucose can fuel its progression. Due to recent light shed on this subject, intensive investigations are underway and have begun to reveal that restricting carbohydrate intake can slow cancer progression and a full-Ketogenic-state may elicit even greater therapeutic benefits. Furthermore, research also suggests that fasting and the state of ketosis may increase the sensitivity of cancer cells to radiation and chemotherapy.
Keto For Alzheimer’s Disease
One characteristic of Alzheimer’s disease is insulin resistance in the brain which in turn, robs this critical tissue of energy. Limiting glucose while introducing ketones can provide an effective mechanism to replenish the energy in the tissue. The higher level of ketone production accompanied with a Ketogenic Diet is another example as to why this Diet is superior to one that simply restricts carbohydrate intake. Additionally, Alzheimer’s Disease is characterized by Beta-amyloid deposition which may also be mitigated by the implementation of a Ketogenic Diet.
Keto For Parkinson’s Disease
Parkinson’s Disease develops as a result from neuron death in the midbrain and is accompanied by tremors as well as physical and cognitive impairments. Due to its neuroprotective effects, the Ketogenic Diet can help protect neurons, increase energy production and mitochondrial function, lower inflammation, and improve motor function-all of which play a role in Parkinson’s Disease.
Keto For Traumatic Brain Injury
Research involving Traumatic Brain Injury (TBI) has found that upon trauma to the head, the brain takes up massive amounts of glucose. This damage, in turn, leads to insulin resistance and inflammation in brain tissue. The anti-oxidative and anti-inflammatory properties of ketones have been shown not only to reduce inflammation but also reduce glucose uptake in the brain. The Ketogenic Diet may also be a therapeutic treatment option for those individuals who have experienced long-term ramifications of a TBI as they also experience impaired glucose uptake in the brain tissue.
The following list are what we consider emerging areas of interest. For some of these disorders, scientists are still working to gather more data on the use of a Ketogenic Diet as a treatment option:
- Crohn’s Disease
- Multiple Sclerosis
- Rett Syndrome
- Angelman Syndrome
- Bipolar Disorder
- Post-Traumatic Stress Disorder
- Huntington’s Disease
- Polycystic Ovary Syndrome (PCOS)
- Amyotrophic Lateral Sclerosis (ALS)
- Attention Deficit Hyperactivity Disorder (ADHD)
- Glut-1 Deficiency Syndrome
- Glycogen Storage Disease
- Inherited Metabolic Disorders
- Aging and Longevity
Frequently Asked Questions
Do I Have to Stay Keto Forever?
No! Studies have actually found that if you go low carb following a Ketogenic Diet, you can still maintain and even further increase your results.
What Happens if I Fall off the Diet?
If you “slip-up” on your Ketogenic Diet, it is not the end-of-the world nor does it mean you should continue off the bandwagon. Unfortunately, having frequent “slip-ups” or “cheat days” may prevent you from becoming “keto-adapted.” However, an occasional “slip-up” for someone who is already “keto-adapted” may not be as detrimental. It should be noted that fluctuating in and out of a Ketogenic state may result in brain fog.
Can I Have Alcohol?
Certain alcohols, in moderation, may be well-tolerated by some individuals. An example of a Ketogenic-friendly red wine (e.g. Dry Farm Wines) and/or low carbohydrate beers may permit certain individuals to remain in a Ketogenic state. Be sure to avoid sugary liquors and beer as well as sugar-filled mixers.
Do I Have to Count Calories?
Restricting your calories may be important for some individuals and may aid in the initiation of ketosis; however, not everyone will require caloric-restriction and more importantly, not everyone will be required to track calories. It is not uncommon for individuals to be so satisfied on the Ketogenic Diet that caloric-restriction occurs inadvertently.
Should I Do a Carb Refeed?
A carbohydrate refeed is not necessary on a low carbohydrate Ketogenic Diet as the proper biological and metabolic changes do not require such carbohydrate macronutrient. There are certain circumstances in which an increase in carbohydrates could be beneficial. However, it must be noted that side-effects and time may be required to transition back to a fully Ketogenic state. More research is needed on this topic, specifically with respect to variations of Ketogenic Dieting including “Cyclic” and “Targeted.”
What is Fasting?
By definition, fasting is the absence of food consumption for a distinct period of time. There are several different fasting strategies:
- Alternate Day
- Whole Day(s)
What is Fat Fasting?
Fat fasting is the consumption of only the macronutrient, “fat” during the fasting period. This is where the famous incorporation of fat filled coffee (butter and coconut oil) has become so popular.
Will I Lose Muscle?
Among the many benefits of being in a Ketogenic state, one of which is muscle preservation. Research has demonstrated that ketones prevent muscle catabolism and furthermore, muscle anabolism may actually occur once “keto-adapted.” For these reasons alone, the Ketogenic Diet is far more superior than a low carbohydrate diet alone.
What are Exogenous Ketones?
Exogenous ketones are molecules, that upon consumption, behave similar to the endogenous ketones that body produces upon the adoption of a Ketogenic Diet.
Will I be Hungry?
At first, you may experience intense hunger; however, if your Diet is well-formulated, once your ketones become elevated and your blood glucose stabilizes, hunger will subside.
What are Medium Chain Triglycerides (MCTs)?
MCTs are fatty acids that are structurally shorter than longer triglycerides that require processing in the gallbladder. As such, MCTs are rapidly digested and are directly used for energy with a lower propensity for fat storage. These fats are a staple on the Ketogenic Diet in which they can be converted to ketones!
Are There Fats I Should Avoid?
Not all fats are created equal! Omega-6 fatty acids as well as “trans” fatty acids should be limited or avoided if possible. Rather one should focus on a diet rich in Omega-3 fatty acids which have anti-inflammatory properties.
Should I Track Net or Total Carbs?
Ketogenic.com suggests tracking total carbs (fiber +non-fiber carbohydrates) in the initial stages of “keto-adaptation;” however, once adapted, one may be able to track “net” carbs (Non-fiber carbohydrates minus fiber).
Can I Have Coffee?
Yes! However, in some individuals, caffeine may elevate blood glucose levels. Checking glucose responses to foods may aid in finding optimal foods and macronutrients that may maximize the benefits of a Ketogenic Diet.
Can I Have Fruit?
Some fruits such as berries, have a low glycemic index and are also lower in carbohydrates. While certain individuals may tolerate fruits in minimal amounts, in most cases, they should be avoided completely.
Can I Have Dairy?
As with other customized properties of the diet, the consumption of dairy is also individualized. If digestive or glycemic problems develop due to the lactose and casein in dairy, then avoidance of this in one’s diet may be necessary. Please ensure that if dairy is included in one’s diet that their carbohydrates are accounted for!
Do I Need to Exercise to See Results?
No! Positive results can be seen on the Ketogenic Diet without exercise. However, exercise will enhance your results and possibly help you adapt quicker!
Is the Ketogenic Diet for Everyone?
Most people can tolerate a well-formulated Ketogenic Diet; however, there are some disorders where adopting a Ketogenic Diet may not be recommended.
Can I Have as Much Protein as I Want?
Tracking protein is important for anyone that has adopted a Ketogenic Diet. Depending on activity level and other metabolic factors, some individuals may be able to tolerate more protein. As mentioned above, protein can be gluconeogenic so optimizing this macronutrient is essential in order to remain in a Ketogenic state.
What Do I Do if I Hit a Plateau?
Hitting a plateau on a Ketogenic Diet is possible regardless of your goal. Here is a step-by-step approach to assessing why you have reached a plateau:
- Track Your Macros
- Check Your Calories
- Weigh Your Food
- Meal Frequency
- Try Fasting
- Ensure Adequate Sleep
- Try Exercise
- Food Sensitivity
Can I Impliment a Ketogenic Diet if I Have Elevated Triglycerides or Cholesterol?
Yes! In fact, research has shown that the Ketogenic Diet can be beneficial for improving one’s blood lipid profile.
Can I Have Too Much Fat?
Yes! Calories are still of some importance, even on a low carbohydrate diet. Simply eating unlimited fat consumption will not guarantee results.
How Important are Strict Ketogenic Macronutrient Ratios?
As mentioned several times, depending on an individual’s current metabolic state, activity levels and goals, macronutrient profiles will vary among individuals. In general, we recommend that a beginner adopts the macronutrient ratios: 70/25/5 (Fat/Protein/Carbohydrate) and then customize from here.
Which Sweeteners are Best on a Ketogenic Diet?
One key to the longevity of a Ketogenic Diet is to incorporate foods that are satisfying. If individuals choose to make Ketogenic-friendly desserts, learning which sweeteners permit one to remain in a Ketogenic state is essential. This is another excellent example in which testing blood glucose responses are critical. It is recommended that “raw” sweeteners such as “raw sucralose” or “raw Stevia” are best. Be sure to avoid the use of sweeteners that contain maltodextrin which are not considered to be Keto-friendly.
What about Fiber Intake?
Fiber is critical on a Ketogenic Diet. One may get adequate dietary fiber through the consumption of high-fiber, nutritious, vegetables with meals. As a personal choice, one may opt for a fiber supplement instead.
Ketogenic Success Stories
Highlighting the success of those who have worked hard and stuck to the Ketogenic lifestyle is one of the main focuses of Ketogenic.com. Be sure to check out our Ketogenic Success Story section of the website to get your motivation to join the Ketogenic Community!
If you have a great story, we want to hear it! Be sure to send us your story to email@example.com and tag us on social media so we can share your success with the Ketogenic Community!
Best Ketogenic Resources
For more Ketogenic resources, be sure to check out our Resources page!
We are excited to see that there is a growing number of physicians that are using the Ketogenic Diet to treat some of their patients. However, it may be difficult to locate these doctors so be sure to check out our Keto Clinicians tool to find a Keto Doctor near you!
6-Week Ketogenic Transformation
It’s time to take that next big step to starting your Ketogenic lifestyle today. Having a community of supporters to encourage you along the way can make this transition much easier. To become a part of our Ketogenic.com Community start your 6-Week Keto transformation today! Here’s how you start:
- Visit our Keto For You application so we can help you come up with a personalized Keto plan.
- Find a friend to take a picture of you holding a newspaper with the date.
- Post this picture on Instagram or Facebook tagging Ketogenic.com.
- Post an updated picture at the end of week 2, 4, and 6 using the hashtag #ketogeniccom
Not only will we encourage you along the way but we will also feature your story on our social media as well as on our weekly Transformation Tuesday email blast!
With the Ketogenic lifestyle, we do not suggest simply dipping your toe in the water. There is no better time to start then today, so just jump in!
Dr. Stephen Cunnane has found that the uptake of ketone bodies in the brain is proportional to their production. Additional research has also demonstrated that as uptake of ketones increases, the uptake of glucose decreases in brain tissue. Due to the high-ketone demands of brain, certain tissues that are able to directly oxidize fatty acids will do so in order to make ketone bodies more readily available for the brain.
One study comparing 30, 60, and 100 grams of carbohydrates found that restricting carbohydrates to 30 grams led to a greater increase in ketone production.
A monumental study by George Cahill found that as the fasting time increases, the level of ketone production also increases and then will eventually stabilize. Spading for a period of 40 days, this landmark study is a prime example of the safety of the Ketogenic Diet for a majority of individuals.
Tip: Fasting can still have its place in a ketogenic diet. Many individuals following a ketogenic diet like to follow a regular fasting protocol such as intermittent fasting. This practice is not necessary for success on a ketogenic diet but it can increase results.
Among the many biological modifications that must occur for sufficient ketone body utilization, the upregulation of ketone transporters must take place. Thus, research has demonstrated that chronic elevations in blood ketone levels positively increase the number of these transporters. Therefore adherence, especially during the initial stages of the Ketogenic Diet, is critical.
Research looking at performance measures following the first 6 days of a ketogenic diet have found that performance suffers. However, Paoli found that after a month of ketogenic dieting, performance did not suffer.
Studies comparing blood ketone meters and breath analyzers have found that the results that the two methods give are similar ketone level readings. This suggests that individuals may select the most user-friendly, meaning you may be able to choose which testing method is easiest for you.
- Being in a state of ketosis can suppress the hunger hormones that typically increased during traditional “dieting.” Even after the Ketogenic Diet was stopped, appetite suppression still remained.
- Additional research has demonstrated that eating dietary fat can biologically effect, through suppression, the hormones responsible for appetite stimulation.
- Ketogenic Diet studies, in which the individuals were not calorie restricted, actually consumed less calories throughout the day in addition to feeling satiated.
Sumithran, P., Prendergast, L. A., Delbridge, E., Purcell, K., Shulkes, A., Kriketos, A., et al. (2013). Ketosis and appetite-mediating nutrients and hormones after weight loss. Eur. J. Clin. Nutr. 67, 759–764. doi: 10.1038/ejcn.2013.90
Obici, S., Feng, Z., Arduini, A., Conti, R., & Rossetti, L. (2003). Inhibition of hypothalamic carnitine palmitoyltransferase-1 decreases food intake and glucose production. Nature medicine, 9(6), 756-761.
McClernon, F. J., Yancy, W. S., Eberstein, J. A., Atkins, R. C., & Westman, E. C. (2007). The Effects of a Low‐Carbohydrate Ketogenic Diet and a Low‐Fat Diet on Mood, Hunger, and Other Self‐Reported Symptoms. Obesity, 15(1), 182-182.
Young, C. M., Scanlan, S. S., Im, H. S., & Lutwak, L. (1971). Effect on body composition and other parameters in obese young men of carbohydrate level of reduction diet. The American journal of clinical nutrition, 24(3), 290-296.
Nair, K. S., Welle, S. L., Halliday, D., & Campbell, R. G. (1988). Effect of beta-hydroxybutyrate on whole-body leucine kinetics and fractional mixed skeletal muscle protein synthesis in humans. Journal of Clinical Investigation, 82(1), 198.
Volek, J. S., Sharman, M. J., Love, D. M., Avery, N. G., Scheett, T. P., & Kraemer, W. J. (2002). Body composition and hormonal responses to a carbohydrate-restricted diet. Metabolism, 51(7), 864-870.
Research investigating the effects of fish oil supplementation on a Ketogenic Diet demonstrated greater reductions in triglyceride levels when compared to a Ketogenic Diet without supplementation.
Unrestricted Ketogenic Diet led to incidental calorie restriction, improved insulin sensitivity, reduced serum glucose, reduced HbA1c.
KD led to reduced body weight, HbA1c, triglycerides, and need for diabetic medication.
Boden, G., Sargrad, K., Homko, C., Mozzoli, M., & Stein, T. P. (2005). Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Annals of internal medicine, 142(6), 403-411.
Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P., & Westman, E. C. (2004). A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemiaA randomized, controlled trial. Annals of internal medicine, 140(10), 769-777.
Early studies found that 12% and 42% of children placed on a ketogenic diet experienced full remission or reductions in seizures respectively.
In patients resistant to drugs, the KD can reduce seizures by more than 50%
Bastible, C. (1931). The ketogenic treatment of epilepsy. Irish Journal of Medical Science (1926-1967), 6(9), 506-520.
Freeman, J. M., Vining, E. P., Pillas, D. J., Pyzik, P. L., & Casey, J. C. (1998). The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics, 102(6), 1358-1363.
|KD can reduce tumor growth and prolong survival in mice|
|KD can reduced tumor growth and prolonged survival|
|Stable or partial remission after 28 days on keto|
|Glucose uptake reduction in cancer cells|
|KD + radiation= greater survival rate and slower tumor growth compared to radiation alone|
Morscher, R. J., Aminzadeh-Gohari, S., Feichtinger, R. G., Mayr, J. A., Lang, R., Neureiter, D., ... & Kofler, B. (2015). Inhibition of neuroblastoma tumor growth by ketogenic diet and/or calorie restriction in a CD1-Nu mouse model. PloS one, 10(6), e0129802.
Stafford, P., Abdelwahab, M. G., Preul, M. C., Rho, J. M., & Scheck, A. C. (2010). The ketogenic diet reverses gene expression patterns and reduces reactive oxygen species levels when used as an adjuvant therapy for glioma. Nutrition & metabolism, 7(1), 1
Otto, C., Kaemmerer, U., Illert, B., Muehling, B., Pfetzer, N., Wittig, R., ... & Coy, J. F. (2008). Growth of human gastric cancer cells in nude mice is delayed by a ketogenic diet supplemented with omega-3 fatty acids and medium-chain triglycerides. BMC cancer, 8(1), 1.
Freedland, S. J., Mavropoulos, J., Wang, A., Darshan, M., Demark‐Wahnefried, W., Aronson, W. J., ... & Pizzo, S. V. (2008). Carbohydrate restriction, prostate cancer growth, and the insulin‐like growth factor axis. The Prostate, 68(1), 11-19.)
Fine, E. J., Segal-Isaacson, C. J., Feinman, R. D., Herszkopf, S., Romano, M. C., Tomuta, N., ... & Sparano, J. A. (2012). Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition, 28(10), 1028-1035.
Nebeling, L. C., Miraldi, F., Shurin, S. B., & Lerner, E. (1995). Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. Journal of the American College of Nutrition, 14(2), 202-208.
Klement, R. J., & Champ, C. E. (2014). Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation. Cancer and Metastasis Reviews, 33(1), 217-229
Abdelwahab, M. G., Fenton, K. E., Preul, M. C., Rho, J. M., Lynch, A., Stafford, P., & Scheck, A. C. (2012). The ketogenic diet is an effective adjuvant to radiation therapy for the treatment of malignant glioma. PloS one, 7(5), e36197.
|Ketone uptake and utilization is not impaired in those with Alzeimer’s|
|25% reduction in amyloid- deposition in mice following a Ketogenic Diet.|
|Ketosis led to improvements on the Alzheimer’s Disease Assessment Scale|
Ogawa, M., Fukuyama, H., Ouchi, Y., Yamauchi, H., & Kimura, J. (1996). Altered energy metabolism in Alzheimer's disease. Journal of the neurological sciences, 139(1), 78-82.
Lying‐Tunell, U., Lindblad, B. S., Malmlund, H. O., & Persson, B. (1981). Cerebral blood flow and metabolic rate of oxygen, glucose, lactate, pyruvate, ketone bodies and amino acids. Acta Neurologica Scandinavica, 63(6), 337-350.
Van der Auwera, I., Wera, S., Van Leuven, F., & Henderson, S. T. (2005). A ketogenic diet reduces amyloid beta 40 and 42 in a mouse model of Alzheimer's disease.Nutrition & metabolism, 2(1), 1.
Henderson, S. T., Vogel, J. L., Barr, L. J., Garvin, F., Jones, J. J., & Costantini, L. C. (2009). Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial.Nutrition & metabolism, 6(1), 1.
5 patients diagnosed with Parkinson’s Disease who adopted a Ketogenic Diet saw a 43.4% reduction in the Unified Parkinson Disease Rating Scale.
Injured brain can still metabolize ketones.
Studies in rats on a ketogenic diet suffering a traumatic brain injury demonstrate improved cognitive performance.
Prins, M. L., Lee, S. M., Fujima, L. S., & Hovda, D. A. (2004). Increased cerebral uptake and oxidation of exogenous βHB improves ATP following traumatic brain injury in adult rats. Journal of neurochemistry, 90(3), 666-672.
Appelberg, K. S., Hovda, D. A., & Prins, M. L. (2009). The effects of a ketogenic diet on behavioral outcome after controlled cortical impact injury in the juvenile and adult rat. Journal of neurotrauma, 26(4), 497-506.
Consuming under 20g of carbs a day compared to a low fat diet led to a 4x increase in HDL concentration.
A 12 week low carb diet led to 10% decrease in LDL, a 5% increase in LDL particle size, and a 19% decrease in total VLDL particles.
6 months of Ketogenic Diet led to a 11% decrease in LDL.
Merchant, A. T., Anand, S. S., Kelemen, L. E., Vuksan, V., Jacobs, R., Davis, B., ... & SHARE and SHARE-AP Investigators. (2007). Carbohydrate intake and HDL in a multiethnic population. The American journal of clinical nutrition, 85(1), 225-230.
Wood, R. J., Volek, J. S., Liu, Y., Shachter, N. S., Contois, J. H., & Fernandez, M. L. (2006). Carbohydrate restriction alters lipoprotein metabolism by modifying VLDL, LDL, and HDL subfraction distribution and size in overweight men. The Journal of nutrition, 136(2), 384-389.
- Westman, E. C., Yancy, W. S., Olsen, M. K., Dudley, T., & Guyton, J. R. (2006). Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. International journal of cardiology, 110(2), 212-216.
This study found that a balloon entered into the stomachs of subjects led to feelings of perceived fullness. This means by doing things like drinking more water, we can improve our feeling of fullness.