Prior to the advent of exogenous insulin for the treatment of diabetes mellitus in the 1920's, the mainstay of therapy was dietary modification. Diet recommendations in that era were aimed at controlling glycemia (actually, glycosuria) and were dramatically different from current low-fat, high-carbohydrate dietary recommendations for patients with diabetes [1,2]. For example, the Dr. Elliot Joslin Diabetic Diet in 1923 consisted of "meats, poultry, game, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, tea" and contained approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat [3]. A similar diet was advocated by Dr. Frederick Allen of the same era [4].
I use it to make crepes, which are like thin pancakes. I’ve never used it for pasta. If I were making low carb pasta, I would use my Sprouted Low Carb Flour Mix. It has more carbs per cup than this mix, but it has real wheat and white (sprouted) flours in it, so will be more like real pasta. If you are celiac, you can’t use that mix. If you are gluten-sensitive, you can try small amounts and see how it does for you since many people who can’t tolerate gluten (note: not those with celiac) can use sprouted flours okay. Let me now if you make pasta with that sprouted mix! I’d love to hear your results.
If you are a coconut lover you will really love this hot cereal in the morning. This is one of the best breakfast cereals you can have, especially on a colder day, as it gets you filled up and heated up at the same time. It has a rich coconut flavor which is complemented by the vanilla and is sweet enough to satisfy a sweet tooth, and with only two grams of carbs in each serving, it is definitely low.
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]
VEGETABLES: Before you think that veggies are an unconventional breakfast choice, remember the omelet. Add half a cup of cooked spinach (3.5 grams of fiber) and two cups of mushrooms, which cook down to half a cup, (add 2.4 grams) and you'll have a fiber bonanza. Add a half cup of black beans (7.5 grams) to your eggs by whipping up huevos rancheros or a breakfast burrito wrapped in a low-carb tortilla (9 grams). Don't forget the salsa; it doesn't have appreciable fiber content, but it does make things taste better.
Rest assured, not everyone experiences this side effect of the ketogenic diet and, if you do, it will abate on its own; furthermore, there are some simple preventative steps you can take to lower your likelihood of “catching” this flu. As you adopt a ketogenic diet, make sure you replace electrolytes, eat enough fat to meet your total caloric needs, drink plenty of water, and exercise as you are able. It’s very important, however, to ensure that you aren’t relying on sugary sports drinks to replace electrolytes, as all that added sugar will prevent your metabolism from entering ketosis. Ultimately, electrolytes play a crucial role in our health and many Americans do not consume them at adequate levels, so it is very important to monitor your intake of these nutrients regardless of whether or not you are an adherent of the ketogenic diet.
To replace 1 egg, mix 1 tbsp ground flax meal with 3 tbsp of water and allow it to swell. This can be used to replace the eggs but it will not give to properties that eggs do. Eggs help bind the ingredients, eggs help the baking become light, fluffy and rise. Eggs help emulsify the mixture. This formula is used in many vegan recipes or those who are allergic to eggs. If a recipe is heavily based on eggs, this substitution will not work.
Regrettably I was one of those who couldn’t get the recipe to work. My baking sheets weren’t perfectly flat so it was a real mess, the batter separated on the silpat and I couldn’t get the thing to set. This morning I had an idea and it worked perfectly- I cooked the batter in a non-stick frying pan with a kiss of EVOO like a crepe! Worked like a charm. Made your alfredo sauce with some chopped spinach, simmered the noodles in the sauce a few minutes and served it with a crispy pork roast. What a treat! Thank you so much, I’ll use this recipe again and again.
This article originally appeared in Personal Training Quarterly (PTQ)—a quarterly publication for NSCA Members designed specifically for the personal trainer. Discover easy-to-read, research-based articles that take your training knowledge further with Nutrition, Programming, and Personal Business Development columns in each quarterly, electronic issue. Read more articles from PTQ »
Natural fat, high-fat sauces – Most of the calories on a keto diet should come from fat. You’ll likely get much of it from natural sources like meat, fish, eggs etc. But also use fat in cooking, like butter or coconut fat, and add plenty of olive oil to salads etc. You can also eat delicious high-fat sauces including Bearnaise sauce etc., or garlic butter (recipes).

The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[37] are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.[19]
Try to replace all soda and juice consumption with something that has no sugar or only trace amounts of sugar. Switch out fruit juices for low-carb smoothies and tea. Tea comes in a variety of flavors that can help you get through the day if you get tired of water. There are a variety of different smoothies you can make for a meal replacement or as a quick snack as well.
Want perfectly uniform mini burger patties? Try using a lid from a small jar, or a cookie cutter, as a form for your ground beef. You’ll have to find one that is the right size (slightly larger than you want the burger to be once it is cooked) but once you have it you’re good to go. Line the lid with plastic wrap to keep the ground beef from sticking inside of it!
Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]
Low carb egg pasta is typically tasteless, with a similar consistency to regular flour. You will love it for its macro content, combining the protein from eggs with the fat from the cream cheese. Eggs are one of the most affordable, nutrient dense foods you can buy, with zero carbs, 7 grams of fat and 6 grams of protein[*]. Cream cheese is a keto-friendly dairy product, as long as you buy from a high quality source.

Dr. Campos, it is unfortunate that you retain the medical community’s negative stance on the ketogenic diet, probably picked up in medical school when you studied ketoacidosis, in the midst of an obesity and type II diabetes epidemic that is growing every year, especially among populations who will never see the Harvard Health Letter. The medical community has failed in reversing this trend, especially among children, and the public is picking up the tab, in the form of higher health insurance premiums to treat chronic metabolic diseases which doctors cannot cure. The ketogenic diet does not bid its adherents to eat unhealthy processed meats, and the green leafy vegetables that it emphasizes are important in a number of nutritional deficiencies. People lose weight on the ketogenic diet, they lose their craving for sugar, they feel more satiety, they may become less depressed, their insulin receptors sensitivity is improved, and these are all the good outcomes you fail to mention. There is a growing body of research which demonstrates the neuroprotective effects of the ketogenic diet to slow cancer progression, as well as diseases like Parkinson’s and Alzheimer’s, for which there are no effective medical treatments. Please respect your patients by providing them with evidence-based medical outcomes, not opinions.
Protein can turn into carbohydrates via a metabolic process called gluconeogenesis (making new carbs) and will do in people at varying degrees. Protein turning into carbohydrates means you’re not in ketosis. However, this is generally an overblown statement that only happens at the extreme cases when you are drinking a lot of liquid protein shakes. 
Even if you don’t like the taste of coconut, you may still want to try baking with coconut flour, as the strong taste can actually be masked well with other strong flavors. I find that vanilla, chocolate, and cocoa powder are good additions to help mask the coconut taste for sweet recipes. For savory items, add a little garlic or onion powder. Enhance other flavors with herbs, spices and extracts, and I think you will find you can still enjoy the end result.
We all know that porridge has been used as a breakfast staple forever, but try this alternative! It is quick and easy to make and, with the cinnamon and cloves, provides a warming breakfast which is ideal on colder days. This is a paleo and keto-compliant recipe that takes only minutes to prepare so you can give the whole family a better start in the morning.

When starting a low carb keto diet, it’s best to stick to breakfast basics like eggs, omelettes, quiche, breakfast meats, or even leftovers. Eating cleanly helps re-adjust the taste buds and provides the body with the nutrition it may have missed while eating the standard American diet (SAD). But anyone can get tired of bacon and eggs, so it’s nice to have other options.


Several studies have investigated the potential of LCD or KD on weight loss. For example, Brinkworth et al. (2) compared one year of low-fat (LF) vs. LCD diet in adults with abdominal obesity. Subjects were randomly assigned and diets were isocaloric, with moderate energy restriction. Both groups realized significant weight loss, however, there was no significant difference between groups, suggesting that a LCD was equally effective as a LF diet.
People suffering from diabetes and taking insulin or oral hypoglycemic agents suffer severe hypoglycemia if the medications are not appropriately adjusted before initiating this diet. The ketogenic diet is contraindicated in patients with pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. People on a ketogenic diet rarely can have a false positive breath alcohol test. Due to ketonemia, acetone in the body can sometimes be reduced to isopropanol by hepatic alcohol dehydrogenase which can give a false positive alcohol breath test result. 
At 64 I had over 125 lbs to lose. I started a Keto Diet 7 months ago and have lost 75lbs. I have a number of autominnune issues and my health was so bad I was almost bedridden. I now do a water workout twice a week and yoga. I can see a low carb diet being my way of life after I get down to my goal weight. I feel so much better and I agree I am never hungry. I recommend the Bullet Proof Coffee for Kate. Coffee with cream, coconut butter and butter, blend. Adds fat to your diet and keeps you full.

Fiber and fatty acids combine in ground flaxseed with ALA and other proteins. Flaxseed promotes healthy cholesterol levels, and its fiber will help to keep your digestive tract running smoothly. The ALA and other proteins promote heart health by increasing the muscle energy of the heart. Smooth hair, clear skin and healthy nails are some other side benefits of flaxseed.
There is nothing inherently difficult about following a ketogenic diet. We have many patients who do this very easily over many years. The metabolic benefits significantly outway any perceived challenges from limiting particular food types. Uptake would be far more widespread if nutrition professionals left their predujical opinions of SFA’s behind. Finally, given the expertise in Ketogenic Diets at Harvard, Dr David Ludwig, for one springs to mind, I am surprised the author did not avail themselves of the local expertise.
Gluconeogenesis is the endogenous production of glucose in the body, especially in the liver primarily from lactic acid, glycerol, and the amino acids alanine and glutamine. When glucose availability drops further, the endogenous production of glucose is not able to keep up with the needs of the body and ketogenesis begins in order to provide an alternate source of energy in the form of ketone bodies. Ketone bodies replace glucose as a primary source of energy. During ketogenesis due to low blood glucose feedback, stimulus for insulin secretion is also low, which sharply reduces the stimulus for fat and glucose storage. Other hormonal changes may contribute to the increased breakdown of fats that result in fatty acids. Fatty acids are metabolized to acetoacetate which is later converted to beta-hydroxybutyrate and acetone. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained. This metabolic state is referred to as "nutritional ketosis." As long as the body is deprived of carbohydrates, metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-threatening condition where ketone bodies are produced in extremely larger concentrations, altering blood ph to acidotic a state.
There is also a common worry the ketogenic diet may cause ketoacidosis, which occurs when the acidity in the blood increases. Diabetic ketoacidosis is a life-threatening condition caused by very high blood sugars and a deficiency of insulin in insulin-dependent diabetics, a very different state from ketones produced by a fat-burning metabolism on a low-carb, high-fat diet.
My point here is that the warnings about the ketogenic principles are well taken and well documented. My concern is implications that this is a fad. I don’t use the word diet with my patients and I’m concerned that the principles behind the label and the real results that these readers have commented on might get minimized. I have found it best to encourage patients to read authors like: Stephen Phinney, Jeff Volek, Patricia Daly, and Charles Gant and the be partners with their doctors and check blood work as they move along. I am not for or against the article. If ketogenic principles offer people enduring, satisfying, and cohesive change then why not read about its potential and flexilbity?
I’ve tried a ”ton” of low carbs foods...so trust me when I tell you how good this stuff is. If your low carb or keto...Sola products are sanity in a bag with a taste authenticity comparitative to their high carb counterparts. You won’t be disappointed so go ahead and order extra. I like to put it in my yogurt, cottage cheese, protein shakes, sugar free pudding, etc. It’s the jam with almond milk by itself too.

Quite by coincidence I started Keto around the same time as you. I’m 48 and had been struggling with hormones. I’ve lost 10 pounds, not bragging as I had far more to lose than you. I have 2 questions. First, I’m struggling with getting all of my fat in. Never thought I’d tire of avocados. Do you have any good fat bomb recipes? I’ve tried many online and they just don’t taste good at all. Hoping with all your experience you may have some ideas. Most websites have the same recipes as others.
i made these for my husband and me today. I used a blue silicone donut pan that i purchased from amazon. I followed the recipe exactly. I oiled the pan with coconut oil. I let the batter sit for 10 minutes before putting it in pan, like one of the other comments suggested. I let it cool for 20 minutes and they came right out…perfect. He had one at 3:00 and just now another at 9:00. He’s not happy about being on keto most days, but his comment after eating both times was: good, very very good! Thank you so much for sharing your life and time with us.
Hi Shandelle, Sorry to hear that it didn’t rise for you! I don’t live at high altitude so can’t test in those conditions. I’ve read that high altitude baking usually requires reducing baking powder slightly and increasing oven temperature by 15-25 degrees. If your bread rose at first but then fell flat, this could help. If it never rose in the first place, you could try more baking powder and whisking the batter more to introduce more air. I’m so glad that you like the recipes overall though!
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.
Most low-carb diet authors don't recommend bothering with it. Even many of those who think a ketogenic diet is a good thing just assume that a very-low-carbohydrate diet (under about 50 net grams of carbohydrate) is ketogenic. On the other hand, many people have found that monitoring their ketones, at least for a while, provides valuable information.
You can grind almost any nut to obtain a flour-like consistency and use it to reduce the carb content of your recipes. Walnut meal, for example, can be used in many recipes that call for almond flour. Other nut flours that you can experiment with are hazelnut meal, pecan meal, macadamia nut meal, and pistachio meal. Each one will provide your baked goods with a unique flavor, so choose wisely.
A well-formulated ketogenic diet, besides limiting carbohydrates, also limits protein intake moderately to less than 1g/lb body weight, unless individuals are performing heavy exercise involving weight training when the protein intake can be increased to 1.5g/lb body weight. This is to prevent the endogenous production of glucose in the body via gluconeogenesis. However, it does not restrict fat or overall daily calories. People on a ketogenic diet initially experience rapid weight loss up to 10 lbs in 2 weeks or less. This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by a fat loss. Interestingly with this diet plan, lean body muscle is largely spared. As a nutritional ketosis state sustains, hunger pangs subside, and an overall reduction in caloric intake helps to further weight loss.
Hi Cathy, are you adapting these recipes yourself or are they already developed using coconut flour? From experience, it takes a lot of attempts to get it right (but fun too, it brings out the scientist in me). Coconut flour requires a high number of eggs for volume, thickening, protein, binding, and structure. I would be worried if there was too much avocado in there as that is just adding a soft ingredient that gives no structure. The sweet potato would add volume but unless there is enough eggs and coconut flour in the recipe, again it won’t add to the solidity of the final recipe. Psyllium I add purely to get a better crumb texture. It swells and thickens and helps bind all the other ingredients together nicely. Scones – they won’t have risen because of the lack of gluten (yay), but I quite like heavy scones as a personal choice. I started baking using recipes that had already been developed using these low-carb flours, and start by adjusting the flavours only not the ratios of the bulk ingredients. You will soon get the hang of them. Start with my flourless berry sponge, I use these ratios all-the-time! Yum.
Hi Cathy, are you adapting these recipes yourself or are they already developed using coconut flour? From experience, it takes a lot of attempts to get it right (but fun too, it brings out the scientist in me). Coconut flour requires a high number of eggs for volume, thickening, protein, binding, and structure. I would be worried if there was too much avocado in there as that is just adding a soft ingredient that gives no structure. The sweet potato would add volume but unless there is enough eggs and coconut flour in the recipe, again it won’t add to the solidity of the final recipe. Psyllium I add purely to get a better crumb texture. It swells and thickens and helps bind all the other ingredients together nicely. Scones – they won’t have risen because of the lack of gluten (yay), but I quite like heavy scones as a personal choice. I started baking using recipes that had already been developed using these low-carb flours, and start by adjusting the flavours only not the ratios of the bulk ingredients. You will soon get the hang of them. Start with my flourless berry sponge, I use these ratios all-the-time! Yum.
Low-carb baking can be a challenge because many of the substitutes for wheat flour, such as bean flour, are very carbohydrate-dense. Flours made with nuts, seeds, soy and coconut are good options, but you will have to play with oven temperature, baking time and recipe ingredients. For the best results, look for recipes that call for your preferred low-carb flour. Remember that although the flour may be low-carb, other ingredients such as sugar will add carbohydrates.
I greased the inside of the mould with melted butter first making sure I didn’t miss the cone or donut hole. I baked in a foster oven until there were 5 mins left. 3.25° for 30mins. When 5 mins were left I turned off the oven and let them sit in the remaining heat for 5 mins. Took them out and set them to cool for a while. Once they were cool I turned them over on to wax paper and they came out no problem nothing stuck even the donut hole.
Participants returned every other week for 16 weeks for further diet counseling and medication adjustment. When a participant neared half the weight loss goal or experienced cravings, he or she was advised to increase carbohydrate intake by approximately 5 g per day each week as long as weight loss continued. Participants could choose 5 g carbohydrate portions from one of the following foods each week: salad vegetables, low-carbohydrate vegetables, hard or soft cheese, nuts, or low-carbohydrate snacks. Diabetes medication adjustment was based on twice daily glucometer readings and hypoglycemic episodes, while diuretic and other anti-hypertensive medication adjustments were based on orthostatic symptoms, blood pressure, and lower extremity edema.
Moreover, two recent meta-analyses sought to investigate the effect of LCD on weight loss and cardiovascular disease risk. Sackner-Bernstein et al. (19) compared LCD to LF, among overweight and obese men and women. The authors found a significantly greater effect of weight loss in the LCD vs. the LF diets (-8.2 kg vs. -5.9 kg). The impact of diet on cardiovascular risk factors was split, with LCD resulting in significantly greater improvements in HDL cholesterol and triglycerides, while the LF resulted in significantly greater improvements in LDL and total cholesterol. From this the authors concluded that LCD were a viable alternative to LF diets and recommended “dietary recommendations for weight loss should be revisited to consider this additional evidence of the benefits of [low] CHO diets.” A significant limitation of this meta-analysis, however, was the authors’ definition of low-carbohydrate as a daily CHO consumption less than 120 grams. This value, while well below the standard recommendation of daily CHO consumption, still far exceeds the strict recommendation of KD (≤50 g/day), therefore the results of this meta-analysis must be approached with caution.
Cereal is a tough one to give up when starting a low carb, grain-free or paleo diet. It’s easy to make, it’s tasty and it fills you up. For a little bit, anyway, before the subsequent blood sugar crash. But it turns out that you don’t have to give it up at all, as long as you are willing to make your own. And many of these low carb cereal recipes are almost as easy to make as grabbing the box from your cupboard and pouring cereal into your bowl. From granola to squares to hot cereals for a cold winter morning, we’ve got you covered.

Make things yourself. While it’s extremely convenient to buy most things pre-made or pre-cooked, it always adds to the price per pound on items. Try prepping veggies ahead of time instead of buying pre-cut ones. Try making your stew meat from a chuck roast. Or, simply try to make your mayo and salad dressings at home. The simplest of things can work to cut down on your overall grocery shopping.
In summary, the LCKD had positive effects on body weight, waist measurement, serum triglycerides, and glycemic control in a cohort of 21 participants with type 2 diabetes. Most impressive is that improvement in hemoglobin A1c was observed despite a small sample size and short duration of follow-up, and this improvement in glycemic control occurred while diabetes medications were reduced substantially in many participants. Future research must further examine the optimal medication adjustments, particularly for diabetes and diuretic agents, in order to avoid possible complications of hypoglycemia and dehydration. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
The importance of dietary CHO is so well ingrained that the concept is taken for granted. In fact, basic macronutrient guidelines are predicated upon the idea that the central nervous system (CNS) requires a minimum of ~130 grams (~520 kcal) per day to function properly (i.e., to maintain optimal cognitive function). As a result, the minimum recommended daily intake of CHO reflects this idea (7). Similarly, most contemporary texts on sports nutrition emphasize the outsized role of CHO in optimizing both athletic performance and recovery (9). Frequently referred to as the “master fuel,” recommendations range from 3 – 12 grams per kilogram of bodyweight, per day. As an example, the recommended daily intake for a 180-lb athlete would be 246 – 982 grams, with a caloric equivalent of 984 – 3,928 calories. In marked contrast, the KD would recommend a maximum of just 50 grams (~ 200 calories) per day for the same individual.
I was doing LCHF (under 20 carbs most days) , Type II diabetic on a little insulin, After less than 3 mos I brought my A1C from 10.9 down to 7.1…….off to a great start. Now…..I am not only diabetic, I recently had open heart surgery (quadruple bypass),meaning “cardiac diet”. Do you know of any diabetic/cardiac people that are doing Keto? Curious about high fat for cardiac. (FYI: My Doctors are following me closely so know what I’m doing.)
Toasted coconut flakes make the perfect alternative to corn flakes in cereals like this one, letting you still enjoy the crunch but without the added issues that traditional cereals can cause. Just be careful to watch the flakes as they toast so they don’t burn. Serve this cereal with your favorite milk and a few berries and you have a tasty and filling breakfast cereal to keep you going all morning.
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