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A sudden drop in carbs can lead to a drop in energy levels, with some dieters reporting unusual fatigue, confusion, or brain fog. “The symptoms are from your brain needing to adjust to the new source of energy, while also trying to deal with a drop in electrolyte levels as you lose weight,” says Sharp. It can also cause nausea, stomach pain, cramping, and constipation, as well, due to the diet’s high-fat and low-fiber makeup.
As low-carb dietitian Franziska Spritzler, RD, CDE, who’s based in Orange County, California, points out, when you cut back on carbs, blood sugar and insulin levels generally go down, which can be a good thing for some people. “Carbs are broken down into glucose, which raises your blood sugar and prompts your pancreas to produce insulin to drive sugar into your cells,” says Spritzler. “When you’re overweight or obese, your blood sugar goes up and your pancreas sends out insulin, but your cells may not be responsive, leading your pancreas to overproduce insulin,” she says. High insulin increases hunger and prompts fat storage, she explains.
Sleep enough and minimize stress. Most people benefit from a minimum of seven hours of sleep per night on average. And try to keep stress under control. Sleep deprivation and stress hormones raise blood sugar levels, slowing ketosis and weight loss. Plus they might make it harder to stick to a keto diet and resist temptations. So while handling sleep and stress will not get you into ketosis on their own, they are still worth thinking about.
In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[54]
A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (two weeks), but the long-term seizure reduction rates are unaffected.[44] Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.[9]
Low-carb diets may improve high-density lipoprotein (HDL) cholesterol and triglyceride values slightly more than do moderate-carb diets. That may be due not only to how many carbs you eat but also to the quality of your other food choices. Lean protein (fish, poultry, legumes), healthy fats (monounsaturated and polyunsaturated) and unprocessed carbs — such as whole grains, legumes, vegetables, fruits and low-fat dairy products — are generally healthier choices.

Vegetables that grow above ground: Cauliflower, broccoli, cabbage and Brussels sprouts, kale, collards, bok choy, spinach, asparagus, zucchini, eggplant, olives, spinach, mushrooms, cucumber, avocado, onions, peppers, tomatoes, lettuce, other kinds of leafy greens etc. These are lowest in net carbs and can be enjoyed at all levels of carb restriction. However, if you are following a keto diet (< 20 grams of carbs per day), you may need to limit your portions for certain types, like bell peppers and Brussels sprouts. Low-carb vegetables guide


The remaining calories in the keto diet come from protein — about 1 gram (g) per kilogram of body weight, so a 140-pound woman would need about 64 g of protein total. As for carbs: “Every body is different, but most people maintain ketosis with between 20 and 50 g of net carbs per day,” says Mattinson. Total carbohydrates minus fiber equals net carbs, she explains.

There’s no scientific definition of keto flu, but it’s often described as flu-like symptoms that start soon after a person cuts carbohydrates largely out of their diet. (To enable “ketosis,” a sort of starvation mode in which the body burns fat rather than glucose, the ketogenic diet allows for only 2% to 5% of a person’s daily calories to come from carbohydrates.)
The medical community is taking note of the high public interest in keto. An article in the Jan. 16, 2018, Journal of the American Medical Association summarized several areas of promise: Many people feel less hungry on the high-fat keto diet and so may naturally reduce their overall calorie intake. Beyond weight loss, there was good news for diabetes management, with improved insulin sensitivity and blood-sugar control for people following a ketogenic diet in an early, still-ongoing study. However, an editorial appearing online July 15, 2019, in JAMA Internal Medicine concluded that “enthusiasm outpaces evidence” when it comes to a keto diet for obesity and diabetes.
When you eat less than 50 grams of carbs a day, your body eventually runs out of fuel (blood sugar) it can use quickly. This typically takes 3 to 4 days. Then you’ll start to break down protein and fat for energy, which can make you lose weight. This is called ketosis. It's important to note that the ketogenic diet is a short term diet that's focussed on weight loss rather than the pursuit of health benefits. 
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