Ketogenic Dietary Pattern
The Ketogenic Diet is illustrative of a carbohydrate-restricted
intervention that promotes utilization of fat for energy and generates
ketosis, which may reduce hunger.
Encouraged Considerations
• Induction phase: ≤20 grams of
carbohydrate per day from non-starchy
vegetables and leafy greens and adequate
protein to reduce insulin levels and generate
a state of nutritional ketosis.
• Ongoing weight loss phase: Wider variety
of vegetables, seeds and nuts, and low-
glycemic whole fruit (i.e., strawberries and
blueberries).
• Pre-maintenance phase: Once goal weight
is achieved, allow carbohydrate intake to
be slowly increased while monitoring for
weight regain.
• Maintenance phase: 60–90 grams of
carbohydrates per day if weight and health
benefits are maintained, may include
legumes, whole grains, and whole fruits.
• All phases encourage a balance of saturated,
monounsaturated, and polyunsaturated
fatty acids.
Vitamin and fiber
supplementation depending
on patient requirement
Avoid:
• Ultra-processed and
ref ined foods
• Foods with a high glycemic
index/glycemic load
• Foods rich in trans fatty
acids
In all but the maintenance
phase, limit:
• Cereals, breads, and grains
• Dairy products, except
cheese
• Starchy vegetables
• Most f ruits
Advantages Disadvantages
• May contribute to clinically meaningful
weight loss in patients with overweight
or obesity
• May reduce hunger
• Lower carbohydrate food intake will
typically result in lower postprandial
glucose and insulin levels
• If associated with weight loss, a ketogenic
diet may improve glucose metabolism
with improved insulin sensitivity, reduced
fasting glucose, and reduced fasting
insulin levels
• May lower diastolic blood pressure
• May reduce triglyceride and increase high
density lipoprotein cholesterol levels
• Ketonemia may help treat seizures
• Possible patient-specif ic adjunct to
multifactorial therapy for certain kinds of
cancers
• May increase LDL
cholesterol levels,
sometimes substantially
so in patients with genetic
hypercholesterolemia
• An increase in LDL
cholesterol with the
ketogenic diet may be
mitigated by consumption
of polyunsaturated fats
versus saturated fats
• May not improve insulin
sensitivity in patients not
experiencing weight loss
• May cause transient
fatigue and mild decrease
in mental cognition upon
start of a ketogenic diet
• Effects upon physical
exercise performance are
inconsistent
