6
Measurements
Treatment
Ketogenic Diet (Keto or Modified Atkins Diet)
The Ketogenic Diet is illustrative of a carbohydrate-restricted
nutritional intervention that promotes utilization of fat for energy and
generates ketosis, which may reduce hunger.
Encouraged Discouraged
• The induction phase allows no more than
20 grams of carbohydrate per day from
non-starchy vegetables and leafy greens;
encourages adequate protein, and higher
proportion of dietary fat to reduce insulin
levels and generate a state of nutritional
ketosis.
• The ongoing weight loss phase allows a
wider variety of vegetables, seeds and nuts,
and low-glycemic fruits (i.e., strawberries
and blueberries).
• The pre-maintenance phase, after the goal
weight is achieved, allows carbohydrate
intake to be slowly increased - provided
weight gain does not occur.
• In the maintenance phase, 60–90 grams of
carbohydrates per day is allowed if weight
and health benefits are maintained, which
may allow legumes, whole grains, and fruits.
• All phases encourage a balance of saturated,
monounsaturated, and polyunsaturated
fatty acids.
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 low
density lipoprotein
(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
