11
Ketogenic Diet (Keto)
The ketogenic dietary pattern represents a carbohydrate-restricted
intervention that encourages the utilization of fat for energy and
induces ketosis, potentially leading to a reduction in hunger.
Emphasized Considerations
• Induction phase
▶ ≤20 grams of carbohydrate per
day f rom non-starchy vegetables
and leafy greens, and adequate
protein to reduce insulin
levels and generate a state of
nutritional ketosis
• Ongoing weight loss phase
▶ Extensive range of vegetables,
seeds, nuts, and low-glycemic
whole f ruits, such as strawberries
and blueberries
• All phases encourage a balance of
saturated, monounsaturated, and
polyunsaturated fatty acids
Supplementation:
• Vitamins, minerals, and f iber
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 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
• Reducing carbohydrate intake is
generally associated with lower
postprandial glucose and insulin
levels
• When linked to weight loss, a
ketogenic diet may enhance
glucose metabolism, leading to
improved insulin sensitivity, lower
fasting glucose levels, 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
• Although low-density lipoprotein
cholesterol levels typically do not
increase, in some patients, they
can increase substantially
• An elevation in low-density
lipoprotein cholesterol
associated with the ketogenic
diet may be mitigated by
consuming polyunsaturated fats
in preference to saturated fats
• May not improve insulin
sensitivity in patients not
experiencing weight loss
• May cause transient fatigue
and a mild decrease in mental
cognition upon the start of a
ketogenic diet
• The effects of physical exercise
performance are inconsistent
