How keto diet works?

It’s all the rage. The internet is filled with stories of how everyone from movie stars to ordinary people have shed stubborn pounds with the ketogenic diet. Some suggest that this eating pattern also may be helpful for managing diabetes and warding off Alzheimer’s disease. So, is it a miracle diet or just the latest fad?

How the Keto Diet Works

The ketogenic diet is a high fat, moderate protein, low carbohydrate eating pattern, which differs from general, healthful eating recommendations. Many nutrient-rich foods are sources of carbohydrates, including fruits, vegetables, whole grains, milk and yogurt. On a keto diet, carbs from all sources are severely restricted. With the goal of keeping carbs below 50 grams per day, keto dieters often consume no breads, grains or cereals. And, even fruits and vegetables are limited because they, too, contain carbs. For most people, the keto diet requires making big shifts in how they usually eat.

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Why does the Keto diet restrict carbs?

Carbs are the main source of energy for our body. Without enough carbs for energy, the body breaks down fat into ketones. The ketones then become the primary source of fuel for the body. Ketones provide energy for the heart, kidneys and other muscles. The body also uses ketones as an alternative energy source for the brain. Hence, the name for this eating pattern.

For our bodies, a ketogenic diet is actually a partial fast. During a total fast or starvation state, the body has no source of energy. Thus, it breaks down lean muscle mass for fuel. With the keto diet, the ketones provide an alternative source of energy. Unlike a full fast, the keto diet helps to maintain lean muscle mass.

Is the Keto Diet Safe?

This eating pattern is not recommended for individuals with:
• Pancreatic disease
• Liver conditions
• Thyroid problems
• Eating disorders or a history of eating disorders
• Gallbladder disease or those who have had their gallbladders removed

Plus, there are both short-term and long-term health risks for all people associated with the keto diet. Short term health risks include flu-like symptoms. For example, upset stomach, headache, fatigue and dizzy spells. This is called the “keto flu.” Some people also report trouble sleeping.  Cutting back on high-fiber vegetables, fruits and whole grains also can increase risk for constipation. Often keto dieters must take a fiber supplement to help stay regular, but this should be discussed with a health care provider.

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Long term health risks of the keto diet include kidney stones, liver disease and deficiencies of vitamins and minerals. To limit carbs, many nutrient-rich vegetables and fruits are cut out. Thus, intakes of vitamin A, C, K and folate usually are low.

The high fat nature of the keto diet is very controversial. A considerable body of research has shown that diets high in saturated fat may increase the risk for heart disease and other chronic health problems. The risk that keto dieters might be taking with regards to their long-term cardiovascular health has not been fully studied.

What the Science Tell Us About the Keto Diet

The keto diet has been used to help manage epilepsy, a disorder characterized by seizures, for more than 100 years. More recent studies are evaluating the keto diet as an alternative dietary treatment for obesity and diabetes. Research findings on the benefits of the keto diet for these health conditions are extremely limited. Studies on effectiveness of the keto diet were conducted with small groups of people. And, most of the research about Alzheimer’s disease relies on research done on lab animals. To fully assess the safety of this eating pattern, more research is needed. Plus, studies must be done on the long-term health effects of the keto diet.

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Body mass index and individual metabolic rates impact how quickly different individuals produce ketones. This means that on the keto diet, some people lose weight more slowly than others — even if they are following the same exact keto diet plan. For this group of people, the keto diet can be frustrating and may impact their motivation for making healthy dietary changes. Plus, many people are not able to stick with the keto diet and gain back the weight after returning to their previous pattern of eating.

The Bottom Line

The ketogenic diet is quite restrictive. Research supports this eating pattern for epilepsy when managed along with a health care team, since its treatment can be very complex. However, with regards to the keto diet as a tool for weight loss and other health benefits, the jury is still out.

For a personalized weight management plan that meets your individual needs, consult a registered dietitian nutritionist. An RDN can create a personalized weight loss program based on your unique health and nutrition needs and goals. To find a dietitian in your area, search the Academy's Find an Expert database.

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Keto diet benefits:

• Burns body fat: When you’re on keto, your body uses stored body fat and fat from your diet as fuel. The result? Weight loss.[5]
• Reduces appetite: Ketones suppress ghrelin — your hunger hormone — and increase cholecystokinin (CCK), which makes you feel full.[6] Reduced appetite means it’s easier to go for longer periods without eating, which encourages your body to dip into its fat stores for energy. More research needs to be done in the area of appetite and ketosis, but it seems a lot of people experience reduced hunger.
• Reduces inflammation: Inflammation is your body’s natural response to an invader it deems harmful. Too much inflammation is bad news because it increases your risk of health problems. A keto diet can reduce inflammation in the body by switching off inflammatory pathways and producing fewer free radicals compared to glucose.
• Fuels your brain: Ketones are so powerful that they can provide a good portion of your brain’s energy needs, which is way more efficient than the energy you get from glucose. Did you know your brain is made up of more than 60 percent fat?That means it needs a lot of fat to keep the engine humming. The quality fats you eat on a ketogenic diet do more than feed your day-to-day activities — they also feed your brain.

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• Increases energy: When your brain uses ketones for fuel, you don’t experience the same energy slumps as you do when you’re eating a lot of carbs. When your metabolism is in fat-burning mode, your body may tap into its readily available fat stores for energy. That means no more energy crashes or brain fog. Ketosis also helps the brain create more mitochondria, the power generators in your cells.[10] More energy in your cells means more energy to get stuff done.
• Curbs cravings: Fat is a satiating macronutrient. You eat a more smart fats on keto, so you feel fuller, longer.

Is keto diet safe for you?

The ketogenic (or keto) diet has been rising in popularity among the low-carb crowd. What makes the keto diet different than other low-carb diets? Why is it popular? And is it safe? Here's a closer look at this latest diet trend.

Back in the 1920's, scientists discovered that a diet very high in fat and very low in carbohydrate helped treat children with epilepsy. The keto diet works by depriving the body of glucose, which is found in carbohydrates. This in turn forces the body to convert fat into energy, forming ketones that are released from your liver. This process of ketosis, the metabolic state where the body derives the energy it needs from fat instead of carbs, also happens with fasting, when the body must rely on fat stores for energy. It isn't completely known why this diet worked for epilepsy, but the results were very positive for the patients.

When the keto diet was first introduced to children with epilepsy, they were instructed to follow a very strict diet, requiring 100 percent commitment. The children were admitted into the hospital so they could be fully monitored. They started with a period of fasting, which produced significant levels of ketones in the body. They were then fed a very high-fat, low-carb diet. After 1-2 months, many children were able to reduce their seizure medication.

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What Is the Keto Diet Good For

The Keto Diet and Weight Loss

Fast forward to today, when the Keto Diet has become popular for weight loss. Many studies have been conducted to research the physiological effects of the diet and have found evidence of its effectiveness. One particular study looked at the effect of the Keto Diet on obesity/weight loss, Type 2 diabetes, cardiovascular disease, and acne, and concluded that results are promising, but more research is needed.

Weight loss often occurs with this diet largely because people tend to consume fewer calories on a high fat, low carb, moderate protein diet. For one thing, people on the diet have are a lot fewer foods to choose from; for another, we tend to get full faster with high-fat foods. Also, the mechanism of the body pulling energy from fat stores rather than glucose can force the body to lose weight.

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What is the Difference between the Atkins Diet and the Keto Diet?
Both the Atkins diet and the keto diet are carbohydrate-restriction diets. One key difference is that the Atkins diet allows more protein than the keto diet. With Atkins, you can eat protein to your heart's content; with keto, protein is limited to about 20 percent of daily calories. Also, with Atkins, a phased diet, carbs can be added back into the diet eventually; not so with the keto diet, as introducing carbs would knock the body out of ketosis. Here's more about What You Should Know about the Atkins Diet.

What is the Difference between the Keto and Paleo Diets?
The paleo diet is another carb-reduction diet, but it is not nearly as severe as the keto diet. The carbs cut from the paleo diet are refined carbs of the modern diet; the assumption of the paleo diet being that what was healthy for hunters and gatherers should be healthy for us modern humans, too, since we evolved for many thousands of years under that particular lifestyle and diet. Basically, if a hunter/gatherer would have eaten it, you can, too. So paleo permits healthy carbohydrates, like whole vegetables and fruit, but cuts out processed foods. The keto diet puts more emphasis on fat in the diet. Also, paleo does not anticipate that dieters will go into ketosis, a key feature of the ketogenic diet.

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Is the Keto Diet Safe?

Those interested in trying the Keto Diet should consult with a physician before starting. This diet can be hard on the kidneys and may have other negative effects on the body,including sensations described as "the keto flu" -- nausea, fatigue, headaches, and fogginess in the head. High levels of ketones in the blood along with low levels of insulin can be very unsafe, especially for those with diabetes. Also, the keto diet is difficult to sustain over time because it is so restrictive. For most of us, eating a variety of nutritious foods that we enjoy (including fruits, vegetables, and whole grains), along with getting plenty of exercise, is more likely going to be a sustainable and healthy way to live.

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The keto diet has been used to help manage epilepsy, a disorder characterized by seizures, for more than 100 years. More recent studies are evaluating the keto diet as an alternative dietary treatment for obesity and diabetes. Research findings on the benefits of the keto diet for these health conditions are extremely limited. Studies on effectiveness of the keto diet were conducted with small groups of people. And, most of the research about Alzheimer’s disease relies on research done on lab animals. To fully assess the safety of this eating pattern, more research is needed. Plus, studies must be done on the long-term health effects of the keto diet.

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Body mass index and individual metabolic rates impact how quickly different individuals produce ketones. This means that on the keto diet, some people lose weight more slowly than others — even if they are following the same exact keto diet plan. For this group of people, the keto diet can be frustrating and may impact their motivation for making healthy dietary changes. Plus, many people are not able to stick with the keto diet and gain back the weight after returning to their previous pattern of eating.

What to eat and don’t eat on keto diet?

If you’re looking to get a jump start on your health and fitness goals this year, you may be thinking about trying the ketogenic diet. Maybe you’ve heard the phrase before — it’s a huge diet buzzword — but aren’t sure what it means. Here’s a primer: The ketogenic diet is an eating plan that drives your body into ketosis, a state where the body uses fat as a primary fuel source (instead of carbohydrates), says Stacey Mattinson, RDN, who is based in Austin, Texas.

When you’re eating the foods that get you there (more on that in a minute), your body can enter a state of ketosis in one to three days, she adds. During the diet, the majority of calories you consume come from fat, with a little protein and very little carbohydrates. Ketosis also happens if you eat a very low-calorie diet — think doctor-supervised, only when medically recommended diets of 600 to 800 total calories.

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Benefits and Risks of the Diet That Beginners Need to Know
Before you dive in, it's key to know the possible benefits and risks of keto.

There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.

But for people with diabetes, one big concern is you're eating a lot of fat on keto, and that fat may be saturated, which is unhealthy when eaten in excess. (The much higher total fat intake is also a challenge among keto beginners.)

Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet, to manage diabetes. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.

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In terms of weight loss, you may be interested in trying the ketogenic diet because you’ve heard that it can make a big impact right away. And that’s true. “Ketogenic diets will cause you to lose weight within the first week,” says Mattinson. She explains that your body will first use up all of its glycogen stores (the storage form of carbohydrate). With depleted glycogen, you’ll drop water weight. While it can be motivating to see the number on the scale go down (often dramatically), do keep in mind that most of this is water loss initially.
But the keto diet can be effective over time. One review suggested the keto diet can spur fat loss in obese people when used for a couple of weeks and up to one year. (1) A meta-analysis noted that one reason for weight loss is likely that keto diets suppress hunger. (2)

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One downside to a ketogenic diet for weight loss is the difficulty maintaining it. “Studies show that weight loss results from being on a low-carb diet for more than 12 months tend to be the same as being on a normal, healthy diet,” says Mattinson. While you may be eating more satiating fats (like peanut butter, regular butter, or avocado), you’re also way more limited in what’s allowed on the diet, which can make everyday situations, like eating dinner with family or going out with friends, far more difficult. Because people often find it tough to sustain, it’s easy to rely on it as a short-term diet rather than a long-term lifestyle.

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.
What to Keep in Mind When Creating Your Ketogenic Meal Plan
If you’ve decided to move forward in trying the keto diet, you will want to stick to the parameters of the eating plan. Roughly 60 to 80 percent of your calories will come from fats. That means you’ll eat meats, fats, and oils, and a very limited amount of nonstarchy vegetables, she says. (This is different from a traditional low-carb diet, as even fewer carbs are allowed on the keto diet.)

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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.

One thing to remember: “It’s easy to get ‘kicked out’ of ketosis,” says Mattinson. Meaning, if you eat something as small as a serving of blueberries, your body could revert to burning carbohydrates for fuel rather than fat.

Not losing weight on keto diet

The keto diet is a type of diet that significantly restricts carbohydrate intake. Ordinarily, the body breaks down carbohydrates into the sugar glucose, which it uses for energy. When there are not enough carbs in the body, it goes into a stage called ketosis.

During ketosis, the body becomes very efficient at burning fat and using it instead of glucose for energy. This fat burning makes the ketogenic diet a popular choice for people looking to lose weight.
However, some people may find that they are not losing weight on the keto diet. In most cases, this will be because they have not gone into ketosis.

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There are other reasons why a person may not lose weight while following the keto diet. In this article, we outline the different possibilities. We also provide some general tips that can help a person achieve their weight loss goals.

1. Not achieving ketosis

A person on the keto diet should try to make carbs only 5–10% of their calorie intake.

Usually, when a person does not lose weight on the keto diet, it is because they have not achieved ketosis.

The most common reason for not getting into ketosis is not cutting back enough on carbs. According to a 2019 articleTrusted Source on the ketogenic diet, carbohydrates should represent only 5–10% of a person's calorie intake.

Specifically, most keto diets require a person to cut down to between 20 and 50 grams of carbs each day.

Sometimes, a person may feel as though they have drastically reduced their carb intake. However, they may still be eating enough carbs for the body to produce energy from glucose, and this will prevent the body from burning fat.

A person who is not losing weight on the keto diet may benefit from purchasing a home testing kit. These kits contain test strips that check for the presence of ketones in the urine. A positive result indicates that the body is in ketosis.

Another option is to use a small machine called a ketone breath analyzer that detects ketones in the breath.

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Home testing can be a helpful way for people to ensure that they are actually entering ketosis. People can use this information to make dietary changes that will help them achieve their weight loss goals.

2. Eating too much protein

Many low carb diets allow for a moderate amount of protein. Some people mistakenly think that a low carb, high protein diet is a keto diet. However, this type of diet is unlikely to cause ketosis because the body can break down excess proteins into amino acids and convert them to types of sugar.

A person who is on the keto diet will get most of their calories from fat, which should represent about 55–60%Trusted Source of their calorie intake. This fat intake leaves little room for protein. If protein makes up more than 35% of a person's diet, it is unlikely that they are going into ketosis.

3. Eating too many acceptable carbs

On the keto diet, several types of carbohydrate are acceptable, including nuts and dairy. These foods are typically high fat, nutrient dense foods that make a great addition to a keto diet. However, they also contain carbohydrates.

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Eating too many of these foods will keep a person from achieving and maintaining ketosis.

4. Eating maltitol

Sugar alcohols are typically a good option for people following the keto diet. They provide sweetness without increasing net carbs in the body. However, not all sugar alcohols are alike.

Maltitol is a sugar alcohol that is not keto friendly. Although maltitol is technically a low glycemic index (GI) sugar, it still affects blood sugar levelsTrusted Source. This effect is enough to prevent a person from entering ketosis.

5. Not counting calories

Counting calories may help a person lose weight on the keto diet.
A person who eats more calories than their body can burn is unlikely to lose weight. People who consume too many calories may gain weight, even if they are in a state of ketosis.

High fat foods tend to contain many more calories than foods that are high in carbohydrates and proteins. It is, therefore, important that people keep track of the number of calories that they consume.
Sticking to a balanced meal plan can help a person work toward their ideal weight.

6. Constant snacking

Even when a person has an approved meal plan in mind, if they succumb to continual snacking, this can greatly increase their calorie intake. A snack may help prevent hunger pangs, but it can easily sabotage weight loss efforts.

7. Drinking alcohol

Many alcoholic drinks, including wine and beer, are high in carbohydrates. Most forms of the ketone diet do not allow these types of alcohol.

Hard alcohols, such as gin and vodka, are lower in carbohydrates, meaning that they are generally acceptable on a keto diet. However, these drinks are very calorie dense. As such, even these options can prevent weight loss.

Drinking alcohol is an easy way to increase calorie intake without providing the body with nutrients.

8. Little to no exercise

Exercise is an important part of staying healthy. Exercise also stimulates the body's metabolism and burns calories. It is, therefore, a great tool for dieters.

Exercise may be especially important on a keto diet, as the high fat foods that a person eats contain many calories. Burning calories through exercise can help a person reach their desired weight.

9. High stress

A high stress lifestyle can also stop a person from losing weight on the keto diet. As one 2012 studyTrusted Source notes, stress can cause changes in hormone levels, which can lead to weight gain or difficulty losing weight.

Chronic stress may also cause people to crave comfort foods. These foods add extra calories to the diet.

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10. Underlying medical conditions

Sometimes, a person may be doing everything right and still be unable to lose weight on the keto diet. In some cases, this may be due to an underlying medical condition that is causing weight gain or preventing weight loss. Alternatively, a medication that a person is taking for the underlying condition may be causing increased appetite as a side effect.
Some conditions that can contribute to weight gain include:
• hypothyroidism
• depression
• high insulin levels
• Cushing's syndrome
• polycystic ovary syndrome (PCOS)

A person should see a doctor if they are unable to lose weight despite adhering to a strict diet and exercise plan. The doctor may carry out tests to determine what is preventing weight loss. Treating the underlying condition may resolve the issue.

Recipes for Cholesterol Free Diet

Cholesterol is an essential building block for cells, and the body makes as much of it as it needs on its own.

A diet that that causes the body to produce too much "bad" LDL cholesterol can cause plaques to form in the arteries, leading to coronary heart disease, heart attack, or stroke.

According to the National Heart, Lung, and Blood Institute, the ideal amount of LDL cholesterol in the blood is 100 milligrams per deciliter (mg/dL) or lower.

If a person's LDL level is greater than this, they might consider trying a cholesterol-lowering diet. This is especially the case if the person is at high risk for heart disease due to obesity, diabetes, or other lifestyle or hereditary factors.

Although it seems counter-intuitive, it is not the cholesterol found in foods that relates to a person's blood cholesterol level. It is the saturated and trans fats that need to be reduced.

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Common diet themes

There are many diets available that claim to lower LDL levels. However, the nutritional plans that work best share the same important elements:
• they cut saturated and trans fat intake
• they replace foods high in cholesterol and saturated fats with unsaturated fats, fruits, vegetables, legumes, and wholegrains
• they keep serving size in check to assure a healthy daily calorie intake

Three cholesterol-cutting diets that follow these guidelines are vegan diets, Mediterranean diets, and the National Institute of Health's TLC diet.

Vegan diet

A vegan diet excludes all animal-based foods and is a true cholesterol-free diet.

A vegan diet prohibits eating animal-based foods, including fish, meat, poultry, eggs, and dairy. Only animal-based foods contain cholesterol. For this reason, veganism is the only truly cholesterol-free diet.
While cholesterol intake does not affect LDL levels as much as saturated fat intake does, many foods that have high cholesterol content also contain a lot of saturated fat. By replacing animal-based foods with plant-based foods, people can avoid both of these LDL-raising factors at once.

However, cutting cholesterol and saturated fat intake is not the only way a vegan diet can reduce LDL levels. To make this diet especially effective, it is important that people include nutrients that actively remove LDL cholesterol from the body.

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The most important of these nutrients are:

• Polyunsaturated fats. These stimulate the liver to dispose of LDL cholesterol. They can be found in natural vegetable oils, such as canola, sunflower, and safflower oils.
• Soluble fibers. These dissolve into a gel in the intestines. The gel binds to cholesterol and fats and carries them off to be removed from the body before they can be absorbed into the bloodstream. Soluble fiber is found in oat-based cereals, whole grains, barley, beans, chia seeds, and eggplant. Apples, grapes, strawberries, and citrus fruits are also rich in a kind of soluble fiber called pectin.
• Stanols and sterols. These also block cholesterol from being absorbed into the bloodstream. They can be extracted from certain plants, and are often used to fortify juices and nutrition bars. They can also be taken in supplement form.

According to the National Heart, Lung and Blood Institute, eating 5 to 10 grams (g) of soluble fiber each day can lead to a 5 percent decrease in LDL cholesterol. Within weeks, a daily intake of about 2 g of either stanols or sterols can reduce LDL by about 5 to 15 percent.

Even a vegan diet fortified with these substances can have shortfalls, though. According to a literature review, cutting all animal products from the diet increases risk for vitamin D, vitamin B-12, and zinc deficiency.

Avoiding fish, eggs, and seaweed also deprives one of omega-3s, which are especially heart-healthy polyunsaturated fats. To reduce these risks, it is recommended that people on a vegan diet include:
• vitamin B-12 fortified foods, such as soy and rice beverages and nutritional yeast - leafy vegetables cannot provide enough B-12 on their own
• vitamin D fortified foods, especially during the winter months
• plant foods rich in omega-3s, such as ground flaxseed, walnuts, canola oil, soy products, and hemp-seed based beverages
• foods rich in zinc, such as whole grains, legumes, soy products, and fortified snacks

As veganism has become more popular, many resources have become available to help develop tasty meals that fit an individual's dietary needs. A recent article in Good Housekeeping suggests a variety of creative vegan recipes.

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The Vegetarian Resource Group also offer a wealth of vegan meal ideas on their website, as well as a directory of vegan and vegetarian-friendly restaurants.

Mediterranean diet

Alongside olive oil and fish, the Mediterranean diet consists of fruits, vegetables, starches, nuts, seeds, eggs, and wine.

If giving up animal-based foods is too difficult, following a Mediterranean diet may be a better option. While the Mediterranean diet does not allow much red meat, dairy products, poultry, and fish are acceptable in low to moderate amounts.

The American Heart Association (AHA) explain that while there are many different versions of the Mediterranean diet, each relies on the same basic nutrients:
• olive oil in place of saturated fats
• high volume of fruits and vegetables
• high-fiber starches, such as potatoes, beans, breads, and whole-grain cereals
• nuts and seeds
• fish and poultry
• eggs, up to four times a week
• wine, in small to moderate amounts
Fatty-fish focused dishes, such as this recipe for salmon with apricots, yogurt, and pistachio sauce, are rich in omega-3 fatty acids. Because vegan diets tend to lack omega-3s, a Mediterranean diet can be more healthful than a vegan diet in this sense.

However, the Mediterranean diet also has shortfalls of its own. The biggest concern is calorie intake. Though unsaturated fats and natural starches are not unhealthful, they contain a lot of calories.

If a person doesn't think about portion size carefully, they could end up gaining more weight from a Mediterranean diet. As being overweight and obesity are also risk factors for heart disease, this would defeat the purpose of lowering one's cholesterol.

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The AHA advise that more than half of the fat calories in a Mediterranean diet should come from monounsaturated fats, such as olive oil. While these are much more healthful than saturated or trans fats, they have not been shown to actively signal the liver to cut LDL levels as polyunsaturated fats can.
The TLC diet

Alongside reducing cholesterol in the diet, the TLC diet pairs dietary adjustments with lifestyle changes.

TLC stands for "Therapeutic Lifestyle Changes," and was created by the National Institute of Health in 2005. It is still considered a very strong low-cholesterol option by health experts.

The diet pairs dietary adjustments with lifestyle changes in order to lower one's risk of heart disease as much as possible. It has fewer restrictions than a vegan diet, but it also follows a much more strict, scientific structure.

According to the TLC handbook, a person should consume the following each day:
• less than 7 percent of calories from saturated fat
• 25 to 35 percent of daily calories from total fat
• less than 200 mg of cholesterol
• a low but healthy number of calories, determined with the help of one's doctor
• an optional 2 g per day of plant stanols or sterols
• an optional 10 to 25 g per day of soluble fiber
For women, 1,000 to 1,200 daily calories are usually recommended for weight loss. For men, 1,200 to 1,600 calories are recommended.
This structure is meant to ensure that LDL levels are not only lowered, but that nutrient intake is well balanced and weight is not gained in the process.

Recipes, menu plans, and tips to make vegetables tastier can all be found in the TLC handbook. The AHA also offer an online collection of heart-healthy recipes that are compatible with the TLC diet.

Health benefits

Regardless of which diet a person chooses, making healthy nutritional changes can do more than just lower cholesterol. Cutting saturated fats and increasing the intake of fruits, vegetables, nuts, seeds, and fibers can help promote healthy vision, as well as brain, muscle, bone, and digestive system health.

Weight loss also relieves stress from the major organs and arteries and reduces the risk of developing type 2 diabetes.

Does the keto diet affect cholesterol?

People who follow the ketogenic, or keto, diet eat high amounts of fat, moderate amounts of protein, and minimal amounts of carbohydrates. Some evidence suggests that following this diet can affect cholesterol levels.

Specifically, the keto diet's daily allowances for fat, protein, and carbohydrates are as follows:
• fat: 55–60% of the day's total macronutrients
• protein: 30–35%
• carbohydrates: 5–10%
Some studies suggest that the keto diet can lower levels of high density lipoprotein (HDL), or "good," cholesterol but raise levels of low density lipoprotein (LDL), or "bad," cholesterol. For this reason, the keto diet may not be appropriate for everyone.

For example, healthcare professionals may advise that people with high cholesterol do not follow the keto diet.

In this article, learn more about the keto diet and its effects on cholesterol. We also describe safety considerations.

What does the research say?

Eating a keto diet may affect cholesterol levels.

An older study in the Annals of Internal Medicine divided participants into a keto diet group and a low fat diet group.

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Throughout the study, people in both groups lost more fat mass than fat free mass. Their LDL cholesterol levels did not change, however.
Those in the keto diet group lost more weight, had more significant reductions in triglyceride levels, and had higher HDL cholesterol levels. HDL levels tend to rise when people replace carbohydrates with saturated, monounsaturated, and polyunsaturated fats.

It is important to note that the researchers only followed the participants for 6 months. As a result, it is not clear whether or how their cholesterol levels changed later on.

The authors mention that in previous studies, researchers have found conflicting results.

For example, they refer to one study in which participants who had followed the keto diet for 2 months experienced an average rise in LDL cholesterol levels of 0.62 millimoles per liter (mmol/L). Another study showed a decrease of 0.26 mmol/L in LDL cholesterol levels after 6 months.

A further study monitored people who had followed either the keto diet or a low fat diet for 1 year.

This was a follow-up study to a previous project. The results of the earlier study had suggested that the keto diet leads to more weight loss and healthier cholesterol levels in people with obesity after 6 months.

The researchers note that after 1 year, participants following the keto diet still had lower triglyceride levels and higher HDL cholesterol levels than those following the low fat diet. They also found that people in both groups lost the same amount of weight, on average.

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However, given that all the participants in these studies had obesity, the results may not apply to people without it.

More recent research has continued to arrive at conflicting results. Research from 2016 observed a rise in LDL cholesterol and a decrease in HDL cholesterol linked with the keto diet.

A paper from 2018 reports the opposite, suggesting that the keto diet could raise HDL cholesterol levels.

Risks of the keto diet

A person on a keto diet may experience headaches, weakness, and muscle cramps.

Some people following the keto diet may experience:
• weakness
• headaches
• constipation
• muscle cramps
• blood pressure changes
• the keto flu

The keto flu is a collection of minor, short term symptoms that some people experience when they start the keto diet. These symptoms

 include:
• nausea
• vomiting
• headache
• fatigue
• dizziness
• sleeplessness
• difficulty tolerating exercise
• constipation

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Safety considerations

Several studies have suggested that the keto diet can affect cholesterol levels.

When people consume low amounts of carbohydrates, the liver produces fewer triglycerides, which may be involved in raising HDL cholesterol levels.

However, the keto diet may raise LDL cholesterol levels in some people. As a result, the diet may not be appropriate for everyone.

It may not be suitable, for example, for people with fat induced lipemia. This condition leads to very high levels of fat in the blood.

If a person with fat induced lipemia follows the keto diet, their triglyceride levels may continue to rise, which may result in pancreatitis. Generally, people with lipemia must follow a low fat diet.

People who want to lose weight should speak with a doctor to identify a suitable diet.

When considering recommending the keto diet, doctors must weigh the risks with the potential benefits, which can include rapid weight loss, reduced triglyceride levels, and increased HDL cholesterol levels.

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The importance of ongoing monitoring

People who follow the keto diet should consult their doctors to arrange frequent monitoring of blood cholesterol and triglyceride levels.
If a doctor notices that LDL cholesterol levels are rising, the diet may no longer be appropriate.

People with high levels of fats, such as cholesterol and triglycerides, in their blood have an increased risk of developing cardiovascular disease.

Foods to eat and avoid

People with high cholesterol should adopt a lifestyle that reduces these levels. This is because high cholesterol is associated with cardiovascular disease.

The keto diet emphasizes high amounts of fat, but not all fats have equal value. For example, replacing saturated fats with unsaturated fats is associated with a lower risk of cardiovascular disease, according to the 2015–2020 Dietary Guidelines for Americans.

Saturated fats occur in foods such as cookies, cakes, and other snacks. Coconut oil, butter, and ghee contain high levels of saturated fats, whereas extra virgin olive oil and margarine are higher in monounsaturated and polyunsaturated fats.

Fish — such as salmon, tuna, and cod — can be an excellent source of protein, and they contain unsaturated fat, such as omega-3 fatty acids, which can be beneficial for the body.

People with high cholesterol who follow the keto diet can snack on certain nuts and seeds that are generally low in carbs and rich in fiber and protein. Chia seeds have a higher content of polyunsaturated fats.
Vegetables, fruits, and legumes are excellent sources of nutrition. However, anyone following the keto diet should be aware of the carbohydrate contents of these foods.

People on the keto diet can consume milk and products containing it, but they may want to choose low fat versions if they have high cholesterol.

Differences between keto and paleo diets

The keto and paleo diets exclude different foods. The keto diet excludes high sugar foods, including most fruits, while the paleo diet allows more fruits and some natural sweeteners. They also have different rules for meats, vegetables, and dairy.

The following sections look into key differences between the keto and paleo diets.

Processed meat

A paleo diet usually excludes processed meats, such as bacon, salami, and ham, as these are the result of modern food processing techniques. Some people believe that minimally processed bacon without nitrates or preservatives is acceptable on the paleo diet, while others do not.

The keto diet allows these types of meat as long as they do not contain sugar or carbohydrates, which could interfere with the body's ability to reach ketosis. Some processed meats, such as bacon or sausage, may contain sugar, so people need to read the labels.

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However, with research indicating that processed meats may increase the risk of cancer and other health issues, people on any diet may wish to focus on eating good quality meats rather than processed ones.
• Paleo: Focuses on natural and grass-fed, no processed meat.
• Keto: Allows any meat that does not contain added sugar or carbohydrates.
Sweeteners and sugar
The paleo diet allows some "natural" sweeteners, such as honey and maple syrup. But, it does not allow artificial sweetener, including sugar alcohols, because they are a result of modern technology.
The keto diet allows some artificial sweeteners as long as they do not contain any sugar (some products contain both sugar and artificial sweeteners). Ideally, a person should choose sweeteners that do not cause spikes in blood sugar, such as stevia and sucralose.
The keto diet does not allow honey, maple syrup, or other products that contain natural sugar or fructose.

• Paleo: Allows raw honey, maple syrup, date sugar, and coconut sugar.
• Keto: Does not allow any sugars, but allows some artificial sweeteners, such as stevia and sucralose.

Starchy vegetables

Some nutrient rich vegetables also have a high starch or carbohydrate content. These "starchy vegetables" are not allowed on the keto diet because they could interrupt ketosis and cause a person to consume more than their allotted total of carbohydrates.

However, the paleo diet allows many of these nutritious vegetables in moderation. A person following the paleo diet can eat foods such as sweet potatoes, beets, and carrots in moderation, but should prioritize lower carb vegetables.

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Fruit

Fruits contain a range of nutrients, vitamins, minerals, fiber, and antioxidants, and are a healthful choice for most people. However, fruits also contain some natural sugar, and some have higher levels of sugar and carbohydrates than others.

A person following a paleo diet can eat all fruits, including fresh, dried, and frozen, but they should generally focus on lower sugar types. A paleo diet includes plenty of berries, citrus fruits, and melons. It can include sweeter fruits, such as bananas, grapes, mangoes, and cherries, but ideally, in lower amounts.

The keto diet is more strict with fruit. It advises that to keep the body in a state of ketosis, a person should only eat lower sugar fruits, and only in small amounts. Berries are a common keto friendly fruit, but a person may also eat small amounts of cranberries, peaches, apricots, apples, and plums.

• Paleo: Allows all fruits, though higher sugar ones in moderation.
• Keto: Allows only lower sugar fruits.
Dairy
The paleo diet excludes all dairy products because Paleolithic humans did not consume them. The paleo diet does not allow a person to consume cheese, milk, cream, or other dairy products.
However, people on the paleo diet can drink unsweetened nut milk, coconut milk, and similar alternatives that do not contain artificial sweeteners or thickeners.

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The keto diet allows some dairy products, especially those that are higher in fat and protein. This allows the person to take in the recommended amounts of these nutrients.

The keto diet does not include any dairy products that may contain sugar, such as ice cream, chocolate milk, or sugar-sweetened coffee creamer. However, a person may consume dairy products that contain artificial sweeteners in moderation.

• Paleo: Excludes dairy products.
• Keto: Allows dairy without sugar, ideally higher fat and higher protein types.

Side effects

People following any diet that eliminates food groups should make sure they are meeting their daily nutrient requirements to avoid deficiencies.
Anyone considering making a new and drastic change to their eating pattern should check in with their healthcare provider first. This is especially important for people who have chronic health conditions, such as heart disease, diabetes, or high blood pressure.

People following the keto diet may experience side effects related to entering a state of ketosis. These include keto breath, a keto skin rash, and the "keto flu." Symptoms off the keto flu include headaches, lethargy, nausea, mental slowness, insomnia, decreased exercise performance, constipation, and low libido. It can be harmful to stay in a state of ketosis for extended periods.

People do not experience these symptoms with paleo diets, as paleo diets do not lead to a state of ketosis.

Certain nutritional supplements can help people following the keto diet to get enough nutrients, ease side effects, and meet their daily macronutrient goals. Read about 7 supplements for the keto diet here.
One article cautions people who follow the paleo diet to make sure they are getting adequate calcium since the diet excludes dairy products. The keto diet lacks fiber and several micronutrients due to the severe restriction of foods that contain carbohydrates.

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Food lists

The following sections provide a list of foods that a person can eat when following the keto or paleo diet.

Keto diet

Common foods that people eat when following the keto diet include:
• fatty fish, such as salmon, tuna, or sardines
• shellfish, including mussels, clams, or oysters
• poultry
• fatty cuts of meat
• game meat
• non-starchy vegetables, such as leafy greens, cruciferous vegetables, asparagus, olives, bell peppers, celery, and
 squash

• mushrooms
• plain Greek yogurt with no sugar or fruit
• plain cottage cheese
• avocados
• eggs, especially egg yolks
• healthful oils, such as olive oil, nut oils, and avocado oil
• nuts, including macadamia nuts, pistachios, peanuts, walnuts, and almonds

• seeds, including chia seeds and flaxseed
• butter, ghee, or cream
• coconut or cocoa butter
• dark chocolate with at least 70% cocoa solids and very little to no sugar added

• nut butters, including almond butter, that contain no added sugar
• cheese
• berries, including raspberries, blueberries, strawberries, and blackberries
• lemons and limes
• tomatoes
• bone broth
• unsweetened tea and coffee
Paleo diet
Common foods that people eat when following the paleo diet include:
• chicken
• turkey
• eggs
• seafood
• pork
• beef
• game meat
• vegetables, especially leafy greens, celery, asparagus, peppers, and cruciferous vegetables
• small-to-moderate amounts of starchy vegetables, such as potatoes and root vegetables
• fruit, emphasizing berries, tomatoes, citrus, and other lower sugar fruits
• avocado
• small or moderate amounts of higher sugar fruits, such as grapes and bananas
• nuts
• seeds
• nut butter
• cocoa butter
• dark chocolate with at least 70% cocoa
• coffee with no dairy cream or refined sugar
• teas
• healthful oils, including nut oils, olive oil, and avocado oil
• honey, maple syrup, and coconut sugar in small amounts