Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%. The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.
Keatley has some…thoughts about those. “Dirty keto is a waste of your time since good habits have not been developed and it is simply too easy to fall back into a high-calorie diet,” he says. If you’re trying to do a lazy keto diet, he recommends following the USDA’s MyPlate instead and monitoring your meals based on proportions vs. macros. “It’s easier, more flexible, and has shown, when combined with moderate exercise, to be effective over the long term,” he says.
Turns out, what’s low carbohydrate for one person isn’t for another. “There’s no medical definition of what low carb is,” says Columbus, Ohio–based Kelly Schmidt, RD. Basically, it’s reducing the number of carbs you eat from your norm. In general, however, a low-carb diet may include 50 to 100 grams (g) of carbohydrates per day, she says. Below that is considered a ketogenic diet, while 100 to 200 g of carbohydrates per day is a moderate-carb diet.
If you’ve recently switched to the keto diet and you’re feeling drowsy, achy, nauseous, dizzy, and irritable, don’t worry. These symptoms are your body’s natural reaction to removing carbs from your diet, and while it may have you second guessing your keto diet decision, we promise you these keto flu symptoms will pass. Stick with it, and soon you’ll be reaping the energizing, fat-burning rewards that come with ketosis.
If you feel as if you’re starving, you’re likely to feel tired and want to give up your diet. But a ketogenic diet should not result in hunger, making it sustainable and possibly making you feel great. So eat enough protein foods and low-carb veggies, with enough added fat to feel satisfied. If you’re hungry all the time, check that you are getting adequate amounts of protein at most meals and, if so, add more fat to your meals (like more butter, more olive oil, or some delicious sauces). Our keto recipes have plenty of fat included, but you can adjust up or down, according to your own needs.