November 7, 2016

The Complete Guide to Ketogenic Diets

I’ve joined the 21st Century and have finally started becoming active on a few Facebook groups dedicated to low-carb and ketogenic diets. Some focus on fat loss and bodybuilding, some are exclusively for discussing the science behind the strategy, and some are geared more toward overall health, with members implementing these types of diets to improve, manage, or reverse conditions like type 1 and type 2 diabetes, PCOS, multiple sclerosis, traumatic brain injury, cancer, and more.

Now that I am more active in these groups, I can see why I stayed away for so long. And I’m considering retreating back into my Twitter comfort zone, because if I don’t see the madness and morass of misinformation being propagated on Facebook about ketogenic and low-carb diets, then I can pretend it doesn’t exist. (It’s more difficult to say idiotic and flat-out incorrect things in 140 characters, although it’s certainly possible. [And it happens all the time.])

I realize I am breaking my own rule here and juxtaposing “ketogenic” and “low-carb,” which might give people the impression that these two dietary approaches are exactly the same, and that the words are interchangeable. They are not. However, just for now, I’m using both phrases for the sake of simplicity, since the same inaccuracies abound about both of these.
With this in mind, here is a comprehensive and exhaustive list of everything required in order to implement a ketogenic diet:

  1. Water
  2. Foods that are low in carbohydrate
  3. (Maybe) supplemental electrolytes (specifically, sodium, magnesium, and potassium)

Here is a list of things that are not required in order to implement a ketogenic diet:

  1. A blood ketone meter
  2. A breath ketone meter
  3. Urine ketone test strips
  4. Fasting
  5. MCT oil
  6. MCT powder
  7. Exogenous ketones
  8. Coconut oil
  9. Coconut butter
  10. Erythritol
  11. Flavored stevia drops
  12. Protein powder
  13. 400-calorie cups of “coffee”
  14. Fat bombs

Now, the thing is, there are tips, tricks, “hacks” (even though I loathe that word), and other add-ons that can be beneficial—in certain circumstances. As always, context, context, CONTEXT!  (As the theme song to the old 80’s show Diff’rent Strokes said, “What might be right for you might not be right for some.” But I would reverse that:  what might be right for some other people might not be right for you.)  It all depends on your goals, and WHY you are implementing this type of diet. Is it for fat loss? As an adjuvant to conventional cancer treatments? To reduce the frequency of epileptic seizures? To boost ketones to fuel the brain because of Alzheimer’s or another form of cognitive decline? There might be—might be—a role for some of the more esoteric (and expensive!) substances, supplements, and measuring/tracking devices in some of those cases. And some people can truly benefit from fasting, while fasting could be disastrous for others. But in terms of just getting started and mastering the basics, stick with that first list and stop driving yourself crazy.

Again, just so we’re clear: I’m not saying any of the things in the second list are outright harmful. I don’t think they are, and some of them can, in fact, be quite helpful … in the right #CONTEXT. As I wrote about recently: different goals may necessitate a different strategy.

That’s all for now.
Keep calm and keto on.

Disclaimer: Amy Berger, MS, CNS, NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition and is not to be used as a substitute for the care and guidance of a physician. Links in this post and all others may direct you to, where I will receive a small amount of the purchase price of any items you buy through my affiliate links.


  1. A lot of that extra stuff is to sell product...thus the reason the low carb and kept diets never appeal to the masses. People like to buy things. IMHO.
    Lauren Romeo MD

  2. Blood ketone meters allow you to know if you are in a ketogenic state. What's the problem if someone wants quantitative feedback ?

    1. No problem at all, and I did not say it was one. All I said was that measuring blood ketones is not *required.*

    2. Another great article Amy! Although more succinct than any of your other articles, it made the point very well. "Ketogenic" is becoming as commercialized as "Paleo". You don't need to buy anything, just use a little willpower and put up the twinkles.

  3. I actually need a blood ketone monitor, as I find it difficult to know whether I'm in ketosis without one. I thought I was in ketosis when I ran out of strips, but when I ordered new ones, I was no longer in ketosis. I also find I need to fast for a few days to get into ketosis, if I have even a moderately high carb intake. I realize it might be possible to get into ketosis without fasting, but it's a heck of a lot easier with fasting. Even with fasting, a 24 hour fast isn't enough to get me in ketosis. I need a longer time, so I usually go 2 days or more. And even then, I'm barely into ketosis. I rarely see levels >3, even while fasting for days. It also takes very few carbs (we're talking small amounts of onion and other vegetables) for me to get kicked out of ketosis. Thus, I personally need a ketone monitor.

    1. I really wouldn't sweat not seeing ketones >3.0. According to Volek and Phinney, nutritional ketosis encompasses anything from 0.5 to 5.0, so even someone who is "only" at 0.8 is still in ketosis. And unless you're aiming to be in perpetual ketosis at all times, don't make yourself crazy doing so. Most people do just fine being fat-adapted, without deliberately chasing high ketones for the sake of high ketones. (But I'm not trying to insult you or anything. If you have a reason to be in "deep ketosis," or you just plain *feel better* there, then yes, of course, by all means, do what you have to do to get there.)

  4. I use the Mk 1 Nose. If my pee whiffs of ketones first thing in the morning but not so much the rest of the day then I'm probably using them at about the same rate I'm generating them Which is after all what they are there for.

  5. Amy this is rather embarrassing for me to ask, me thinking I have a strong knowledge of Keto but....... Can you explain further what you meant when you were saying "Most people do fine being fat adapted rather than chasing high ketones" I am a chaser of high ketones because I always thought the deeper in ketosis the more fat you are burning. It may be that I have read too much and have now composed some misguided view of Keto from information overload with lack of ability to process it logically. I think I have become a bit Keto neurotic and by striving harder for perfection I have fallen if the low carb-Keto bus more times than I can imagine.
    So, please write a ranty response to people like me who have entered Keto overload confusion. Now you have called me out on my overuse of ketostix for confirmation of how deep I am in ketosis, please help me understand why I wouldn't want to be permanently in ketosis. My primary goal would be weight loss and feeling good.

    1. Hi there... I have a huge post (probably a multi-parter) coming up about exactly these issues. In the meantime, you might like this post and the second part of it:
      Start there. But beyond that, if your goal is specifically fat loss: Ketones are the *result,* not the cause, of using fat for fuel. Ketones do not drive the process of “burning fat”; they are the byproduct of it. In other words, higher ketones do not mean you will lose more fat. Remember: ketones are a byproduct of burning fat, BUT: there's no way to tell if that fat is coming from your food or from your body's stored fat. (And you haven't told me how much fat you are looking to lose anyway -- I'm finding more and more that a lot of women who are *already* at a healthy weight are following a strict ketogenic diet because they *think* (incorrectly) that they need to lose weight.

      Are you part of the KetoGains group? They have a fantastic Facebook group. You will also probably benefit from reading this:

    2. Thanks for this response Amy, I will check out Ketogains website (not on Facebook). I have at least 70lbs to lose, probably 90lbs but I am 47 now and have given up the bikini dream and 70 would see me a relatively healthy weight. So not one of those skinny women looking to get skinnier ha ha I WISH!
      I am very guilty of thinking the more ketones the more weight loss, lost sight of how to do this sensibly. I lost 56lbs doing it moderately then lost the plot and have been trying to get back on track but going to extremes. I need people like you to 'keep it real'. Thanks for being the voice of reason in the crowd.

  6. Hi Amy. You may enjoy this conference where all the biggest names in LCHF are speaking:

    1. Oh, yes, I'm well aware. Can't afford to go, unfortunately, but it looks like a fantastic gathering of many people I would love to meet and talk with. (I've met a few of those rock stars at other events, but not all of them.)

  7. Amen! :D Some I like, but only because I like 'em (cooking in coconut oil and fasting for breakfast).

  8. I know this is an older blog post, but I totally agree. The first time I did ketogenics was back in 2010. Online information was limited but I understood the concepts. There were no products on the market whatsoever. I lost 20 lbs - my goal without any of the items listed above. I'm a bit older but trying it again.