Everything You Need to Know About the Keto Diet for Beginners

There’s no doubt that keto is popular. The Kardashians have done it. Halle Berry talked about it on morning television. Even famous athletes like LeBron James and Tim Tebow have given the super low-carb diet a shot.

But in 2021, it seems like the keto craze is finally coming to an end. According to Google Trends, searches for the ketogenic diet are down a whopping 70 percent since December 2020. That might come as a shock to your friends who still swear by the bread-free, butter-heavy diet, but nutrition experts everywhere are breathing a sigh of relief.

Sure, the keto diet is known to deliver quick weight loss results at the beginning. But those who love eating nothing but bacon, cheese, and avocado all day might be disappointed to learn that researchers have yet to prove that keto has any lasting health benefits, and some worry about the potential health risks of consuming so much fat and so little carbohydrate. What’s more, the research is pretty clear that keto isn’t any more effective for long-term weight loss than other diets out there.

Frankly, we’re relieved to see that the keto bubble is bursting — who really wants to go the rest of their life without a stack of pancakes or a really great sandwich (on actual bread, not a sliced bell pepper). Now that the hype is dying down, it’s time for a reality check. Here’s everything you should know if you’re thinking about trying keto and want to determine if it’s worth sacrificing carbs.

What is ketosis?

Ketogenesis has existed as long as humans have. If you eat a very low amount of carbohydrates, you starve your brain of glucose, its main fuel source. Your body still needs fuel to function, so it taps into your reserve of ketones, which are compounds the liver creates from fat when blood insulin is low. This process is known as ketosis: It’s like when a hybrid car runs out of gas and reverts to pure electricity.

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Ketogenesis has existed as long as humans have. If you eat a very low amount of carbohydrates, you starve your brain of glucose, its main fuel source. Your body still needs fuel to function, so it taps into your reserve of ketones, which are compounds the liver creates from fat when blood insulin is low. This process is known as ketosis: It’s like when a hybrid car runs out of gas and reverts to pure electricity.

“Your liver produces ketones all the time, but the rate depends on carbohydrate and protein intake,” says Jeff Volek, Ph.D., R.D., a professor of human sciences at Ohio State University. When the majority of your diet is made up of carbs and protein, ketogenesis slows. Replacing carbs and protein with fat will put your body into ketosis, thus ramping up ketone production. Essentially, you’ll burn fat instead of carbs for energy. This process takes about three days to induce.

Do ketone supplements put you in ketosis? No. While it is possible to elevate ketones by taking them, “without the low-carb stimulus, there is no net increase in ketone production, no decrease in insulin, and no net increase in fat oxidation,” says Volek. Don’t trust trainers or “body hackers” who say you can induce ketosis quickly without changing your diet.

What can you eat on the keto diet?

A ketogenic diet requires that fat comprise 60 to 80 percent of your total calories. Protein makes up about 20 percent, while 10 percent comes from carbs. Generally speaking, it’s best to keep carb intake between 20-30 grams per day in order to maintain ketosis. That’s the equivalent of about half a medium bagel.

And remember, carbs aren’t just present in starchy foods; a cup of chopped broccoli has 6 grams of carbs, a cup of chopped carrots has 12 grams, and a cup of Brussels sprouts has 8 grams. In other words, eating the recommended five servings of vegetables per day (because fruits, which are higher in carbs, are pretty much off the table) will probably put you at your max carb allowance.

If this sounds like the Atkins Diet, it’s close, but “ketogenic diets tend to be more severe in carb restriction and have a more moderate protein restriction,” says Spencer Nadolsky, D.O., author of The Fat Loss Prescription.

Though you can eat bacon on a ketogenic diet, the rest of the spectrum is limited. Starchy vegetables like potatoes, corn, and squash are too high in carbs. Same with most fruits. Milk, beans, rice, pasta, bread: nope.

However, bacon is still heavily processed and has been linked to an increased risk of cancer and heart disease, so you may not want to eat it at every meal. To stay as healthy as possible, keto dieters should eat plenty of low-carb vegetables like red bell pepper, kale and cauliflower. These vegetables contain important micronutrients (AKA vitamins and minerals), as well as fiber, which is linked to a lower risk of heart disease, diabetes, and cancer.

The rules of keto impact more than just mealtime, too, since juices, sodas and alcohol will knock you out of ketosis.

Sample keto meal plan

• Breakfast: 4 eggs, 1/2 avocado, 1 to 2 Tbsp olive oil
• Lunch: 4 oz baked salmon with 1 Tbsp olive oil, 1/2 bunch asparagus with 1 to 2 Tbsp butter
• Dinner: Rib-eye steak, 2 cups spinach with coconut oil, 2 oz macadamia nuts

Most men consume nearly half of their calories from carbs, according to the Centers for Disease Control and Prevention. And that’s not a bad thing; it’s actually within the range of what the Dietary Guidelines for Americans recommend for optimal health. So, it goes without saying that cutting your intake to less than 10 percent will be a challenge, and may pose some risks.

What are the benefits of the keto diet?

Some keto dieters believe that eating fewer carbs may boost physical and mental performance, regulate appetite, and lower blood sugar.

Although studies have shown that the keto diet can reduce seizures for children with epilepsy, there is no evidence indicating that keto helps with other brain disorders or improves mental cognition, according to Harvard Health Publishing. Some studies show that keto may lower blood sugar for people with type 2 diabetes, but there is not enough long-term research to determine whether it’s safe and effective for diabetics.

When it comes to weight loss, “there is no question that ketosis does work in the short term,” Dr. Konstantinos Spaniolas, Associate Director of the Stony Brook Metabolic and Bariatric Weight Loss Center in New York, .

Anecdotally, plenty of men have told Men’s Health that the keto diet helped them lose large amounts of weight.

According to Spaniolas, keto helps with weight loss by reducing cravings.

Does the keto diet work for long-term weight loss?

It’s too soon to tell. The rapid weight loss which occurs at the start of a keto diet may not be fat loss at all.

“Early weight loss at the beginning of the Keto diet is likely related to fluctuations in fluid,” says Ashley Harpst, R.D., a sports dietitian and the owner of Go For the Gold Nutrition in San Diego. “Three to four ounces of water is retained for every 1 gram of carbohydrate stored as glycogen in the muscles to use for energy.” So, as your glycogen stores are depleted and you enter ketosis, there’s less water in your body as well.

There’s also no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.

Another study, published in 2020 in The BMJ, analyzed the results from 121 previously conducted clinical trials that looked at the effectiveness of various diets (low-fat, low-carb, low-calorie, etc.) for weight loss and lowering markers of cardiovascular disease risk, like blood pressure and LDL cholesterol. Based on data from nearly 22,000 adults, the researchers found that while all of these diets led to weight loss and improvements in cardiovascular health markers in the first six months, virtually all of those benefits had disappeared at the one year mark.

The bottom line: Keto (and any other diet) may lead to weight loss and improved health in the first several months, but even if you’re able to stay on the diet for longer, those benefits will likely disappear after about a year.

Keto diet side effects

Keto flu

People who begin the diet often develop “Keto Flu,” as their bodies get accustomed to eating fewer carbs. During this time you may experience headaches, nausea, fogginess, muscle cramps and fatigue. Symptoms last about a week, but staying hydrated and getting ample sleep will help with cramps and exhaustion.

Bad breath

Aside from Keto Flu, you may notice a few other unpleasant side effects. Acetone — yes, the ingredient in nail polish remover — is one of the compounds found in ketones, so your breath may be stinkier than normal. Pooping may be difficult since cutting carbs will lower fiber intake, but a fiber supplement will help keep you regular.

Nutrient deficiencies

There’s also the risk of nutrient deficiencies when you’re on the keto diet. “An individual who cuts out whole grains may become deficient in vitamin B1 (thiamine) and B3 (niacin),” Harpst says.

These essential vitamins are added to grain products through fortification, as it’s tough to eat enough of them through food alone, and deficiencies can lead to adverse health effects. Iron and vitamin B9 (folate) are also added to grains, and while it’s relatively easy to get enough iron by eating animal products, eliminating grains can lead to folate deficiencies, as well. (This is particularly concerning for women who may become pregnant, as folate is essential for neural tube development in the first month of pregnancy, before most women even realize they’re expecting.)

And, while there’s not enough long-term research on keto diets specifically, a 2021 review published in Frontiers in Nutrition concluded that foods and nutrients typically consumed at higher than average levels on the keto diet (namely red meat, processed meat, and saturated fat) are linked to an increased risk of kidney disease, heart disease, cancer, diabetes and Alzheimers, whereas restricted foods like fruits, vegetables, legumes, and whole grains are associated with lowered risk of these same conditions. “Current evidence suggests that for most individuals, the risks of such diets outweigh the benefits,” the authors state.

How to know if you’re in ketosis

Sure, eating bacon and cheese may sound like a dream but achieving ketosis isn’t easy, says Registered Dietitian Melanie Boehmer of Lenox Hill Hospital.

“Sometimes people try and teeter into it and they won’t lower their carbohydrates enough,” she previously told Men’s Health. She recommends eating no more than 20-30 grams of carbohydrates per day to maintain the ketogenic state.

Often people think they can eat unlimited amounts of meat on the diet, but that isn’t true. Consuming too much protein will also decrease ketone levels.

Cheat days, even if they are rare, and drinking alcohol can take you out of ketosis, too.

You can determine whether you’re actually in ketosis by purchasing an over-the-counter test. However, they’re not always accurate, warns Ginger Hultin, MS, RDN, CSO, spokesperson for the Academy of Nutrition and Dietetics.

“They sell testing strips for urine, though those can get false reads for a number of reasons, like hydration levels,” she previously told Men’s Health.

And those gnarly side effects, like bad breath, are a good indicator that you’re in fat-burning mode. However, they’ll only be helpful in the beginning since signs disappear once your body is accustomed to the new diet.

Is the ketogenic diet for you?

This may sound like a cop out, but the best diet is the one you stick with. For Volek, who’s been following an ultra-low-carb diet for two decades, it works.

If you can’t stick to it, then it probably won’t.

“This is the problem I have with all of these fad diets,” registered dietitian Andy Yurechko, MS, RD, of Augusta University Medical Center in Georgia, previously told Men’s Health. “A healthier type of diet is something you can do every day of your life.”

Since maintaining ketosis requires strict carb counting, this diet works best for people who are diligent. And, it’s probably not a good idea for athletes or avid gym-goers to do the keto diet long-term.

“There is no conclusive research to support any athletic performance benefit [of keto],” Harpst says. “Research continues to show that training on a low carb diet impairs intensity and decreases endurance, recovery and cognitive function.”

It can also impair muscle strength, she says, since carbohydrates are muscle’s preferred energy source during workouts, and because muscle synthesis (AKA, repairing and building muscle in order to get stronger) requires both protein and carbohydrates.

Keto diet tips

Still, there are a few healthy habits from the keto diet that are easy to adopt:

Eat fewer processed carbs

Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruits, vegetables, whole grains, and legumes, all of which deliver loads of and health-supporting fiber and antioxidants? Fantastic. Or are you consuming them mostly in the form of added sugars (cookies, candy, soda) or refined flour? It’s fine to enjoy your favorite sweet treats and processed foods sometimes, but the bulk of your carbs should come from whole food sources.

Don’t fear fat

The ketogenic diet may seem like the Jekyll to the Hyde-like low-fat craze of the 1990s. The bulk of current research finds that the middle ground between the two extremes is more beneficial for overall health. Make it easy for yourself: Eat at least two servings a week of fatty fish (salmon, sardines, mackerel) and cook with a variety of quality fats (olive oil, canola oil, avocado oil) throughout the week.

Pack in the greens

Leafy vegetables are loaded with nutrients and they’re keto-friendly. There’s kale, spinach, bok choy, Swiss chard, collards, watercress, mizuna, and arugula. Dig in.

Oh, and you might be wondering—how’d things turn out with the bacon beaus? Their experiment worked until life changed. They had a kid. They made a big move. They stopped the diet. “It was too hard to maintain,” she told me. Proof that all the bacon you can handle even grows boring after a while.

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